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Mosquera I, Barajas CB, Theriault H, Benitez Majano S, Zhang L, Maza M, Luciani S, Carvalho AL, Basu P. Assessment of barriers to cancer screening and interventions implemented to overcome these barriers in 27 Latin American and Caribbean countries. Int J Cancer 2024; 155:719-730. [PMID: 38648380 DOI: 10.1002/ijc.34950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/19/2024] [Accepted: 02/28/2024] [Indexed: 04/25/2024]
Abstract
There is a gap in the understanding of the barriers to cancer screening participation and complying with downstream management in the Community of Latin American and Caribbean states (CELAC). Our study aimed to assess barriers across the cancer screening pathway from the health system perspective, and interventions in place to improve screening in CELAC. A standardized tool was used to collect information on the barriers across the screening pathway through engagement with the health authorities of 27 member states of CELAC. Barriers were organized in a framework adapted from the Tanahashi conceptual model and consisted of the following dimensions: availability of services, access (covering accessibility and affordability), acceptability, user-provider interaction, and effectiveness of services (which includes governance, protocols and guidelines, information system, and quality assurance). The tool also collected information of interventions in place, categorized in user-directed interventions to increase demand, user-directed interventions to increase access, provider-directed interventions, and policy and system-level interventions. All countries prioritized barriers related to the information systems, such as the population register not being accurate or complete (N = 19; 70.4%). All countries implemented some kind of intervention to improve cancer screening, group education being the most reported (N = 23; 85.2%). Training on screening delivery was the most referred provider-directed intervention (N = 19; 70.4%). The study has identified several barriers to the implementation of cancer screening in the region and interventions in place to overcome some of the barriers. Further analysis is required to evaluate the effectiveness of these interventions in achieving their objectives.
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Affiliation(s)
- Isabel Mosquera
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | | | - Hannah Theriault
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Sara Benitez Majano
- Pan American Health Organization, Washington, DC, USA
- Inequalities in Cancer Outcomes Network, London School of Hygiene and Tropical Medicine, London, UK
| | - Li Zhang
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Mauricio Maza
- Pan American Health Organization, Washington, DC, USA
| | | | - Andre L Carvalho
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - Partha Basu
- Early Detection, Prevention & Infections Branch, International Agency for Research on Cancer, Lyon, France
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Palomino-Secca I, Peña-Tuya M, Quintana-García LA, Guevara Pinares MA, Quiñones-Laveriano DM, Malpartida Palomino R, De La Cruz-Vargas JA. Pan-immune-inflammation value and survival in patients with breast cancer from a Peruvian reference hospital. Sci Rep 2024; 14:17132. [PMID: 39054357 PMCID: PMC11272920 DOI: 10.1038/s41598-024-68304-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 07/22/2024] [Indexed: 07/27/2024] Open
Abstract
The pan-immune-inflammation value (PIV), calculated as (neutrophil × platelet × monocyte)/lymphocyte count, may be useful for estimating survival in breast cancer patients. To determine the prognostic value of PIV for overall survival in breast cancer patients in Lima, Peru. A retrospective cohort study was conducted. 97 breast cancer patients diagnosed between January 2010 and December 2016 had their medical records analyzed. The primary dependent variable was overall survival, and the key independent variable was the PIV, divided into high (≥ 310) and low (< 310) groups. Patient data included demographics, treatment protocols and other clinical variables. Statistical analysis involved Kaplan-Meier survival curves and Cox proportional hazards modeling. Patients with a PIV ≥ 310 had significantly lower 5-year survival functions (p = 0.004). Similar significant differences in survival were observed for clinical stage III-IV (p = 0.015), hemoglobin levels < 12 mg/Dl (p = 0.007), histological grade (p = 0.019), and nuclear grade (p < 0.001); however, molecular classification did not show a significant survival difference (p = 0.371). The adjusted Hazard Ratios showed that PIV ≥ 310 was significantly associated with poor outcome (5.08, IC95%: 1.52-16.92). While clinical stage and hemoglobin levels were associated with survival in the unadjusted model. These factors did not maintain significance after adjustment. PIV is an independent predictor of reduced survival in Peruvian breast cancer patients.
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Affiliation(s)
- Iris Palomino-Secca
- Instituto de Investigaciones en Ciencias Biomédicas, Universidad Ricardo Palma, Lima, Perú
| | - Mariella Peña-Tuya
- Instituto de Investigaciones en Ciencias Biomédicas, Universidad Ricardo Palma, Lima, Perú
| | - Lynn A Quintana-García
- Instituto de Investigaciones en Ciencias Biomédicas, Universidad Ricardo Palma, Lima, Perú
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Geremew H, Golla EB, Simegn MB, Abate A, Ali MA, Kumbi H, Wondie SG, Mengstie MA, Tilahun WM. Late-stage diagnosis: The driving force behind high breast cancer mortality in Ethiopia: A systematic review and meta-analysis. PLoS One 2024; 19:e0307283. [PMID: 39028722 PMCID: PMC11259299 DOI: 10.1371/journal.pone.0307283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 07/03/2024] [Indexed: 07/21/2024] Open
Abstract
INTRODUCTION Breast cancer continues to be the most common malignancy and the leading cause of cancer-related deaths in Ethiopia. The poor prognosis and high mortality rate of breast cancer patients in the country are largely caused by late-stage diagnosis. Hence, understanding the epidemiology of late-stage diagnosis is essential to address this important problem. However, previous reports in Ethiopia indicated inconsistent findings. Therefore, this literature review was conducted to generate dependable evidence by summarizing the prevalence and determinants of late-stage diagnosis among breast cancer patients in Ethiopia. METHODS Pertinent articles were retrieved by systematically searching on major electronic databases and gray literature. Data were extracted into an Excel spreadsheet and analyzed using the STATA 17 statistical software. The pooled estimates were summarized using the random effect meta-analysis model. Heterogeneity and small study effect were evaluated using the I2 statistics and Egger's regression test in conjunction with the funnel plot, respectively. Meta-regression, sub-group analysis, and sensitivity analysis were also employed. Protocol registration number: CRD42024496237. RESULTS The pooled prevalence of late-stage diagnosis after combining reports of 24 studies with 8,677 participants was 65.85 (95% CI: 58.38, 73.32). Residence (adjusted OR: 1.92; 95% CI: 1.45, 2.53), patient delay at their first presentation (adjusted OR: 2.65; 95% CI: 1.56, 4.49), traditional medicine use (adjusted OR: 2.54; 95% CI: 1.89, 3.41), and breast self-examination practice (adjusted OR: 0.28; 95% CI: 0.09, 0.88) were significant determinants of late-stage diagnosis. CONCLUSION Two-thirds of breast cancer patients in Ethiopia were diagnosed at an advanced stage. Residence, delay in the first presentation, traditional medicine use, and breast self-examination practice were significantly associated with late-stage diagnosis. Public education about breast cancer and its early detection techniques is crucial to reduce mortality and improve the survival of patients. Besides, improving access to cancer screening services is useful to tackle the disease at its curable stages.
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Affiliation(s)
- Habtamu Geremew
- College of Health Science, Oda Bultum University, Chiro, Ethiopia
| | | | - Mulat Belay Simegn
- Department of Public Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Alegntaw Abate
- Department of Medical Laboratory Science, College of Health Science, Oda Bultum University, Chiro, Ethiopia
| | - Mohammed Ahmed Ali
- Department of Midwifery, College of Health Science, Oda Bultum University, Chiro, Ethiopia
| | - Hawi Kumbi
- Department of Laboratory, Adama Hospital Medical College, Adama, Ethiopia
| | - Smegnew Gichew Wondie
- Department of Human Nutrition, College of Medicine and Health Science, Mizan Tepi University, Mizan Aman, Ethiopia
| | - Misganaw Asmamaw Mengstie
- Department of Biochemistry, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Werkneh Melkie Tilahun
- Department of Public Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
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Abdul Rahman H, Zaim SNN, Suhaimei US, Jamain AA. Prognostic Factors Associated with Breast Cancer-Specific Survival from 1995 to 2022: A Systematic Review and Meta-Analysis of 1,386,663 Cases from 30 Countries. Diseases 2024; 12:111. [PMID: 38920543 PMCID: PMC11203054 DOI: 10.3390/diseases12060111] [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: 04/09/2024] [Revised: 05/09/2024] [Accepted: 05/15/2024] [Indexed: 06/27/2024] Open
Abstract
Breast cancer is the fifth-ranked cancer globally. Despite early diagnosis and advances in treatment, breast cancer mortality is increasing. This meta-analysis aims to examine all possible prognostic factors that improve/deteriorate breast cancer-specific survival. MEDLINE, PubMed, ScienceDirect, Ovid, and Google Scholar were systematically searched until September 16, 2023. The retrieved studies from 1995 to 2022 accumulated 1,386,663 cases from 30 countries. A total of 13 out of 22 prognostic factors were significantly associated with breast cancer-specific survival. A random-effects model provided a pooled estimate of the top five poorest prognostic factors, including Stage 4 (HR = 12.12; 95% CI: 5.70, 25.76), followed by Stage 3 (HR = 3.42, 95% CI: 2.51, 4.67), a comorbidity index ≥ 3 (HR = 3.29; 95% CI: 4.52, 7.35), the poor differentiation of cancer cell histology (HR = 2.43; 95% CI: 1.79, 3.30), and undifferentiated cancer cell histology (HR = 2.24; 95% CI: 1.66, 3.01). Other survival-reducing factors include positive nodes, age, race, HER2-receptor positivity, and overweight/obesity. The top five best prognostic factors include different types of mastectomies and breast-conserving therapies (HR = 0.56; 95% CI: 0.44, 0.70), medullary histology (HR = 0.62; 95% CI: 0.53, 0.72), higher education (HR = 0.72; 95% CI: 0.68, 0.77), and a positive estrogen receptor status (HR = 0.78; 95% CI: 0.65, 0.94). Heterogeneity was observed in most studies. Data from developing countries are still scarce.
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Affiliation(s)
- Hanif Abdul Rahman
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Tungku Link Road, Gadong BE1410, Brunei; (S.N.N.Z.); (U.S.S.); (A.A.J.)
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Grajales-Alvarez R, Gutiérrez-Mata A, Pichardo-Piña C, Gutiérrez-De la Barrera M, Dip-Borunda K. Survival Outcomes of Patients With Breast Cancer in a Mexican Population. JCO Glob Oncol 2024; 10:e2300233. [PMID: 38330273 PMCID: PMC10861020 DOI: 10.1200/go.23.00233] [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: 07/12/2023] [Revised: 10/24/2023] [Accepted: 11/29/2023] [Indexed: 02/10/2024] Open
Abstract
PURPOSE The Instituto Mexicano del Seguro Social is a tripartite contribution providing care to more than 74 million beneficiaries, representing more than 50% of the country's general population. This study aims to describe the survival outcomes and clinicopathologic characteristics of patients with breast cancer at our Center. METHODS A retrospective cohort of patients with breast cancer treated between January 2012 and December 2020 was conducted. Survival outcomes were assessed using the Kaplan-Meier method. Univariate and multivariate analyses were performed using a Cox proportional hazards model. RESULTS There were 5,264 patients included with a median follow-up of 54.9 months. Forty-three percent (n = 2,274) were diagnosed in stage I-IIA, 43.1% (n = 2,269) in stage IIB-III, and 7% (n = 383) in stage IV. At 5 years, disease-free survival was 74.9% (95% CI, 73.5 to 76.3) and overall survival (OS) 90.4% (95% CI, 89.4 to 91.3). For stage IV, it was 22.7% (95% CI, 17.3 to 28.5). High histologic grade (hazard ratio, 1.51 [95% CI, 1.34 to 1.7]; P < .001) and lymphovascular invasion (LVI; hazard ratio, 1.85 [95% CI, 1.62 to 2.1]; P < .001) were associated with a higher risk of recurrence. CONCLUSION Histologic grade and LVI should be considered in the decision to treat with adjuvant chemotherapy in sites where genomic signatures are not available. Our OS data are comparable with other Mexican series; however, it is lower in stage IV. Much remains to be done at the national level, mainly regarding access to additional therapies for each breast cancer subtype. This work contributes to the evaluation of areas for improvement in outcomes in our population.
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Affiliation(s)
| | - Alicia Gutiérrez-Mata
- Unidad Médica de Alta Especialidad No. 1, Instituto Mexicano del Seguro Social, León, Mexico City, Mexico
| | | | | | - Karim Dip-Borunda
- Hospital de Oncología, Instituto Mexicano del Seguro Social, Mexico City, Mexico
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Alam M, Saleem Z, Haseeb A, Qamar MU, Sheikh A, Almarzoky Abuhussain SS, Iqbal MS, Raees F, Chigome A, Cook A, Moore CE, Mustafa ZU, Salman M, Saleh U, Shabbir S, Godman B. Tackling antimicrobial resistance in primary care facilities across Pakistan: Current challenges and implications for the future. J Infect Public Health 2023; 16 Suppl 1:97-110. [PMID: 37973496 DOI: 10.1016/j.jiph.2023.10.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/28/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023] Open
Abstract
Antibiotics are gradually becoming less effective against bacteria worldwide, and this issue is of particular concern in economically-developing nations like Pakistan. We undertook a scoping review in order to review the literature on antimicrobial use, prescribing, dispensing and the challenges associated with antimicrobial resistance in primary care (PC) settings in Pakistan. Furthermore, this review aims to identify potential solutions to promote appropriate use of antimicrobials in Pakistan. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) checklist, a comprehensive scoping review was conducted to review the literature of antimicrobials used, prescribed and dispensed in PC settings in Pakistan. Google Scholar and Pub-Med were searched for the period 2000-2023. Papers were analyzed on the basis of eligibility i.e., included antimicrobial use, prescribing and dispensing practices by general population at homes, by prescribers in outpatient departments of hospitals and by pharmacists/dispensers in community pharmacies, respectively. Two researchers analyzed the articles thoroughly and disagreements were resolved through discussion with a third reviewer. Both quantitative and qualitative research studies were eligible for inclusion. Additionally, the selected papers were grouped into different themes. We identified 4070 papers out of which 46 studies satisfied our eligibility criteria. The findings revealed limited understanding of antimicrobial resistance (AMR) by physicians and community pharmacists along with inappropriate practices in prescribing and dispensing antibiotics. Moreover, a notable prevalence of self-medication with antibiotics was observed among the general population, underscoring a lack of awareness and knowledge concerning proper antibiotic usage. Given the clinical and public health implications of AMR, Pakistan must prioritize its policies in PC settings. Healthcare professionals (HCPs) need to reduce inappropriate antibiotic prescribing and dispensing, improve their understanding of the AWaRe (access, watch and reserve antibiotics) classification and guidance, monitor current usage and resistance trends, as well as implement antimicrobial stewardship (ASP) activities starting in targeted locations.
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Affiliation(s)
- Muniba Alam
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan.
| | - Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 21955, Saudi Arabia
| | - Muhammad Usman Qamar
- Institute of Microbiology, Faculty of Life Sciences, Government College University Faisalabad, Faisalabad 38000, Pakistan; Division of Infectious Diseases, Department of Medicine, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - Aziz Sheikh
- Usher Institute, The University of Edinburgh, Teviot Place, Edinburgh EH16 4UX, UK
| | | | - Muhammad Shahid Iqbal
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Fahad Raees
- Department of Medical Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Audrey Chigome
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
| | - Aislinn Cook
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George's University of London, London SW17 0RE, UK; Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX1 2JD, UK
| | - Catrin E Moore
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George's University of London, London SW17 0RE, UK
| | - Zia-Ul- Mustafa
- Department of Pharmacy Services, District Headquarter Hospital, Pakpattan, Pakistan
| | - Muhammad Salman
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore, Pakistan
| | - Umar Saleh
- University College of Pharmacy, Faculty of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Sana Shabbir
- University College of Pharmacy, Faculty of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa; Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
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Mosquera I, Barajas CB, Zhang L, Lucas E, Benitez Majano S, Maza M, Luciani S, Basu P, Carvalho AL. Assessment of organization of cervical and breast cancer screening programmes in the Latin American and the Caribbean states: The CanScreen5 framework. Cancer Med 2023; 12:19935-19948. [PMID: 37768035 PMCID: PMC10587918 DOI: 10.1002/cam4.6492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 07/21/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND In the Community of Latin American and Caribbean States (CELAC), breast cancer and cervical cancer are the first and third causes of cancer death among females. The objectives are to assess the characteristics of the cervical and breast cancer screening programmes in CELAC, their level of organization, and the association of screening organization and coverage of essential health services. METHODS Representatives of the Ministries of Health of 33 countries were invited to the CanScreen5 project. Twenty-seven countries participated in a "Train The Trainers" programme on cancer screening, and 26 submitted data using standardized questionnaires. Data were discussed and validated. The level of organization of the screening programmes was examined adapting the list of essential elements of organized screening programmes identified in a recently published IARC study. RESULTS Twenty-one countries reported a screening programme for cervical cancer and 15 for breast cancer. For cervical cancer, 14 countries dedicated budget for screening (66.7%), and women had to pay in 3 countries for screening (14.3%), 9 for diagnosis (42.9%) and 8 for treatment (38.1%). Only 4 countries had a system to invite women individually (19.0%). For breast cancer, 8 countries dedicated budget for screening (53.3%), and women had to pay for screening in 3 countries (20.0%), diagnosis in 7 (46.7%) and treatment in 6 (40.0%). One country (6.7%) invited women individually. There was variability in the level of organization of both cancer screening programmes. The level of organization of cervical cancer screening and coverage of essential health services were correlated. CONCLUSION Large gaps were identified in the organization of cervical and breast cancer screening services. CELAC governments need pragmatic public health policies and strengthened health systems. They should guarantee sustainable funding, and universal access to cancer diagnosis and treatment. Moreover, countries should enhance their health information system and ensure adequate monitoring and evaluation.
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Affiliation(s)
- Isabel Mosquera
- Early Detection, Prevention & Infections BranchInternational Agency for Research on CancerLyonFrance
| | | | - Li Zhang
- Early Detection, Prevention & Infections BranchInternational Agency for Research on CancerLyonFrance
| | - Eric Lucas
- Early Detection, Prevention & Infections BranchInternational Agency for Research on CancerLyonFrance
| | - Sara Benitez Majano
- Pan American Health OrganizationWashingtonDCUSA
- Inequalities in Cancer Outcomes NetworkLondon School of Hygiene and Tropical MedicineLondonUK
| | | | | | - Partha Basu
- Early Detection, Prevention & Infections BranchInternational Agency for Research on CancerLyonFrance
| | - Andre L. Carvalho
- Early Detection, Prevention & Infections BranchInternational Agency for Research on CancerLyonFrance
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Unger-Saldaña K, Bandala-Jacques A, Huerta-Gutierrez R, Zamora-Muñoz S, Hernández-Ávila JE, Cabrera-Galeana P, Mohar A, Lajous M. Breast cancer survival in Mexico between 2007 and 2016 in women without social security: a retrospective cohort study. LANCET REGIONAL HEALTH. AMERICAS 2023; 23:100541. [PMID: 37408951 PMCID: PMC10319338 DOI: 10.1016/j.lana.2023.100541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 07/07/2023]
Abstract
Background Essential indicators of health system performance for breast cancer are lacking in Mexico. We estimated survival and clinical stage distribution for women without social insurance who were treated under a health financing scheme that covered 60% of the Mexican population. Methods We conducted a retrospective cohort study cross-linking reimbursement claims for 56,847 women treated for breast cancer between 2007 and 2016 to a mortality registry. We estimated overall- and clinical stage-specific survival and breast cancer survival according to patient age, state of residence, marginalization, type of treatment facility, and patient volume of the treatment facility. We also explored the distribution of clinical stage according to age, year of treatment initiation, and state where the woman was treated. We used log-rank tests and estimated 95% CIs to compare differences between patient groups. Findings Median age was 52 years (interquartile range [IQR] 45, 61) (Sixty five percent patients (36,731/56,847) had advanced disease at treatment initiation. Five-year overall survival was 72.2% (95% CI 71.7, 72.6). For early disease (excluding stage 0), 5-year overall survival was 89.0% (95% CI 88.4, 89.5), for locally advanced disease 69.9% (95% CI 69.0, 70.2) and for metastatic 36.9% (95% CI 35.4, 38.4). Clinical stage at treatment initiation and breast cancer survival remained unchanged in the period analyzed. Clinical stage and survival differed across age groups, state of residence, and type of facility where women received treatment. Interpretation In the absence of population-based cancer registries, medical claims data may be efficiently leveraged to estimate essential cancer-related performance indicators. Funding The authors received no financial support for this research.
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Affiliation(s)
| | - Antonio Bandala-Jacques
- Center for Research on Population Health, National Institute of Public Health, Mexico City, Mexico
| | - Rodrigo Huerta-Gutierrez
- Institute of Public Health and Center for Stroke Research, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Salvador Zamora-Muñoz
- Facultad de Ciencias, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | | | | | - Alejandro Mohar
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM) and National Cancer Institute, Mexico City, Mexico
| | - Martin Lajous
- Center for Research on Population Health, National Institute of Public Health, Mexico City, Mexico
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
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Vázquez ML, Vargas I, Rubio-Valera M, Aznar-Lou I, Eguiguren P, Mogollón-Pérez AS, Torres AL, Peralta A, Dias S, Jervelund SS. Improving equity in access to early diagnosis of cancer in different healthcare systems of Latin America: protocol for the EquityCancer-LA implementation-effectiveness hybrid study. BMJ Open 2022; 12:e067439. [PMID: 36523219 PMCID: PMC9748968 DOI: 10.1136/bmjopen-2022-067439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Healthcare fragmentation, a main cause for delay in cancer diagnosis and treatment, contributes to high mortality in Latin America (LA), particularly among disadvantaged populations. This research focuses on integrated care interventions, which have been limitedly implemented in the region. The objective is to evaluate the contextual effectiveness of scaling-up an integrated care intervention to improve early diagnosis of frequent cancers in healthcare networks of Chile, Colombia and Ecuador. METHODS AND ANALYSIS This research is two pronged: (A) quasi-experimental design (controlled before and after) with an intervention and a control healthcare network in each LA country, using an implementation-effectiveness hybrid approach to assess the intervention process, effectiveness and costs; and (B) case study design to analyse access to diagnosis of most frequent cancers. Focusing on the most vulnerable socioeconomic population, it develops in four phases: (1) analysis of delays and barriers to early diagnosis (baseline); (2) intervention adaptation and implementation (primary care training, fast-track referral pathway and patient information); (3) intracountry evaluation of intervention and (4) cross-country analysis. Baseline and evaluation studies adopt mixed-methods qualitative (semistructured individual interviews) and quantitative (patient questionnaire survey) methods. For the latter, a sample size of 174 patients with cancer diagnosis per healthcare network and year was calculated to detect a proportions difference of 15%, before and after intervention (α=0.05; β=0.2) in a two-sided test. A participatory approach will be used to tailor the intervention to each context, led by a local steering committee (professionals, managers, policy makers, patients and researchers). ETHICS AND DISSEMINATION This study complies with international and national legal stipulations on ethics. It was approved by each country's ethical committee and informed consent will be obtained from participants. Besides the coproduction of knowledge with key stakeholders, it will be disseminated through strategies such as policy briefs, workshops, e-tools and scientific papers.
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Affiliation(s)
- Maria-Luisa Vázquez
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - Ingrid Vargas
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - Maria Rubio-Valera
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Ignacio Aznar-Lou
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Research and Development Unit, Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - Pamela Eguiguren
- Escuela de Salud Pública Dr. Salvador Allende Gossens, Facultad de Medicina, Universidad de Chile, Santiago de Chile, Chile
| | | | - Ana-Lucía Torres
- Public Health Institute, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - Andrés Peralta
- Public Health Institute, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - Sónia Dias
- NOVA National School of Public Health, Public Health Research Centre, NOVA University of Lisbon & Comprehensive Health Research Center (CHRC), Lisboa, Portugal
| | - Signe Smith Jervelund
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Obesity is associated with early recurrence on breast cancer patients that achieved pathological complete response to neoadjuvant chemotherapy. Sci Rep 2022; 12:21145. [PMID: 36477462 PMCID: PMC9729290 DOI: 10.1038/s41598-022-25043-2] [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: 01/25/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
Pathological complete response (pCR) after neoadjuvant chemotherapy (NCT) is associated with good long-term prognosis in breast cancer (BC) patients. However, some patients still recur and eventually die from this disease. For years, clinical stage at diagnosis has been consistently linked to recurrence and survival in the pCR setting. Herein, we aimed to identify other potential predictors of recurrence and survival in patients that achieved pCR. We performed a retrospective analysis of patients diagnosed between 2011 and 2020 in our center. We calculated overall survival (OS), invasive disease-free survival (IDFS), distant disease-free survival (DDFS), and BC-specific survival (BCSS). Among the 241 patients included into our study 36% were obese (Body Mass Index (BMI) > 29.9 kg/m2) and 47% were stage III. Multivariate analysis confirmed that obesity was a significant risk factor associated with early recurrence and poorer survival in these patients. In summary, obesity and clinical stage predict early recurrence and poorer survival in patients that achieved pCR after NCT. Pending further investigation and based on our findings we speculate that weight management could be beneficial for this subset of patients. To our knowledge, this is the first Latin American report linking obesity and recurrence within this setting.
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Werutsky G, Gössling G, Pellegrini RA, Ampuero GAS, Rebelatto T. Socioeconomic Impact of Cancer in Latin America and The Caribbean. Arch Med Res 2022; 53:818-825. [PMID: 36460548 DOI: 10.1016/j.arcmed.2022.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 11/30/2022]
Abstract
The incidence of cancer in Latin America and the Caribbean (LAC) is increasing yearly and is expected to reach 2.4 million new cases by 2040, with a more pronounced effect in Central America and South America. In addition, cancer is already the most frequent cause of premature death for most countries in LAC, and the second cause of death independent of country socioeconomic status, clearly demonstrating that the cancer burden in LAC should be addressed now rather than considered as an issue to be dealt with in the future. LAC countries performed in a mid-range zone in terms of income and mortality-to-incidence ratio compared to other countries globally. The LAC continent has, in general, a median income per capita and a median availability of radiotherapy (RDT) machines per capita. Patients that have private health coverage are more likely to receive preventive care such as pap smears and mammography in many countries of the LAC. The human development index was negatively related to mortality from oral cancer in the LAC countries with medium and low Human Development Index (HDI). Cancer treatment adverse events can negatively affect survivors' workability compromising their return to work after diagnosis. In conclusion, the cancer burden can be a major public health issue with a considerable socioeconomic impact in LAC countries. It is demonstrated in several studies that unequal access to optimal care is frequent in LAC and that health insurance type may impact patients' diagnosis and outcome.
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Affiliation(s)
- Gustavo Werutsky
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil.
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Piñeros M, Ginsburg O, Bendahhou K, Eser S, Shelpai WA, Fouad H, Znaor A. Staging practices and breast cancer stage among population-based registries in the MENA region. Cancer Epidemiol 2022; 81:102250. [PMID: 36115143 PMCID: PMC9693698 DOI: 10.1016/j.canep.2022.102250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/25/2022] [Accepted: 09/05/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Availability of stage information by population-based cancer registries (PBCR) remains scarce for diverse reasons. Nevertheless, stage is critical cancer control information particularly for cancers amenable to early detection. In the framework of the Global Initiative for Cancer Registry Development (GICR), we present the status of stage data collection and dissemination among registries in the Middle East and Northern Africa (MENA) region as well as the stage distribution of breast cancer patients. METHODS A web-based survey exploring staging practices and breast cancer stage was developed and sent to 30 PBCR in 18 countries of the MENA region. RESULTS Among 23 respondent PBCR, 21 collected stage data, the majority (80%) for all cancers. Fourteen registries used a single classification (9 TNM and 5 SEER), 7 used both staging systems in parallel. Out of 12,888 breast cancer patients (seven registries) 27.7% had unknown TNM stage (11.1% in Oman, 46% in Annaba). When considering only cases with known stage, 65.3% were early cancers (TNM I+II), ranging from 57.9% in Oman to 83.3% in Batna (Algeria), and 9.9% were stage IV cancers. Among the nine registries providing SEER Summary stage for breast cancer cases, stage was unknown in 19% of the cases, (0 in Bahrain, 39% in Kuwait). Stage data were largely absent from the published registry reports. CONCLUSION Despite wide stage data collection by cancer registries, missing information and low dissemination clearly limit informing efforts on early detection. The use of two classification systems in parallel implies additional workload and might undermine completeness. The favourable results of early cancer (TNM I+II) in two thirds of breast cancer patients needs to be interpreted with caution and followed up in time. Although efforts to improve quality of stage data are needed, our findings are particularly relevant to the WHO Global Breast Cancer Initiative.
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Affiliation(s)
- Marion Piñeros
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France.
| | - Ophira Ginsburg
- Center for Global Health, US National Cancer Institute, MD, USA
| | | | - Sultan Eser
- Balıkesir University, Faculty of Medicine, Balikesir, Turkey
| | | | - Heba Fouad
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Ariana Znaor
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
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Equations based on anthropometric measurements for adipose tissue, body fat, or body density prediction in children and adolescents: a scoping review. Eat Weight Disord 2022; 27:2321-2338. [PMID: 35699918 DOI: 10.1007/s40519-022-01405-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/05/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Assessing the body composition of children and adolescents is important to monitor their health status. Anthropometric measurements are feasible and less-expensive than other techniques for body composition assessment. This study aimed to systematically map anthropometric equations to predict adipose tissue, body fat, or density in children and adolescents, and to analyze methodological aspects of the development of anthropometric equations using skinfolds. METHODS A scoping review was carried out following the PRISMA-ScR criteria. The search was carried out in eight databases. The methodological structure protocol of this scoping review was retrospectively registered in the Open Science Framework ( https://osf.io/35uhc/ ). RESULTS We included 78 reports and 593 anthropometric equations. The samples consisted of healthy individuals, people with different diseases or disabilities, and athletes from different sports. Dual-energy X-ray absorptiometry (DXA) was the reference method most commonly used in developing equations. Triceps and subscapular skinfolds were the anthropometric measurements most frequently used as predictors in the equations. Age, stage of sexual maturation, and peak height velocity were used as complementary variables in the equations. CONCLUSION Our scoping review identified equations proposed for children and adolescents with a great diversity of characteristics. In many of the reports, important methodological aspects were not addressed, a factor that may be associated with equation bias. LEVEL IV Evidence obtained from multiple time series analysis such as case studies. (NB: dramatic results in uncontrolled trials might also be regarded as this type of evidence).
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Piñeros M, Laversanne M, Barrios E, Cancela MDC, de Vries E, Pardo C, Bray F. An updated profile of the cancer burden, patterns and trends in Latin America and the Caribbean. LANCET REGIONAL HEALTH. AMERICAS 2022; 13:None. [PMID: 36189115 PMCID: PMC9483035 DOI: 10.1016/j.lana.2022.100294] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Cancer is a leading cause of disease and death in Latin America and the Caribbean (LAC). Contemporary data on the cancer burden aims to inform effective cancer policies; this article provides an update and benchmarking of national cancer incidence and mortality estimates for the year 2020, alongside recent mortality trends in the region. Methods The number of new cancer cases and deaths were extracted from the GLOBOCAN 2020 database developed by the International Agency for Research on Cancer (IARC), and mortality data over time from IARC's cancer mortality database, New cancer cases, deaths and corresponding age-standardized rates per 100,000 person-years are presented. Random fluctuations in mortality trends by country, sex and cancer site were smoothed using LOWESS regression. Findings An estimated total of 1.5 million new cancer cases and 700,000 deaths occur annually in LAC, with corresponding incidence and mortality rates of 186.5 and 86.6 per 100,000. The most common cancers in 2020 were prostate (15%), breast (14%), colorectal (9%), lung (7%) and stomach (5%). Lung cancer remained the leading cause of cancer death (12%), though rates varied substantially between countries. The mortality trends of infectious-related cancers tended to decline in most countries, while rates of cancer types linked to westernization were mainly increasing. Assuming rates remain unchanged, the cancer burden in LAC will increase by 67% reaching 2.4 million new cases annually by 2040. Interpretation The cancer patterns reflect important underlying sociodemographic changes occurring over the last decades. With an increasing burden anticipated over the next decades in this region, there is a need to plan oncological service provision accordingly. Funding No external funds received.
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Affiliation(s)
- Marion Piñeros
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Mathieu Laversanne
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Enrique Barrios
- National Cancer Registry, Honorary Commission for the Fight against Cancer, Montevideo, Uruguay
| | | | - Esther de Vries
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Constanza Pardo
- Cancer Surveillance Group, National Cancer Institute, INC Bogotá, Colombia
| | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
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Sobral GS, Araújo YB, Kameo SY, Silva GM, Santos DKDC, Carvalho LLM. Análise do Tempo para Início do Tratamento Oncológico no Brasil: Fatores Demográficos e Relacionados à Neoplasia. REVISTA BRASILEIRA DE CANCEROLOGIA 2022. [DOI: 10.32635/2176-9745.rbc.2022v68n3.2354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
Introdução: E reservado a todo brasileiro com câncer, pela Lei dos 60 Dias, o direito de começar o tratamento em até dois meses. Todavia, estudos anteriores apontam a dificuldade dos pacientes em fazer valer essa normativa ao esbarrarem em problemáticas macroestruturais dos sistemas de saúde. Objetivo: Avaliar a influência de fatores demográficos e relacionados a neoplasia sobre o tempo para início do tratamento oncológico no Brasil. Método: Estudo seccional, desenvolvido com dados oriundos do PAINEL-Oncologia, uma base publica nacional, alimentada por diversas fontes de informação do Sistema Único de Saúde. Como variáveis de interesse, elegeram-se: a) tempo de tratamento; b) sexo; c) idade; d) diagnostico; e) estadiamento; f) modalidade terapêutica. Então, foi analisado o tempo transcorrido entre o diagnóstico e o início do tratamento oncológico. Resultados: Percebeu-se aumento exponencial, ao longo dos anos, da proporção de casos tratados oportunamente, isto e, em até 60 dias, como regulamenta a Lei. Entretanto, ainda e considerável a prevalência de atrasos no início do tratamento, sobretudo entre indivíduos idosos, do sexo masculino, com canceres em estádios menos avançados e que precisaram de radioterapia como primeira modalidade terapêutica. Além disso, o tempo de espera foi especialmente maior para os canceres de órgãos genitais masculinos, de cabeça e pescoço e de mama. Conclusão: Alguns fatores demográficos e relacionados a neoplasia estão envolvidos no atraso do início da terapia oncológica.
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Sadat Abolmaali S, Zarenejad S, Mohebi Y, Najafi H, Javanmardi S, Abedi M, Mohammad Tamaddon A. Biotin receptor-targeting nanogels loaded with methotrexate for enhanced antitumor efficacy in triple-negative breast cancer in vitro and in vivo models. Int J Pharm 2022; 624:122049. [PMID: 35878871 DOI: 10.1016/j.ijpharm.2022.122049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/06/2022] [Accepted: 07/20/2022] [Indexed: 11/27/2022]
Abstract
High-dose methotrexate (MTX) chemotherapeutic applications confront drug specificity and pharmacokinetic challenges, which can be overcome by utilizing targeted drug delivery systems. In the present study, biotin-PEG conjugated nanogels of carboxymethyl polyethyleneimine (Biotin-PEG-CMPEI) were developed for active targeted delivery of MTX in triple negative breast cancer (TNBC). TEM and DLS analyses revealed uniform, discrete, and spherical particles with a mean hydrodynamic diameter of about 100 nm and ζ-potential of + 15 mV (pH = 7.4). Biotin-PEG-CMPEI nanogels exhibited a zero-order MTX release kinetics at pH = 7.5 and a swelling-controlled release at pH = 5.5. In 4 T1 cells treated with the MTX-loaded Biotin-PEG-CMPEI, the IC50 was reduced by about 10 folds compared to the free drug, while the unloaded nanogels showed no significant toxicity. In the model mice, the group treated with the MTX-loaded Biotin-PEG-CMPEI had a lower tumor volume and mortality rate animal model when compared to free drug. Additionally, histopathological analyses showed that the group treated with the MTX-loaded nanogels had less lung metastasis and glomerular damage caused by MTX. Overall, the MTX-loaded Biotin-PEG-CMPEI targeted directly against overexpressed biotin receptors in TNBC have been shown to improve the MTX safety and therapeutic efficacy.
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Affiliation(s)
- Samira Sadat Abolmaali
- Pharmaceutical Nanotechnology Department and Center for Nanotechnology in Drug Delivery, Shiraz University of Medical Sciences, Shiraz 71345, Iran.
| | - Sepideh Zarenejad
- Center for Nanotechnology in Drug Delivery, Shiraz University of Medical Sciences, Shiraz 71345, Iran
| | - Younes Mohebi
- Center for Nanotechnology in Drug Delivery, Shiraz University of Medical Sciences, Shiraz 71345, Iran
| | - Haniyeh Najafi
- Pharmaceutical Nanotechnology Department and Center for Nanotechnology in Drug Delivery, Shiraz University of Medical Sciences, Shiraz 71345, Iran
| | - Sanaz Javanmardi
- Center for Nanotechnology in Drug Delivery, Shiraz University of Medical Sciences, Shiraz 71345, Iran
| | - Mehdi Abedi
- Pharmaceutical Nanotechnology Department and Center for Nanotechnology in Drug Delivery, Shiraz University of Medical Sciences, Shiraz 71345, Iran
| | - Ali Mohammad Tamaddon
- Center for Nanotechnology in Drug Delivery, Shiraz University of Medical Sciences, Shiraz 71345, Iran
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Díaz-Casas SE, Briceño-Morales X, Puerto-Horta LJ, Lehmann-Mosquera C, Orozco-Ospino MC, Guzmán-AbiSaab LH, Ángel-Aristizábal J, García-Mora M, Duarte-Torres CA, Mariño-Lozano IF, Briceño-Morales C, Sánchez-Pedraza R. OUP accepted manuscript. Oncologist 2022; 27:e142-e150. [PMID: 35641213 PMCID: PMC8895754 DOI: 10.1093/oncolo/oyab023] [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] [Received: 05/30/2021] [Accepted: 08/20/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose About 10% of breast cancer (BC) is diagnosed in stage IV. This study sought to identify factors associated with time to progression (TTP) and overall survival (OS) in a cohort of patients diagnosed with de novo metastatic breast cancer (MBC), from a single cancer center in Colombia, given that information on this aspect is limited. Methodology An observational, analytical, and retrospective cohort study was carried out. Time to progression and OS rates were estimated using the Kaplan–Meier survival functions. Cox models were developed to assess association between time to progression and time to death, using a group of fixed variables. Results Overall, 175 patients were included in the study; 33.7% of patients had luminal B HER2-negative tumors, 49.7% had bone involvement, and 83.4% had multiple metastatic sites. Tumor biology and primary tumor surgery were the variables associated with TTP and OS. Patients with luminal A tumors had the lowest progression and mortality rates (10 per 100 patients/year (95% CI: 5.0-20.0) and 12.6 per 100 patients/year (95% CI: 6.9-22.7), respectively), and patients with triple-negative tumors had the highest progression and mortality rates (40 per 100 patients/year (95% CI: 23.2-68.8) and 44.1 per 100 patients/year (95% CI: 28.1-69.1), respectively). Across the cohort, the median TTP was 2.1 years (95% CI: 1.6; the upper limit cannot be reached) and the median OS was 2.4 years (95% CI: 2-4.3). Conclusions In this cohort, patients with luminal A tumors and those who underwent tumor surgery given that they presented clinical benefit (CB) after initial systemic treatment, had the lowest progression and mortality rates. Overall, OS was inferior to other series due to high tumor burden and difficulties in accessing and continuing oncological treatments.
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Affiliation(s)
- Sandra Esperanza Díaz-Casas
- Breast Unit, National Cancer Institute of Colombia, Bogotá, Colombia
- Corresponding author: Sandra Esperanza Díaz-Casas, Breast and Soft Tissue Unit, National Cancer Institute, Calle 1A #9-85, Bogotá, DC 110321, Colombia. Tel: +57 310 819 7384;
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Li B, Faúndez Salazar J, Rivera AF, Babayemi T, Colqui Campos K, Del Castillo Pacora RF, Noreña Gómez MP, Gamboa Garay OA, Vacaflor Romero L, Rodríguez Moura D, Condori Vasquez N, Martínez Pérez DA. Radiation Oncology Residency Training in Latin America, a Call to Attention. Adv Radiat Oncol 2022; 7:100898. [PMID: 35281882 PMCID: PMC8914461 DOI: 10.1016/j.adro.2022.100898] [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: 08/12/2021] [Accepted: 01/03/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose Despite the call to increase the number of radiation oncologists in Latin America, the quality, similarity, and number of residency training programs are unknown. We seek to describe the current state of residency programs in radiation oncology in Latin America. Methods and Materials Latin American Residents in Radiation Oncology performed a cross-sectional analysis of universities and training centers for radiation oncologists in Latin America. Latin American Residents in Radiation Oncology members identified and contacted current residents and specialists at each center to obtain information and documents that described their training curricula. Results As of 2020, 13 of 23 (56.5%) Latin American countries have radiation oncology training. Seventy-three training centers were identified (59 active and 14 inactive), associated with 28 universities. On average, each active center trains 2.6 new residents per year, and in total, 156 residents are trained annually. The average length of training programs is 3.6 years. Brazil and Mexico comprise 31 (52.5%) and 7 (11.9%) of active programs, respectively, and 64 (41.8%) and 50 (32.7%) residents, respectively. Training is available in 38 cities in 13 countries, and outside Brazil and Mexico, only 13 cities in 11 countries (9 capitals and 4 noncapital cities). Individualized curriculum documents were provided by 20 (83.3%) of 24 non-Brazilian programs, while 1 standardized guideline was provided for Brazilian training programs. These demonstrated variation between subjects taught, their devoted time, outside specialty rotations, and experiences in modern techniques. Seventy-five percent include volumetric modulated arc therapy, 70% stereotactic radiosurgery, and 55% stereotactic body radiation therapy training. One-hundred percent include gynecologic brachytherapy education and <50% brachytherapy education in other disease sites. Conclusions Training is highly centralized in capital cities. The number of trainees is insufficient to close the current human resource divide but is limited by available job openings. Over 50% of training programs now include technological training in stereotactic radiosurgery, stereotactic body radiation therapy, or volumetric modulated arc therapy; however, substantial variation still exists. The development of radiation oncology specialists must be improved and modernized to address the escalating demand for cancer care.
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Affiliation(s)
- Benjamin Li
- Department of Radiation Oncology, University of California, San Francisco, California
- Rayos Contra Cancer, San Francisco, California
- Corresponding author: Benjamin Li, MD, MBA
| | | | | | - Towo Babayemi
- Rayos Contra Cancer, San Francisco, California
- University of Texas Health Science Center at Houston School of Public Health, Houston, Texas
| | | | | | | | | | - Liceth Vacaflor Romero
- Departamento de Radioterapia, Instituto Oncológico del Oriente Boliviano, Santa Cruz, Bolivia
| | | | - Nancy Condori Vasquez
- Departamento de Oncología Radioterápica, Hospital de Clinicas Dr Manuel Quintela, Montevideo, Uruguay
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Almeida PH, Godman B, dos Santos Nunes-Nogueira V, de Lemos LL, de Assis Acúrcio F, Guerra-Junior AA, de Araújo VE, Almeida AM, Alvares-Teodoro J. A Cross-Sectional Study of Quality of Life Among Brazilian Adults With Type 1 Diabetes Treated With Insulin Glargine: Findings and Implications. Clin Diabetes 2022; 40:312-326. [PMID: 35983417 PMCID: PMC9331629 DOI: 10.2337/cd21-0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This article describes a cross-sectional study involving 401 adults with type 1 diabetes treated with insulin glargine in Minas Gerais, Brazil. Health-related quality of life was assessed, and worse scores were found to be associated with a low level of education, self-perceived health reported as poor/very poor, being bedridden and not physically exercised, having seen a doctor more than four times in the past year, and having reported comorbidities and episodes of hypoglycemia.
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Affiliation(s)
- Paulo H.R.F. Almeida
- Graduate Program in Medicines and Pharmaceutical Services, Department of Social Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, U.K
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | | | - Lívia L.P. de Lemos
- Graduate Program in Public Health, Faculty of Medicine, Department of Preventive and Social Medicine, Federal University of Minas Gerais Belo Horizonte, Minas Gerais, Brazil
| | - Francisco de Assis Acúrcio
- Graduate Program in Medicines and Pharmaceutical Services, Department of Social Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Graduate Program in Public Health, Faculty of Medicine, Department of Preventive and Social Medicine, Federal University of Minas Gerais Belo Horizonte, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, Belo Horizonte, Minas Gerais, Brazil
| | - Augusto A. Guerra-Junior
- Graduate Program in Medicines and Pharmaceutical Services, Department of Social Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, Belo Horizonte, Minas Gerais, Brazil
| | - Vânia E. de Araújo
- Graduate Program in Medicines and Pharmaceutical Services, Department of Social Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, Belo Horizonte, Minas Gerais, Brazil
- Department of Dentistry, Pontifical Catholic University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Alessandra M. Almeida
- Graduate Program in Medicines and Pharmaceutical Services, Department of Social Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, Belo Horizonte, Minas Gerais, Brazil
| | - Juliana Alvares-Teodoro
- Graduate Program in Medicines and Pharmaceutical Services, Department of Social Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, Belo Horizonte, Minas Gerais, Brazil
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Ávila DL, Nunes NAM, Almeida PHRF, Gomes JAS, Rosa COB, Alvarez-Leite JI. Signaling Targets Related to Antiobesity Effects of Capsaicin: A Scoping Review. Adv Nutr 2021; 12:2232-2243. [PMID: 34171094 PMCID: PMC8634413 DOI: 10.1093/advances/nmab064] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 02/22/2021] [Accepted: 05/03/2021] [Indexed: 01/01/2023] Open
Abstract
The search for new antiobesogenic agents is increasing because of the current obesity pandemic. Capsaicin (Caps), an exogenous agonist of the vanilloid receptor of transient potential type 1 (TRPV1), has shown promising results in the treatment of obesity. This scoping review aims to verify the pathways mediating the effects of Caps in obesity and the different methods adopted to identify these pathways. The search was carried out using data from the EMBASE, MEDLINE (PubMed), Web of Science, and SCOPUS databases. Studies considered eligible evaluated the mechanisms of action of Caps in obesity models or cell types involved in obesity. Nine studies were included and 100% (n = 6) of the in vivo studies showed a high risk of bias. Of the 9 studies, 66.6% (n = 6) administered Caps orally in the diet and 55.5% (n = 5) used a concentration of Caps of 0.01% in the diet. In vitro, the most tested concentration was 1 μM (88.9%; n = 8). Capsazepine was the antagonist chosen by 66.6% (n = 6) of the studies. Seven studies (77.8%) linked the antiobesogenic effects of Caps to TRPV1 activation and 3 (33.3%) indicated peroxisome proliferator-activated receptor (PPAR) involvement as an upstream connection to TRPV1, rather than a direct metabolic target of Caps. The main secondary effects of Caps were lower weight gain (33.3%; n = 3) or loss (22.2%; n = 2), greater improvement in lipid profile (33.3%; n = 3), lower white adipocyte adipogenesis (33.3%; n = 3), browning process activation (44.4%; n = 4), and higher brown adipocyte activity (33.3%; n = 3) compared with those of the control treatment. Some studies have shown that PPAR agonists modulate TRPV1 activity, and no study has evaluated the simultaneous antagonism of these 2 receptors. Consequently, further studies are necessary to elucidate the role of each of these signaling molecules in the antiobesogenic effects of Caps.
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Affiliation(s)
- Danielle L Ávila
- Instituto de Ciências Biológicas, Departamento de Bioquímica e Imunologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Núbia A M Nunes
- Instituto de Ciências Biológicas, Departamento de Bioquímica e Imunologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Paulo H R F Almeida
- Programa de Pós-Graduação em Medicamentos e Assistência Farmacêutica, Departamento de Farmácia Social, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Juliana A S Gomes
- Instituto de Ciências Biológicas, Departamento de Morfologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Carla O B Rosa
- Faculdade de Nutrição, Departamento de Nutrição e Saúde, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil
| | - Jacqueline I Alvarez-Leite
- Instituto de Ciências Biológicas, Departamento de Bioquímica e Imunologia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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21
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Fernandes BD, Foppa AA, Almeida PHRF, Lakhani A, Lima TDM. Application and utility of geographic information systems in pharmacy specific health research: A scoping review. Res Social Adm Pharm 2021; 18:3263-3271. [PMID: 34836813 DOI: 10.1016/j.sapharm.2021.11.004] [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: 06/22/2021] [Revised: 09/25/2021] [Accepted: 11/12/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Geographic Information Systems (GIS) are considered essential tools to analyze spatially referenced health data. OBJECTIVES The purpose of this scoping review is to describe how GIS is used in pharmacy specific health research. METHODS During July 2020, the following databases were searched: EMBASE, MEDLINE (PubMed), Web of Science and Scopus. The search strategy included terms relating to spatial analysis and pharmacy. Studies were considered eligible if they involved the use of GIS and focused on pharmacies. A narrative and tabular synthesis of the results was carried out, structured around the spatial analysis methods utilized across studies, as well as the characteristics of pharmacies evaluated in studies. RESULTS After a review of 6967 sources, 48 studies were included in this review. Twenty-nine studies were conducted in the United States (60.4%) and thirty-six focused on accessibility (75.0%; n = 36). Twenty-two studies investigated the relationship between sociodemographic aspects of the population and the accessibility and availability of pharmacies (45.8%). Twelve studies (25.0%) performed distance analysis and six studies (12.5%) performed geostatistical analysis. Community pharmacies were the setting evaluated most frequently, with over-the-counter selling products being the most evaluated pharmacy variable (13.3%; n = 6). Population density (58.3%; n = 28), income indicators (43.8%; n = 21) and minority community composition rates (41.7%; n = 20) were the most used population variables. CONCLUSIONS GIS have been increasingly used in pharmacy specific health research. Generally, research has sought to identify potential barriers to access and their effects on the population. Future research may benefit by utilizing robust spatial methods and applications across countries outside of the United States. Doing so could help to confirm the impact of sociodemographic characteristics on the availability and/or accessibility of pharmacies globally.
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Affiliation(s)
- Brígida Dias Fernandes
- Department of Pharmaceutical Sciences, Federal University of Espirito Santo (UFES), Avenida Marechal Campos, 1468, Bonfim, Vitória, Espirito Santo, 29047105, Brazil.
| | - Aline Aparecida Foppa
- Graduate Program in Medicines and Pharmaceutical Services, Department of Social Pharmacy, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Avenida Presidente Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270901, Brazil.
| | - Paulo Henrique Ribeiro Fernandes Almeida
- Graduate Program in Medicines and Pharmaceutical Services, Department of Social Pharmacy, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Avenida Presidente Antônio Carlos, 6627, Pampulha, Belo Horizonte, Minas Gerais, 31270901, Brazil.
| | - Ali Lakhani
- School of Psychology and Public Health, La Trobe University, 360 Collins St, Melbourne, Victoria, Australia, 3000; The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Logan Campus, University Drive, Meadowbrook, Queensland, Australia, 4131.
| | - Tácio de Mendonça Lima
- Department of Pharmaceutical Sciences, Federal Rural University of Rio de Janeiro (UFRRJ), Brazil.
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22
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Barrios CH, Werutsky G, Mohar A, Ferrigno AS, Müller BG, Bychkovsky BL, Castro E CJ, Uribe CJ, Villarreal-Garza C, Soto-Perez-de-Celis E, Gutiérrez-Delgado F, Kim JS, Ismael J, Delgado L, Santini LA, Teich N, Chavez PC, Liedke PER, Exman P, Barroso-Sousa R, Stefani SD, Cáceres SAB, Rebelatto TF, Pastrana T, Chavarri-Guerra Y, Vargas Y, Cazap E. Cancer control in Latin America and the Caribbean: recent advances and opportunities to move forward. Lancet Oncol 2021; 22:e474-e487. [PMID: 34735817 DOI: 10.1016/s1470-2045(21)00492-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 08/03/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
The increasing burden of cancer represents a substantial problem for Latin America and the Caribbean. Two Lancet Oncology Commissions in 2013 and 2015 highlighted potential interventions that could advance cancer care in the region by overcoming existing challenges. Areas requiring improvement included insufficient investment in cancer control, non-universal health coverage, fragmented health systems, inequitable concentration of cancer services, inadequate registries, delays in diagnosis or treatment initiation, and insufficient palliative services. Progress has been made in key areas but remains uneven across the region. An unforeseen challenge, the COVID-19 pandemic, strained all resources, and its negative effect on cancer control is expected to continue for years. In this Series paper, we summarise progress in several aspects of cancer control since 2015, and identify persistent barriers requiring commitment of additional resources to reduce the cancer burden in Latin America and the Caribbean.
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Affiliation(s)
- Carlos H Barrios
- Oncology Department, Oncoclinicas Group, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil.
| | - Gustavo Werutsky
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Alejandro Mohar
- Unidad de Epidemiología, Instituto Nacional de Cancerología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Ana S Ferrigno
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo León, Mexico
| | - Bettina G Müller
- Department of Medical Oncology, Instituto Nacional del Cáncer, Santiago, Chile
| | - Brittany L Bychkovsky
- Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | | | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo León, Mexico
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | - Francisco Gutiérrez-Delgado
- Centro de Estudios y Prevención del Cancer Tuxtla Gutiérrez, Chiapas, México; Latin American School of Oncology (ELO), México City, México
| | - Ji Seok Kim
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Dewpoint Therapeutics, Boston, MA, USA
| | | | - Lucia Delgado
- Faculty of Medicine, University of Uruguay, Montevideo, Uruguay; Honorary Commission for the Fight Against Cancer, Montevideo, Uruguay
| | - Luiz A Santini
- Center of Strategic Studies of FIOCRUZ (Fundação Oswaldo Cruz), Rio de Janeiro, Brazil
| | - Nelson Teich
- Teich Health Care Consulting, Rio de Janeiro, Brazil
| | - Pamela C Chavez
- Department of Internal Medicine, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Pedro E R Liedke
- Oncology Department, Oncoclinicas Group, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Department of Oncology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Unidade de Pesquisa Clínica em Oncologia, Porto Alegre, Brazil
| | - Pedro Exman
- Department of Medical Oncology, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | | | | | - Suyapa A Bejarano Cáceres
- Medicine Universidad Católica de Honduras, San Pedro Sula, Honduras; Department of Clinical Oncology, Liga Contra el Cáncer, San Pedro Sula, Honduras
| | | | - Tania Pastrana
- Department of Palliative Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Yanin Chavarri-Guerra
- Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | - Yolanda Vargas
- Unidad de Cuidados Paliativos y Clínica de Alivio del Dolor Oncológico, Instituto Oncológico Nacional, Ciudad de Panamá, Panamá
| | - Eduardo Cazap
- Latin American and Caribbean Society of Medical Oncology (SLACOM), Buenos Aires, Argentina
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23
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Gomez HL, Bargallo-Rocha JE, Billinghurst RJ, Núñez De Pierro AR, Coló FA, Gil LLB, Allemand C, McLean IL, Lema-Medina M, Herazo-Maya F, Terrier FJ, Cwilich RG, Leon M, Falcon SG, Castaño RE, Oliveira SC, Jakubowski DM, Chao C. Practice-Changing Use of the 21-Gene Test for the Management of Patients With Early-Stage Breast Cancer in Latin America. JCO Glob Oncol 2021; 7:1364-1373. [PMID: 34506221 PMCID: PMC8440019 DOI: 10.1200/go.21.00008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE We present a physician survey of the impact of 21-gene Breast Recurrence Score test results on treatment decisions in clinical practice in Latin America. METHODS This prospective survey enrolled consecutive patients at 14 sites in Argentina, Colombia, Mexico, and Peru who had routine 21-gene testing. Physician surveys captured patient and tumor characteristics and treatment decisions before and after 21-gene test results. The survey spanned the period before and after Trial Assigning Individualized Options for Treatment (TAILORx) results reported (June 2018). Overall net percent change in adjuvant chemotherapy recommendations was estimated, and asymptotic 95% CIs with continuity correction were calculated. The proportion with a change between pretest treatment recommendation and actual treatment received was calculated overall and by Recurrence Score groups per TAILORx. RESULTS Between March 2015 and December 2019, the survey was completed for 647 patients; 20% were node-positive. The mean patient age was 54 years (24-85 years); 55% were postmenopausal; 17%, 63%, and 20% had grade 1, 2, and 3 tumors, respectively; and 30% had tumors > 2 cm. Recurrence Score (RS) results were as follows: 20% RS 0-10, 56% RS 11-25, and 24% RS 26-100. Overall, chemotherapy recommendations fell by a relative proportion of 39% (95% CI, 33.4 to 44.3) after 21-gene testing (33% decrease in node-negative and 55% decrease in node-positive). Among node-negative patients, the relative decrease in chemotherapy recommendations was 28% (95% CI, 18.9 to 39.5) before TAILORx and 36% (95% CI, 28.4 to 43.7) after. CONCLUSION To our knowledge, this large survey of 21-gene test practice patterns was the first conducted in Latin America and showed the relevance of 21-gene testing in low- and medium-resource countries to minimize chemotherapy overuse and underuse in breast cancer. The results showed substantial reductions in chemotherapy use overall—especially after TAILORx reported—indicating the practice-changing potential of that study.
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Affiliation(s)
- Henry L Gomez
- Oncosalud-AUNA, Lima, Peru.,Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | | | | | | | | | | | | | | | | | | | - Francisco J Terrier
- Breast-Clínica de la Mama y Hospital Italiano de La Plata, La Plata, Argentina
| | | | | | | | | | | | | | - Calvin Chao
- Exact Sciences Corporation, Redwood City, CA
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24
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Marcelino AC, Gozzi B, Cardoso-Filho C, Machado H, Zeferino LC, Vale DB. Race disparities in mortality by breast cancer from 2000 to 2017 in São Paulo, Brazil: a population-based retrospective study. BMC Cancer 2021; 21:998. [PMID: 34488654 PMCID: PMC8422690 DOI: 10.1186/s12885-021-08735-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/18/2021] [Indexed: 12/30/2022] Open
Abstract
Background In Brazil, inequalities in access may interfere with cancer care. This study aimed to evaluate the influence of race on breast cancer mortality in the state of São Paulo, from 2000 to 2017, contextualizing with other causes of death. Methods A population-based retrospective study using mortality rates, age and race as variables. Information on deaths was collected from the Ministry of Health Information System. Only white and black categories were used. Mortality rates were age-adjusted by the standard method. For statistical analysis, linear regression was carried out. Results There were 60,940 deaths registered as breast cancer deaths, 46,365 in white and 10,588 in black women. The mortality rates for 100,000 women in 2017 were 16.46 in white and 9.57 in black women, a trend to reduction in white (p = 0.002), and to increase in black women (p = 0.010). This effect was more significant for white women (p < 0.001). The trend to reduction was consistent in all age groups in white women, and the trend to increase was observed only in the 40–49 years group in black women. For ‘all-cancer causes’, the trend was to a reduction in white (p = 0.031) and to increase in black women (p < 0.001). For ‘ill-defined causes’ and ‘external causes’, the trend was to reduce both races (p < 0.001). Conclusion The declared race influenced mortality rates due to breast cancer in São Paulo. The divergences observed between white and black women also were evident in all cancer causes of death, which may indicate inequities in access to highly complex health care in our setting.
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Affiliation(s)
- Ana Cláudia Marcelino
- Obstetrics and Gynecology Department, State University of Campinas, Rua Alexander Fleming 101, Campinas, SP, CEP 13083-881, Brazil
| | - Bruno Gozzi
- Obstetrics and Gynecology Department, State University of Campinas, Rua Alexander Fleming 101, Campinas, SP, CEP 13083-881, Brazil
| | - Cássio Cardoso-Filho
- Obstetrics and Gynecology Department, State University of Campinas, Rua Alexander Fleming 101, Campinas, SP, CEP 13083-881, Brazil
| | - Helymar Machado
- Obstetrics and Gynecology Department, State University of Campinas, Rua Alexander Fleming 101, Campinas, SP, CEP 13083-881, Brazil
| | - Luiz Carlos Zeferino
- Obstetrics and Gynecology Department, State University of Campinas, Rua Alexander Fleming 101, Campinas, SP, CEP 13083-881, Brazil
| | - Diama Bhadra Vale
- Obstetrics and Gynecology Department, State University of Campinas, Rua Alexander Fleming 101, Campinas, SP, CEP 13083-881, Brazil.
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25
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Godman B, Fadare J, Kwon HY, Dias CZ, Kurdi A, Dias Godói IP, Kibuule D, Hoxha I, Opanga S, Saleem Z, Bochenek T, Marković-Peković V, Mardare I, Kalungia AC, Campbell S, Allocati E, Pisana A, Martin AP, Meyer JC. Evidence-based public policy making for medicines across countries: findings and implications for the future. J Comp Eff Res 2021; 10:1019-1052. [PMID: 34241546 DOI: 10.2217/cer-2020-0273] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: Global expenditure on medicines is rising up to 6% per year driven by increasing prevalence of non-communicable diseases (NCDs) and new premium priced medicines for cancer, orphan diseases and other complex areas. This is difficult to sustain without reforms. Methods: Extensive narrative review of published papers and contextualizing the findings to provide future guidance. Results: New models are being introduced to improve the managed entry of new medicines including managed entry agreements, fair pricing approaches and monitoring prescribing against agreed guidance. Multiple measures have also successfully been introduced to improve the prescribing of established medicines. This includes encouraging greater prescribing of generics and biosimilars versus originators and patented medicines in a class to conserve resources without compromising care. In addition, reducing inappropriate antibiotic utilization. Typically, multiple measures are the most effective. Conclusion: Multiple measures will be needed to attain and retain universal healthcare.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, SE-141 86, Stockholm, Sweden
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Joseph Fadare
- Department of Pharmacology & Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Hye-Young Kwon
- Division of Biology and Public Health, Mokwon University, Daejeon, Korea
| | - Carolina Zampirolli Dias
- Graduate Program in Public Health, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Isabella Piassi Dias Godói
- Institute of Health & Biological Studies - Universidade Federal do Sul e Sudeste do Pará, Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá, Pará, Brazil
- Researcher of the Group (CNPq) for Epidemiological, Economic and Pharmacological Studies of Arboviruses (EEPIFARBO) - Universidade Federal do Sul e Sudeste do Pará; Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá, Pará, Brazil
| | - Dan Kibuule
- Department of Pharmacy Practice & Policy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, Albania
| | - Sylvia Opanga
- Department of Pharmaceutics & Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Zikria Saleem
- Faculty of Pharmacy, University of Lahore, Lahore, Pakistan
| | - Tomasz Bochenek
- Department of Nutrition & Drug Research, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Vanda Marković-Peković
- Department of Social Pharmacy, University of Banja Luka, Faculty of Medicine, Banja Luka, Republic of Srpska, Bosnia & Herzegovina
| | - Ileana Mardare
- "Carol Davila" University of Medicine & Pharmacy, Bucharest, Romania
| | | | - Stephen Campbell
- Centre for Primary Care, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, M13 9PL, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester, UK
| | - Eleonora Allocati
- Istituto di Ricerche Farmacologiche 'Mario Negri' IRCCS, Milan, Italy
| | - Alice Pisana
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Antony P Martin
- Faculty of Health & Life Sciences, The University of Liverpool, Brownlow Hill, Liverpool, L69 3BX, UK
| | - Johanna C Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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26
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Samaroo K, Hosein A, Olivier LK, Ali J. Breast Cancer in the Caribbean. Cureus 2021; 13:e17042. [PMID: 34522520 PMCID: PMC8428164 DOI: 10.7759/cureus.17042] [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] [Accepted: 08/07/2021] [Indexed: 11/22/2022] Open
Abstract
Breast cancer (BC) is one of the leading causes of death among women globally. In the Caribbean, there is a higher mortality rate compared with North American and European countries which have higher incidence rates. We conducted a literature review to examine the BC dynamic in the Caribbean and determine the areas where further investigations are needed. The PubMed database was used for identifying relevant studies using a combination of specific keyword searches. All studies focusing on BC within the defined Caribbean population were selected for this review. A total of 117 papers were included. The data were organized and presented under the following headings and reported according to the country where available: BC incidence and mortality, patient demographics, clinicopathology, genetics, behavioral risks, diagnosis and treatment, and BC control. Our review uncovered major variability in the incidence, management, etiology, and mortality of BC among Caribbean countries. Low-resource countries are burdened by more advanced disease with expected poorer BC outcomes (i.e., shorter periods of disease-free survival). Countries with established national cancer registries seem to have a better approach to the management of BC. The introduction of cancer treatment programs in association with international nonprofit groups has shown tremendous improvement in quality, accessible cancer care for patients, particularly in low- and middle-income settings. BC research is relatively limited in the Caribbean, lacking in both scope and consistency. The unique Caribbean BC population of diverse ethnicities, environmental influence, immigrants, socioeconomic status, and sociocultural practices allows an optimal opportunity for epidemiological investigations that can provide deeper insights into the status of BC.
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Affiliation(s)
- Kristy Samaroo
- Biomedical Engineering, The University of Trinidad & Tobago, Port of Spain, TTO
| | - Amalia Hosein
- Biomedical Engineering, The University of Trinidad & Tobago, Port of Spain, TTO
| | - Lyronne K Olivier
- General Surgeon/Breast Surgical Oncologist, Sangre Grande General Hospital, Port of Spain, TTO
| | - Jameel Ali
- Surgery, University of Toronto, Toronto, CAN
- Breast Unit, St. James Medical Complex, Port of Spain, TTO
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27
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Alvarado-Cabrero I, Doimi F, Ortega V, de Oliveira Lima JT, Torres R, Torregrosa L. Recommendations for streamlining precision medicine in breast cancer care in Latin America. Cancer Rep (Hoboken) 2021; 4:e1400. [PMID: 33939336 PMCID: PMC8714537 DOI: 10.1002/cnr2.1400] [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: 02/21/2021] [Revised: 03/27/2021] [Accepted: 03/30/2021] [Indexed: 12/27/2022] Open
Abstract
Background The incidence of breast cancer (BC) in LMICs has increased by more than 20% within the last decade. In areas such as Latin America (LA), addressing BC at national levels evoke discussions surrounding fragmented care, limited resources, and regulatory barriers. Precision Medicine (PM), specifically companion diagnostics (CDx), links disease diagnosis and treatment for better patient outcomes. Thus, its application may aid in overcoming these barriers. Recent findings A panel of LA experts in fields related to BC and PM were provided with a series of relevant questions to address prior to a multi‐day conference. Within this conference, each narrative was edited by the entire group, through numerous rounds of discussion until a consensus was achieved. The panel proposes specific, realistic recommendations for implementing CDx in BC in LA and other LMIC regions. In these recommendations, the authors strived to address all barriers to the widespread use and access mentioned previously within this manuscript. Conclusion This manuscript provides a review of the current state of CDx for BC in LA. Of most importance, the panel proposes practical and actionable recommendations for the implementation of CDx throughout the Region in order to identify the right patient at the right time for the right treatment.
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Affiliation(s)
| | - Franco Doimi
- Department of Pathology, Oncosalud AUNA, Lima, Peru
| | - Virginia Ortega
- Department of Pathology, Diagnostico SRL, Montevideo, Uruguay
| | | | | | - Lilian Torregrosa
- Department of Breast and Soft Tissue Surgery, Pontificia Universidad Javeriana, Bogotá, Colombia
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28
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Almeida PHRF, Godman B, de Lemos LLP, Silva TBC, De Assis Acúrcio F, Guerra‑Junior AA, De Araújo VE, Almeida AM, Alvares-Teodoro J. A cross-sectional study of the quality of life of patients living with type 1 diabetes treated with insulin glargine and neutral protamine Hagedorn insulin and the implications. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2021. [DOI: 10.1093/jphsr/rmab021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Abstract
Objectives
The study aim was to identify key factors associated with the health-related quality of life (HRQOL) of patients with type 1 diabetes mellitus (T1DM) treated with neutral protamine Hagedorn (NPH) insulin or human insulin analog glargine (IGLA).
Methods
We conducted two cross-sectional studies in Minas Gerais State, Brazil. One with 401 patients treated with IGLA, and the other with 179 T1DM patients treated with NPH. HRQOL was measured by Euroqol (EQ-5D-3L).
Key findings
Most participants were male (51%), aged between 18 and 40 years (47%), non-black (58%) and from the highest economic strata (A1-B2) (74%). Participants perceived their health as good/very good (51%), had one to three medical consultations in the previous year (51%), were not hospitalized in the previous year (74%), did not report angina (96%), diabetic neuropathy (90%), hearing loss (94%) or kidney disease (89%). Non-severe hypoglycaemia episodes in the last 30 days were reported by 17% of participants.
Conclusions
Higher HRQOL was associated with younger age (18–40 years), good/very good health self-perception, having had up to three medical consultations in the last year, not being hospitalized in the last year, having none to three comorbidities, not reporting angina, diabetic neuropathy, hearing loss or kidney disease and having had episodes of non-severe hypoglycaemia. In addition, the findings of our study demonstrated inequalities in access to treatment, which will be the subject of future research projects.
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Affiliation(s)
- Paulo H R F Almeida
- Graduate Program in Medicines and Pharmaceutical Services, Department of Social Pharmacy, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Lívia L P de Lemos
- Graduate Program in Public Health, Faculty of Medicine, Department of Preventive and Social Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Thales B C Silva
- Graduate Program in Medicines and Pharmaceutical Services, Department of Social Pharmacy, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Francisco De Assis Acúrcio
- Graduate Program in Medicines and Pharmaceutical Services, Department of Social Pharmacy, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
- Graduate Program in Public Health, Faculty of Medicine, Department of Preventive and Social Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Brazil
| | - Augusto Afonso Guerra‑Junior
- Graduate Program in Medicines and Pharmaceutical Services, Department of Social Pharmacy, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Brazil
| | - Vânia E De Araújo
- Graduate Program in Medicines and Pharmaceutical Services, Department of Social Pharmacy, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Brazil
- Department of Dentistry, Pontifical Catholic University of Minas Gerais (PUCMG), Belo Horizonte, Brazil
| | - Alessandra M Almeida
- Graduate Program in Medicines and Pharmaceutical Services, Department of Social Pharmacy, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Brazil
| | - Juliana Alvares-Teodoro
- Graduate Program in Medicines and Pharmaceutical Services, Department of Social Pharmacy, Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health (CCATES), Belo Horizonte, Brazil
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Lu J, Zhou P, Jin C, Xu L, Zhu X, Lian Q, Gong X. Diagnostic Value of Contrast-Enhanced Ultrasonography With SonoVue in the Differentiation of Benign and Malignant Breast Lesions: A Meta-Analysis. Technol Cancer Res Treat 2020; 19:1533033820971583. [PMID: 33308040 PMCID: PMC7739090 DOI: 10.1177/1533033820971583] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
PURPOSE A meta-analysis was conducted to evaluate the diagnostic performance of contrast-enhanced ultrasonography using the contrast agent SonoVue to differentiate benign from malignant breast lesions. METHOD A comprehensive search of the literature was performed using the Embase, PubMed, and Web of Science databases to retrieve studies published before February 2020. Data were extracted, and pooled sensitivity, specificity, and diagnostic odds ratios were calculated with meta-analysis software. Heterogeneity was evaluated via the Q test and I2 statistic. Meta-regression and subgroup analyses were applied to evaluate potential sources of heterogeneity. Publication bias was assessed using the Deeks' funnel plot asymmetry test. A summary receiver operating characteristic curve (SROC) was constructed. RESULTS A total of 27 studies including 5378 breast lesions subjected to CEUS examination with SonoVue were included in the meta-analysis. The pooled sensitivity and specificity values were 0.90 (95% confidence interval [CI], 0.88-0.91; inconsistency index [I2] = 75.7%) and 0.83 (95% CI, 0.82-0.85; I2 = 91.0%), respectively. The pooled diagnostic odds ratio was 48.35% (95% CI, 31.22-74.89; I2 = 77.6%). The area under the summary receiver operating characteristic curve (AUC) was 0.9354. Meta-regression analysis revealed the region of patient residence and dose of contrast agent as potential sources of heterogeneity (P < .01). Subgroup analysis showed a higher area under the summary receiver operating characteristic curve for European and higher contrast agent dose subgroups (P < .05). CONCLUSION Contrast-enhanced ultrasonography with SonoVue displays high sensitivity, specificity, and accuracy when differentiating benign from malignant breast lesions. Despite its current limitations, this technique presents a promising tool for diagnosing breast lesions in clinical practice.
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Affiliation(s)
- Jianghao Lu
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Peng Zhou
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Chunchun Jin
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Lifeng Xu
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Xiaomin Zhu
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Qingshu Lian
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
| | - Xuehao Gong
- Department of Ultrasound, First Affiliated Hospital of Shenzhen University Health Science Center, Shenzhen Second People's Hospital, Shenzhen, China
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