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El Saghir NS, Khalil LE, El Dick J, Atwani RW, Safi N, Charafeddine M, Al-Masri A, El Saghir BN, Chaccour M, Tfayli A, Assi H, Abbas J, Ayoub Z, Sbaity E, Moukadem HA. Improved Survival of Young Patients With Breast Cancer 40 Years and Younger at Diagnosis. JCO Glob Oncol 2023; 9:e2200354. [PMID: 37229627 PMCID: PMC10497296 DOI: 10.1200/go.22.00354] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 01/11/2023] [Accepted: 02/28/2023] [Indexed: 05/27/2023] Open
Abstract
PURPOSE Around 50% of patients with breast cancer in low- or middle-income countries are younger than 50 years, a poor prognostic variable. We report the outcome of patients with breast cancer 40 years and younger. METHODS We reviewed 386 patients with breast cancer 40 years and younger and retrieved demographic, clinicopathologic, treatment-related, disease progression, and survival data from electronic medical records. RESULTS The median age at diagnosis was 36 years, and infiltrating ductal carcinoma was present in 94.3% of patients, infiltrating lobular carcinoma in 1.3%, and ductal carcinoma in situ in 4.4%. Grade 1 disease was present in 8.5% of patients, grade 2 in 35.5%, and grade 3 in 53.4%; 25.1% had human epidermal growth factor receptor 2 (HER2)-positive, 74.6% had hormone receptor (HR)+, and 16.6% had triple-negative breast cancer. Early breast cancer (EBC) constituted 63.6% (stage I, 22.4%; stage II, 41.2%) of patients, whereas 23.2% had stage III, and 13.2% had metastatic disease at diagnosis. Of patients with EBC, 51% had partial mastectomy and 49.0% had total mastectomy. And 77.1% had chemotherapy with or without anti-HER2 therapy. All HR+ patients received adjuvant hormonal therapy. The disease-free survival at 5 years was 72.5% and 55.9% at 10 years. The overall survival (OS) was 89.4% at 5 years and 76% at 10 years. Patients with stages I/II had an OS of 96.0% at 5 years and 87.1% at 10 years. Patients with stage III had an OS of 88.3% at 5 years and 68.7% at 10 years. The OS of patients with stage IV was 64.5% at 5 years and 48.4% at 10 years. CONCLUSION We report survival rates of 89% at 5 years and 76% at 10 years with modern multidisciplinary management. Best results were seen in EBC: OS rates of 96% and 87% at 5 years and 10 years.
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Affiliation(s)
| | - Lana E. Khalil
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Joud El Dick
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Rula W. Atwani
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Nadine Safi
- American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Ahmad Al-Masri
- American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Maha Chaccour
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Arafat Tfayli
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Hazem Assi
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Jaber Abbas
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Zeina Ayoub
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Eman Sbaity
- American University of Beirut Medical Center, Beirut, Lebanon
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Mark M, Finley J, Binkley J. Disparities in Cancer Survivorship: From Global Impact to Individual Responsibility. REHABILITATION ONCOLOGY 2023. [DOI: 10.1097/01.reo.0000000000000337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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Lubuzo B, Hlongwana K, Ginindza T. Model for Achieving a Coordinated Access to Lung Cancer Care in Selected Public Health Facilities in KwaZulu-Natal, South Africa: Protocol for a Qualitative Study. JMIR Res Protoc 2023; 12:e34341. [PMID: 36867453 PMCID: PMC10024215 DOI: 10.2196/34341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Timely delivery of high-quality cancer care to all patients is barely achieved in South Africa and many other low- and middle-income countries, mainly due to poor care coordination and access to care services. After health care visits, many patients leave facilities confused about their diagnosis, prognosis, options for treatment, and the next steps in their care continuum. They often find the health care system disempowering and inaccessible, thereby making access to health care services inequitable, with the resultant outcome of increased cancer mortality rates. OBJECTIVE The aim of this study is to propose a model for cancer care coordination interventions that can be used to guide and achieve coordinated access to lung cancer care in the selected public health care facilities in KwaZulu-Natal. METHODS This study will be conducted through a grounded theory design and an activity-based costing approach that will include health care providers, patients, and their caregivers. The study participants will be purposively selected, and a nonprobability sample will be selected based on characteristics, experiences of the health care providers, and the objectives of the study. With the study's objectives in mind, communities in Durban and Pietermaritzburg were selected as study sites, for the study along with the 3 public health facilities that provide cancer diagnosis, treatment, and care in the province. The study involves a range of data collection techniques, namely, in-depth interviews, evidence synthesis reviews, and focus group discussions. A thematic and cost-benefit analysis will be used. RESULTS This study receives support from the Multinational Lung Cancer Control Program. The study obtained ethics approval and gatekeeper permission from the University's Ethics Committee and the KwaZulu-Natal Provincial Department of Health, as it is being conducted in health facilities in KwaZulu-Natal province. As of January 2023, we had enrolled 50 participants, both health care providers and patients. Dissemination activities will involve community and stakeholder dissemination meetings, publications in peer-reviewed journals, and presentations at regional and international conferences. CONCLUSIONS This study will provide comprehensive data to inform and empower patients, professionals, policy architects, and related decision makers to manage and improve cancer care coordination. This unique intervention or model will address the multifactorial problem of cancer health disparities. If successful, this study will affect the design and implementation of coordination programs to promote optimal cancer care for underserved patients. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/34341.
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Affiliation(s)
- Buhle Lubuzo
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Khumbulani Hlongwana
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Themba Ginindza
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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Matthay KK, Hylton J, Penumarthy N, Khattab M, Soh SY, Nguyen HTK, Alcasabas AP, Fawzy M, Saab R, Khan MS, Ghandour K, Chantada G, Parikh NS, Faulkner L, Lam CG, Howard SC. Global Neuroblastoma Network: An international multidisciplinary neuroblastoma tumor board for resource-limited countries. Pediatr Blood Cancer 2022; 69:e29568. [PMID: 35084087 DOI: 10.1002/pbc.29568] [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: 10/13/2021] [Revised: 12/24/2021] [Accepted: 01/02/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Tumor boards are part of standard care of patients with complex cancers, but appropriate multidisciplinary expertise and infrastructure are often not available in low- and middle-income countries (LMIC) for pediatric cancers, such as neuroblastoma. Our goal was to review results of a Global Neuroblastoma Network (GNN) tumor board accessible to LMIC. METHODS De-identified clinical cases presented via internet conference during a weekly GNN virtual tumor board from 2010 through 2020 were evaluated in a standardized format, including diagnostic imaging, pathology, therapy information, resource limitations, and questions for discussion. Information summarized included the presentations, a survey of the impact on care, and a resource questionnaire. RESULTS Registered GNN participants included 575 individuals from 77 countries, with a median of 39 participants per session. Total 412 cases were presented from 32 countries, including 351 unique neuroblastoma patients, 52 follow-up cases, and nine non-neuroblastoma diagnoses. Twenty-eight educational sessions were presented. Limited critical resources for diagnostics and staging of cases included MYCN analysis (54.7%), metaiodobenzylguanidine (MIBG) scans (38.7%), and International Neuroblastoma Pathology Classification (49%). Therapies were also limited, with markedly decreased use of radiation and autologous stem cell transplant for high-risk cases, and no availability of anti-GD2 antibody in LMIC. Limited sampling with a post-presentation survey showed that 100% found the GNN helpful, and 70% altered the care plan based on the discussion. CONCLUSION This report shows the utility of an international tumor board for LMIC focused on a challenging solid tumor where local expertise may be limited, with international multidisciplinary expert participation and educational sessions.
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Affiliation(s)
- Katherine K Matthay
- Department of Pediatrics, Benioff Children's Hospital and University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Jennifer Hylton
- Department of Network Development, Resonance Health, Memphis, Tennessee, USA
| | - Neela Penumarthy
- Department of Pediatrics, Kaiser Permanente, Oakland, California, USA
| | - Mohammed Khattab
- Pediatric Hematology-Oncology Center, Children's Hospital, University Mohammed Vth, Rabat, Morocco
| | - Shui Yen Soh
- Pediatric Hematology-Oncology, KK Women and Children's Hospital, Singapore
| | | | - Ana Patricia Alcasabas
- Division of Pediatric Hematology Oncology, University of the Philippines - Philippine General Hospital, Manila, Philippines
| | - Mohammed Fawzy
- Children's Cancer Hospital - Egypt (CCHE/57357) and National Cancer Institute, Cairo University, Cairo, Egypt
| | - Raya Saab
- Children's Cancer Institute, Department of Pediatrics, American University of Beirut Medical Center, Beirut, Lebanon
| | - Muhammad Saghir Khan
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center Al Madinah, Riyadh, Saudi Arabia
| | | | - Guillermo Chantada
- Fundacion Perez-Scremini-Hospital Pereira Rossell, Montevideo, Uruguay and Institute for Translational Research (IIMT) CONICET-Austral University, Pilar, Argentina
| | - Nehal S Parikh
- Department of Pediatrics, Children's Hospital of NJ and Rutgers, New Jersey Medical School, Newark, New Jersey, USA
| | | | - Catherine G Lam
- Departments of Global Pediatric Medicine and Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Scott C Howard
- Acute and Tertiary Care, University of Tennessee Health Science Center College of Medicine Memphis, Memphis, Tennessee, USA
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El Saghir NS, Anderson BO, Gralow J, Lopes G, Shulman LN, Moukadem HA, Yu PP, Hortobagyi G. Impact of Merit-Based Immigration Policies on Brain Drain From Low- and Middle-Income Countries. JCO Glob Oncol 2021; 6:185-189. [PMID: 32023124 PMCID: PMC7051246 DOI: 10.1200/jgo.19.00266] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Brain drain is the migration of educated and skilled individuals from a less developed region or country to a more economically established one. The Trump administration proposed a merit-based immigration plan. This article addresses its potential impact on health care delivery in low- and middle-income countries (LMICs) and their preparedness to deal with it. MATERIALS AND METHODS Data on immigration policies, numbers of international medical graduates practicing in high-income countries (HICs), various scientific exchange methods, and efforts for capacity building in LMICs. RESULTS Talented individuals seek to advance their knowledge and skills, and may stay in HICs because of greater rewards and opportunities. HICs also rely on immigrant international medical graduates to supplement their physician workforces. CONCLUSION Ambitious individuals from LMICs need and should have opportunities to advance their education and training in more advanced countries. LMICs should increase their educational efforts, research capabilities, infrastructures, and living conditions to better serve their own populations and reduce their brain drain phenomenon.
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Affiliation(s)
- Nagi S El Saghir
- Division of Hematology Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Benjamin O Anderson
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA
| | - Julie Gralow
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA
| | - Gilberto Lopes
- Sylvester Comprehensive Cancer Center at the University of Miami and the Miller School of Medicine, Miami, FL
| | | | - Hiba A Moukadem
- Division of Hematology Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Cancer care reform in South Africa: A case for cancer care coordination: A narrative review. Palliat Support Care 2021; 20:129-137. [PMID: 33952380 DOI: 10.1017/s1478951521000432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This review provides an overview of the existing literature on the importance of care coordination for lung cancer care and other cancers in general. The review is inclusive of the burden of cancer, with a special reference to lung cancer, as well as challenges and achievements relating to cancer care coordination. METHOD We conducted a search of online databases of peer-reviewed studies published in the English language. The analysis for this review has been packaged into themes in order to generate results that can inform researchers and cancer health professionals, on the existing gaps necessary for developing appropriate intervention strategies and policy guidelines. RESULTS Cancer is a complex condition that often requires multiple interventions provided by a variety of health professionals within the healthcare continuum. This paper reviewed research studies that explored the supportive care needs of cancer patients. The results are presented in three superordinate themes, namely (a) cancer as a healthcare priority in South Africa (SA), (b) making a case for coordinated cancer care in SA, and (c) care coordination: a poorly defined, yet complex concept. One major need identified was the requirement of informational support. Other essential needs included referral, emotional, and financial support. SIGNIFICANCE OF RESULTS The identification of current obstacles has the potential to guide the development of a model to improve quality coordinated cancer health care. It remains that limited research exists around cancer services and cancer care in the South African region. This narrative review identified common elements and barriers to care for lung cancer patients and survivors, and offers recommendations for developing clinical care models.
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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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Nkosi PB, Sibiya MN. A practice framework for the cooperative treatment of cancer between traditional health practitioners and radiation oncologists in KwaZulu-Natal province, South Africa. Health SA 2021; 26:1427. [PMID: 33824726 PMCID: PMC8008014 DOI: 10.4102/hsag.v26i0.1427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 12/16/2020] [Indexed: 12/02/2022] Open
Abstract
Background Cooperative practice between traditional health practitioners (THPs) and radiation oncologists (ROs) is crucial for the continuity of care in the treatment of patients with cancer. However, scant information exists on how to co-ordinate cooperation between these health practitioners without interrupting the treatment of the patients. Aim The study aimed to explore the practices of THPs and ROs in cancer treatment and ultimately derive a workable practice framework between these health practitioners in the KwaZulu-Natal (KZN) province. Setting The study was conducted in selected districts, namely eThekwini, uThukela, Amajuba, uMkhanyakude, iLembe, uMzinyathi and uMgungundlovu, in KZN. Methods A qualitative study by using a descriptive phenomenological approach was conducted to collect data from 28 THPs involved in the treatment of cancer and four ROs from public oncology hospitals. Focus groups and one-on-one semi-structured interviews by using open-ended questions were conducted to collect data from THPs and ROs, respectively. Framework analysis was used for data analysis to identify themes. Results The study found that in KZN, THPs and ROs are working in parallel and that there are problems when patients seek cancer treatment from both health practitioners. Furthermore, the THPs and ROs work in an environment where there is no relationship, respect and trust, open communication and referral of patients by ROs to THPs. Both teams indicated that patients consult both traditional medicine (TM) and allopathic medicine (AM) by moving between the two health practitioners, resulting in interruptions in treatment. In addition, the study found that cooperation between THPs and ROs is understood as the provision of continuity care, where the parties work independently but share certain information of the patient on treatment, or as already being treated by each of them. The focus was on the type of relationship, enablers and common grounds for cooperation. Conclusion The workable cooperative practice framework could be an inclusive health system where the parties work in parallel, with the patient being the main actor in the collaboration.
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Affiliation(s)
- Pauline B Nkosi
- Department of Radiography, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
| | - Maureen N Sibiya
- Department of Nursing, Faculty of Health Sciences, Durban University of Technology, Durban, South Africa
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Zhao Y, Bilal M, Raza A, Khan MI, Mehmood S, Hayat U, Hassan STS, Iqbal HMN. Tyrosine kinase inhibitors and their unique therapeutic potentialities to combat cancer. Int J Biol Macromol 2021; 168:22-37. [PMID: 33290765 DOI: 10.1016/j.ijbiomac.2020.12.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 02/05/2023]
Abstract
Cancer is one of the leading causes of death with a mortality rate of 12%. Although significant progress has been achieved in cancer research, the effective treatment of cancer remains the greatest global challenge in medicine. Dysregulation of tyrosine kinases (TK) is one of the characteristics of several types of cancers. Thus, drugs that target and inhibit these enzymes, known as TK inhibitors (TKIs), are considered vital chemotherapeutics to combat various types of cancer. The oral bioavailability of available TKIs and their targeted therapy are their potential benefits. Based on these characteristics, most TKIs are included in first/second-line therapy for the treatment of different cancers. This review aims to shed light on orally-active TKIs (natural and synthetic molecules) and their promising implication in the therapy of numerous types of tumors along with their mechanisms of action. Further, recent progress in the development of synthetic and isolation of natural TKIs is reviewed. A significant growth in research regarding the development of new-generation TKIs is made with time (23 FDA-approved TKIs from 2018) due to their better therapeutic response. Oral bioavailability should be considered as an important parameter while developing of new-generation TKIs; however, drug delivery systems can also be used to address issue of poor bioavailability to a certain extent. Moreover, clinical trials should be designed in consideration of the development of resistance and tumor heterogeneity.
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Affiliation(s)
- Yuping Zhao
- School of Life Science and Food Engineering, Huaiyin Institute of Technology, Huaian 223003, China.
| | - Muhammad Bilal
- School of Life Science and Food Engineering, Huaiyin Institute of Technology, Huaian 223003, China.
| | - Ali Raza
- School of Biomedical Engineering, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai 200240, China
| | - Muhammad Imran Khan
- Hefei National Lab for Physical Sciences at the Microscale and the Centers for Biomedical Engineering, University of Science and Technology of China, Hefei, Anhui 230027, China
| | - Shahid Mehmood
- Key Laboratory of Protein and Peptide Pharmaceuticals, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
| | - Uzma Hayat
- School of Biomedical Engineering, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai 200240, China
| | - Sherif T S Hassan
- Department of Applied Ecology, Faculty of Environmental Sciences, Czech University of Life Sciences Prague, Kamýcká 129, 6-Suchdol, 165 21 Prague, Czech Republic
| | - Hafiz M N Iqbal
- Tecnologico de Monterrey, School of Engineering and Sciences, Monterrey, 64849, Mexico.
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El Khoury CJ, Adib SM, Chaaya M, El Asmar K, Charafeddine M, El-Saghir NS. Trends in Breast Cancer Staging at Diagnosis Associated with Screening Campaigns in Lebanon. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2020; 1:521-528. [PMID: 33786518 PMCID: PMC7785066 DOI: 10.1089/whr.2020.0076] [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] [Accepted: 09/21/2020] [Indexed: 11/26/2022]
Abstract
Introduction: Mammography screening has been shown to improve early breast cancer (BC) detection, by shifting the disease at diagnosis to locally confined stages, offering lighter treatments and better prognoses. BC awareness campaigns calling for annual mammography screenings have been ongoing in Lebanon since 2002. Changes in BC staging at diagnosis as a consequence of documented improvements in mammography uptake remain to be described. Materials and Methods: We reviewed 2,822 BC cases identified by pathology reports in the American University of Beirut Medical Center between the years 1990 and 2015. After age stratification, we have trended the extracted stages versus time. Results were compared between the prescreening (1990-2001) and the postscreening period (2002-2015). Results: During the postscreening period, stage I represented 31%, stage II 47%, stage III 14%, and stage IV 8% of the cases. Stage I cases had more than doubled whereas stage III cases showed a mirror decrease compared with the years before the implementation of awareness campaigns. The increase in stage I was significantly more prominent in women aged 40 years and older (from 14% to 32%), compared with the younger group. Shifts in staging happened in parallel with a concurrent rise in reported uptake of mammography screening. Conclusions: Our findings demonstrate significant trends in earlier detection, which are likely associated with an increase in screening uptake and an awareness of BC as a public health issue. Staging data from hospitals all over Lebanon should be available for building national evidence. The Ministry of Public Health should require reporting of BC stage at diagnosis to the National Cancer Registry, as part of the annual cancer incidence reporting in Lebanon.
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Affiliation(s)
- Christiane J. El Khoury
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Salim M. Adib
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Monique Chaaya
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Khalil El Asmar
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Maya Charafeddine
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nagi S. El-Saghir
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Einführung eines interdisziplinären Tumorboards führt zur Verbesserung der Behandlungsergebnisse von Cholangio- und Gallenblasenkarzinomen. Chirurg 2020; 91:650-661. [DOI: 10.1007/s00104-019-01100-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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12
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Rositch AF, Loffredo C, Bourlon MT, Pearlman PC, Adebamowo C. Creative Approaches to Global Cancer Research and Control. JCO Glob Oncol 2020; 6:4-7. [PMID: 32716656 PMCID: PMC7846070 DOI: 10.1200/go.20.00237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Christopher Loffredo
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Maria T Bourlon
- Hemato-Oncology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Paul C Pearlman
- National Cancer Institute Center for Global Health, Rockville, MD
| | - Clement Adebamowo
- Institute of Human Virology, Department of Epidemiology and Public Health, Marlene and Stewart Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, MD.,Institute of Human Virology, Abuja, Nigeria.,Center for Bioethics and Research, Ibadan, Nigeria
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Analysis of management decisions and outcomes of a weekly multidisciplinary pediatric tumor board meeting in Uganda. Future Sci OA 2019; 5:FSO417. [PMID: 31608156 PMCID: PMC6787502 DOI: 10.2144/fsoa-2019-0070] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Aim: To evaluate the efficacy of a pediatric multidisciplinary tumor board (MTB) in Uganda. Patients & methods: We documented the discussion of cases presented at a pediatric MTB and subsequently, though retrospective chart review, determined the degree to which decision were implemented. Results: 95 patients were discussed. In total, 129 of 226 (57%) distinct management decisions reached during the MTBs were implemented. Of these, 15 resulted in changes in diagnosis and 53 were classified as major changes in management. Decisions on chemotherapy were the most likely to be successfully enacted (51/58), followed by radiotherapy (18/30) and surgery (12/21). Labs/consults were less likely to be implemented. Conclusion: Key improvements, specifically in the documentation and implementation of management decisions, are needed to improve the MTB's efficacy. Tumor board meetings, which are standard of care for cancer management and well-studied in high income settings, have not been appropriately evaluated in low-income settings. Therefore, we undertook a review of a weekly pediatric tumor board meeting in Uganda, in which we documented the patients discussed and management decisions reached. We found that many diverse patients were discussed in tumor board meetings, with important implications in diagnosis and management. However, many of the decisions reached in the meetings were not subsequently implemented, underscoring the need to improve the effectiveness of the tumor board meeting.
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Integration of Research Priorities in Low and Middle-Income Countries: A Qualitative Analysis of National Cancer Control Plans. J Cancer Policy 2019. [DOI: 10.1016/j.jcpo.2019.100190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Smith SR, Zheng JY, Silver J, Haig AJ, Cheville A. Cancer rehabilitation as an essential component of quality care and survivorship from an international perspective. Disabil Rehabil 2018; 42:8-13. [PMID: 30574818 DOI: 10.1080/09638288.2018.1514662] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: There has recently been an emphasis on improving cancer care globally, including access to lifesaving treatment and earlier identification of disease. This will lead to more survivors stricken by impairments related to the early and late effects of cancer treatment. An unintended consequence of the noble plan to improve oncology care worldwide is demand on health care systems that may be unable to accommodate increased patient care needs for myriad reasons. As a result, those with disabilities may suffer.Methods: Literature search and input from experts in the field were used to evaluate the growing need for cancer rehabilitation and survivorship care to reduce morbidity associated with cancer treatment.Results: Many governmental and non-governmental organizations have started initiatives to improve cancer care across the continuum, and reduce the symptom burden of those living with cancer. While the start is promising, many barriers must be overcome to ensure high-quality care that would reduce cost and improve patient access, including a lack of trained rehabilitation specialists, poor coordination of efforts, and funding restrictions. Furthermore, global efforts to improve rehabilitation care often do not emphasize cancer rehabilitation, potentially leaving a gap and increasing physical and economic costs of disability. Finally, low-resource countries face unique challenges in improving cancer rehabilitation care.Conclusion: Cancer rehabilitation and survivorship care are needed to improve health care quality, as there is an expected influx of cancer patients with new global efforts to improve oncology care. To accomplish this, rehabilitation initiatives must emphasize cancer rehabilitation as a component of any program, and oncology endeavors should include a plan for the rehabilitation of cancer survivors to reduce morbidity and health care cost.Implications for RehabilitationCancer rehabilitation has the potential to reduce morbidity and health care costs associated with cancer and disability worldwideAdvocacy from international organizations regarding cancer rehabilitation is increasing, but has been disjointed and incompleteLow-resource countries in particular face several barriers to providing cancer rehabilitation and survivorship care.
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Affiliation(s)
- Sean R Smith
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, MI, USA
| | - Jasmine Y Zheng
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, Pennsylvania, PA, USA
| | - Julie Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, MA, USA
| | - Andrew J Haig
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, MI, USA
| | - Andrea Cheville
- Department of Physical Medicine and Rehabilitation, The Mayo Clinic, Rochester, Minnesota, MN, USA
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Ramirez O, Aristizabal P, Zaidi A, Gagnepain-Lacheteau A, Ribeiro RC, Bravo LE. Childhood cancer survival disparities in a universalized health system in Cali, Colombia. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2018. [DOI: 10.1016/j.phoj.2019.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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El Saghir NS, El Tomb PA, Carlson RW. Breast Cancer Diagnosis and Treatment in Low- and Mid-Resource Settings: the Role of Resource-Stratified Clinical Practice Guidelines. CURRENT BREAST CANCER REPORTS 2018. [DOI: 10.1007/s12609-018-0287-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hortobagyi GN, Pyle D, Cazap EL, El Saghir NS, Shulman LN, Lyman GH, Schnipper LE, Adebamowo CA, Gandara DR, Vose J, Wong SL, Yu P. American Society of Clinical Oncology's Global Oncology Leadership Task Force: Findings and Actions. J Glob Oncol 2017; 4:1-8. [PMID: 30241187 PMCID: PMC6180769 DOI: 10.1200/jgo.17.00060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
In response to rising cancer incidence and mortality rates in low- and
middle-income countries and the increasingly global profile of ASCO’s
membership, the ASCO Board of Directors appointed the Global Oncology Leadership
Task Force (Task Force) to provide recommendations on ASCO’s engagement
in global oncology. To accomplish its work, the Task Force convened meetings of
global oncology experts, conducted focus group discussions with member groups,
did site visits to South America and India, and met regularly to analyze the
findings and develop recommendations. Task Force findings included global
concerns, such as access to care, and specific concerns of middle- and
low-resource settings. The need to strengthen health systems and the importance
of alliances with a range of international cancer stakeholders were emphasized.
Task Force recommendations to the ASCO Board of Directors were based on a
three-part global oncology strategy of professional development, improvement of
access to quality care, and acceleration of global oncology research. Specific
areas of focus within each of these strategic pillars are provided along with an
update on areas of ASCO activity as these recommendations are implemented.
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Affiliation(s)
- Gabriel N Hortobagyi
- Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Doug Pyle, American Society of Clinical Oncology, Alexandria, VA; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe de Oncología Médica, Buenos Aires, Argentina; Nagi S. El Saghir, American University of Beirut Medical Center, Beirut, Lebanon; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Boston, MA; Clement Adebayo Adebamowo, Institute of Human Virology, Baltimore, MD; David R. Gandara, University of California Davis Comprehensive Cancer Center, Sacramento, CA; Julie Vose, University of Nebraska Medical Center, Omaha, NE; Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; and Peter Yu, Hartford HealthCare, Hartford, CT
| | - Doug Pyle
- Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Doug Pyle, American Society of Clinical Oncology, Alexandria, VA; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe de Oncología Médica, Buenos Aires, Argentina; Nagi S. El Saghir, American University of Beirut Medical Center, Beirut, Lebanon; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Boston, MA; Clement Adebayo Adebamowo, Institute of Human Virology, Baltimore, MD; David R. Gandara, University of California Davis Comprehensive Cancer Center, Sacramento, CA; Julie Vose, University of Nebraska Medical Center, Omaha, NE; Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; and Peter Yu, Hartford HealthCare, Hartford, CT
| | - Eduardo L Cazap
- Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Doug Pyle, American Society of Clinical Oncology, Alexandria, VA; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe de Oncología Médica, Buenos Aires, Argentina; Nagi S. El Saghir, American University of Beirut Medical Center, Beirut, Lebanon; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Boston, MA; Clement Adebayo Adebamowo, Institute of Human Virology, Baltimore, MD; David R. Gandara, University of California Davis Comprehensive Cancer Center, Sacramento, CA; Julie Vose, University of Nebraska Medical Center, Omaha, NE; Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; and Peter Yu, Hartford HealthCare, Hartford, CT
| | - Nagi S El Saghir
- Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Doug Pyle, American Society of Clinical Oncology, Alexandria, VA; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe de Oncología Médica, Buenos Aires, Argentina; Nagi S. El Saghir, American University of Beirut Medical Center, Beirut, Lebanon; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Boston, MA; Clement Adebayo Adebamowo, Institute of Human Virology, Baltimore, MD; David R. Gandara, University of California Davis Comprehensive Cancer Center, Sacramento, CA; Julie Vose, University of Nebraska Medical Center, Omaha, NE; Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; and Peter Yu, Hartford HealthCare, Hartford, CT
| | - Lawrence N Shulman
- Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Doug Pyle, American Society of Clinical Oncology, Alexandria, VA; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe de Oncología Médica, Buenos Aires, Argentina; Nagi S. El Saghir, American University of Beirut Medical Center, Beirut, Lebanon; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Boston, MA; Clement Adebayo Adebamowo, Institute of Human Virology, Baltimore, MD; David R. Gandara, University of California Davis Comprehensive Cancer Center, Sacramento, CA; Julie Vose, University of Nebraska Medical Center, Omaha, NE; Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; and Peter Yu, Hartford HealthCare, Hartford, CT
| | - Gary H Lyman
- Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Doug Pyle, American Society of Clinical Oncology, Alexandria, VA; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe de Oncología Médica, Buenos Aires, Argentina; Nagi S. El Saghir, American University of Beirut Medical Center, Beirut, Lebanon; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Boston, MA; Clement Adebayo Adebamowo, Institute of Human Virology, Baltimore, MD; David R. Gandara, University of California Davis Comprehensive Cancer Center, Sacramento, CA; Julie Vose, University of Nebraska Medical Center, Omaha, NE; Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; and Peter Yu, Hartford HealthCare, Hartford, CT
| | - Lowell E Schnipper
- Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Doug Pyle, American Society of Clinical Oncology, Alexandria, VA; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe de Oncología Médica, Buenos Aires, Argentina; Nagi S. El Saghir, American University of Beirut Medical Center, Beirut, Lebanon; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Boston, MA; Clement Adebayo Adebamowo, Institute of Human Virology, Baltimore, MD; David R. Gandara, University of California Davis Comprehensive Cancer Center, Sacramento, CA; Julie Vose, University of Nebraska Medical Center, Omaha, NE; Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; and Peter Yu, Hartford HealthCare, Hartford, CT
| | - Clement Adebayo Adebamowo
- Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Doug Pyle, American Society of Clinical Oncology, Alexandria, VA; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe de Oncología Médica, Buenos Aires, Argentina; Nagi S. El Saghir, American University of Beirut Medical Center, Beirut, Lebanon; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Boston, MA; Clement Adebayo Adebamowo, Institute of Human Virology, Baltimore, MD; David R. Gandara, University of California Davis Comprehensive Cancer Center, Sacramento, CA; Julie Vose, University of Nebraska Medical Center, Omaha, NE; Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; and Peter Yu, Hartford HealthCare, Hartford, CT
| | - David R Gandara
- Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Doug Pyle, American Society of Clinical Oncology, Alexandria, VA; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe de Oncología Médica, Buenos Aires, Argentina; Nagi S. El Saghir, American University of Beirut Medical Center, Beirut, Lebanon; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Boston, MA; Clement Adebayo Adebamowo, Institute of Human Virology, Baltimore, MD; David R. Gandara, University of California Davis Comprehensive Cancer Center, Sacramento, CA; Julie Vose, University of Nebraska Medical Center, Omaha, NE; Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; and Peter Yu, Hartford HealthCare, Hartford, CT
| | - Julie Vose
- Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Doug Pyle, American Society of Clinical Oncology, Alexandria, VA; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe de Oncología Médica, Buenos Aires, Argentina; Nagi S. El Saghir, American University of Beirut Medical Center, Beirut, Lebanon; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Boston, MA; Clement Adebayo Adebamowo, Institute of Human Virology, Baltimore, MD; David R. Gandara, University of California Davis Comprehensive Cancer Center, Sacramento, CA; Julie Vose, University of Nebraska Medical Center, Omaha, NE; Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; and Peter Yu, Hartford HealthCare, Hartford, CT
| | - Sandra L Wong
- Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Doug Pyle, American Society of Clinical Oncology, Alexandria, VA; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe de Oncología Médica, Buenos Aires, Argentina; Nagi S. El Saghir, American University of Beirut Medical Center, Beirut, Lebanon; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Boston, MA; Clement Adebayo Adebamowo, Institute of Human Virology, Baltimore, MD; David R. Gandara, University of California Davis Comprehensive Cancer Center, Sacramento, CA; Julie Vose, University of Nebraska Medical Center, Omaha, NE; Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; and Peter Yu, Hartford HealthCare, Hartford, CT
| | - Peter Yu
- Gabriel N. Hortobagyi, The University of Texas MD Anderson Cancer Center, Houston, TX; Doug Pyle, American Society of Clinical Oncology, Alexandria, VA; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe de Oncología Médica, Buenos Aires, Argentina; Nagi S. El Saghir, American University of Beirut Medical Center, Beirut, Lebanon; Lawrence N. Shulman, University of Pennsylvania, Philadelphia, PA; Gary H. Lyman, Fred Hutchinson Cancer Research Center, Seattle, WA; Lowell E. Schnipper, Beth Israel Deaconess Medical Center, Boston, MA; Clement Adebayo Adebamowo, Institute of Human Virology, Baltimore, MD; David R. Gandara, University of California Davis Comprehensive Cancer Center, Sacramento, CA; Julie Vose, University of Nebraska Medical Center, Omaha, NE; Sandra L. Wong, Dartmouth-Hitchcock Medical Center, Lebanon, NH; and Peter Yu, Hartford HealthCare, Hartford, CT
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Sawyer KN, Callaway CW, Wagner AK. Life After Death: Surviving Cardiac Arrest—an Overview of Epidemiology, Best Acute Care Practices, and Considerations for Rehabilitation Care. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2017. [DOI: 10.1007/s40141-017-0148-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Ndarukwa S, Nyakabau AM, Chagpar AB, Raben D, Ndlovu N, Kadzatsa W, Eaton VJ, Mafunda P, Razis E. American Society of Clinical Oncology Multidisciplinary Cancer Management Course: Connecting Lives, Cancer Care, Education, and Compassion in Zimbabwe-A Pilot for Efforts of Sustainable Benefit? J Glob Oncol 2016; 3:409-417. [PMID: 28831449 PMCID: PMC5560449 DOI: 10.1200/jgo.2016.003673] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The burden of cancer in low- to middle-income countries is growing and is expected to rise dramatically while resources to manage this disease remain inadequate. All authorities for the management of cancer recommend multidisciplinary care. Educational efforts by international organizations to assist local professionals in caring for their patients tend to have a lasting impact because they empower local professionals and enhance their skills. A multidisciplinary cancer management course was designed by American Society of Clinical Oncology staff and local experts to provide a roadmap for cross-specialty interaction and coordination of care in Zimbabwe. The outcome of the course was measured through feedback obtained from participants and impact on local workforce. The cancer management course was relevant to daily practice and fostered long-lasting partnerships and collaborations. Furthermore, it resulted in a more motivated local workforce and strengthened existing multidisciplinary practices. Cancer care is in a critical state in low- to middle-income countries. Educational efforts and collaborative partnerships may provide a cost-effective strategy with sustainable benefits. A multidisciplinary approach to optimize therapy is desirable. Evaluation of the course impact after a period of 6 months to 1 year is needed to determine the sustainability and impact of such efforts.
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Affiliation(s)
- Sandra Ndarukwa
- and , Parirenyatwa Group of Hospitals; and , University of Zimbabwe College of Health Science, Harare; , Junior Chamber International Zimbabwe, Harare, Zimbabwe; , Yale University, New Haven, CT; , University of Colorado School of Medicine, Denver, CO; , American Society of Clinical Oncology, Alexandria, VA; and , Hygeia Hospital, Athens, Greece
| | - Anna Mary Nyakabau
- and , Parirenyatwa Group of Hospitals; and , University of Zimbabwe College of Health Science, Harare; , Junior Chamber International Zimbabwe, Harare, Zimbabwe; , Yale University, New Haven, CT; , University of Colorado School of Medicine, Denver, CO; , American Society of Clinical Oncology, Alexandria, VA; and , Hygeia Hospital, Athens, Greece
| | - Anees B Chagpar
- and , Parirenyatwa Group of Hospitals; and , University of Zimbabwe College of Health Science, Harare; , Junior Chamber International Zimbabwe, Harare, Zimbabwe; , Yale University, New Haven, CT; , University of Colorado School of Medicine, Denver, CO; , American Society of Clinical Oncology, Alexandria, VA; and , Hygeia Hospital, Athens, Greece
| | - David Raben
- and , Parirenyatwa Group of Hospitals; and , University of Zimbabwe College of Health Science, Harare; , Junior Chamber International Zimbabwe, Harare, Zimbabwe; , Yale University, New Haven, CT; , University of Colorado School of Medicine, Denver, CO; , American Society of Clinical Oncology, Alexandria, VA; and , Hygeia Hospital, Athens, Greece
| | - Ntokozo Ndlovu
- and , Parirenyatwa Group of Hospitals; and , University of Zimbabwe College of Health Science, Harare; , Junior Chamber International Zimbabwe, Harare, Zimbabwe; , Yale University, New Haven, CT; , University of Colorado School of Medicine, Denver, CO; , American Society of Clinical Oncology, Alexandria, VA; and , Hygeia Hospital, Athens, Greece
| | - Webster Kadzatsa
- and , Parirenyatwa Group of Hospitals; and , University of Zimbabwe College of Health Science, Harare; , Junior Chamber International Zimbabwe, Harare, Zimbabwe; , Yale University, New Haven, CT; , University of Colorado School of Medicine, Denver, CO; , American Society of Clinical Oncology, Alexandria, VA; and , Hygeia Hospital, Athens, Greece
| | - Vanessa J Eaton
- and , Parirenyatwa Group of Hospitals; and , University of Zimbabwe College of Health Science, Harare; , Junior Chamber International Zimbabwe, Harare, Zimbabwe; , Yale University, New Haven, CT; , University of Colorado School of Medicine, Denver, CO; , American Society of Clinical Oncology, Alexandria, VA; and , Hygeia Hospital, Athens, Greece
| | - Paida Mafunda
- and , Parirenyatwa Group of Hospitals; and , University of Zimbabwe College of Health Science, Harare; , Junior Chamber International Zimbabwe, Harare, Zimbabwe; , Yale University, New Haven, CT; , University of Colorado School of Medicine, Denver, CO; , American Society of Clinical Oncology, Alexandria, VA; and , Hygeia Hospital, Athens, Greece
| | - Evangelia Razis
- and , Parirenyatwa Group of Hospitals; and , University of Zimbabwe College of Health Science, Harare; , Junior Chamber International Zimbabwe, Harare, Zimbabwe; , Yale University, New Haven, CT; , University of Colorado School of Medicine, Denver, CO; , American Society of Clinical Oncology, Alexandria, VA; and , Hygeia Hospital, Athens, Greece
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El Saghir NS, Kreidieh FY, El-Baba S, Anderson BO. Management of locally advanced and metastatic breast cancer: guidelines, infrastructures and low resource settings. BREAST CANCER MANAGEMENT 2016. [DOI: 10.2217/bmt-2016-0012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Breast cancer incidence is rising and it accounts for over 1.6 million cases per year worldwide. It represents about one-third of female cancers and is a significant health issue in countries at all economic levels. In this article, we review global cancer statistics, breast cancer staging including late-stage presentation in limited resource settings, disparities in the breast cancer outcomes and requirements for optimal management, including infrastructure needs for optimal surgery, radiation treatment and systemic therapy. We will discuss controversies related to drug pricing and availability, process and delays in registration of new drugs as well as resource stratification and resource-stratified guidelines for locally advanced breast cancer and metastatic breast cancer.
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Affiliation(s)
- Nagi S El Saghir
- Department of Internal Medicine, Breast Center of Excellence, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Firas Y Kreidieh
- Department of Internal Medicine, Breast Center of Excellence, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sarah El-Baba
- Department of Internal Medicine, Breast Center of Excellence, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Benjamin O Anderson
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Departments of Surgery & Global Health-Medicine, University of Washington, Seattle, Washington, DC, USA
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El Saghir NS, Charara RN, Kreidieh FY, Eaton V, Litvin K, Farhat RA, Khoury KE, Breidy J, Tamim H, Eid TA. Global Practice and Efficiency of Multidisciplinary Tumor Boards: Results of an American Society of Clinical Oncology International Survey. J Glob Oncol 2015; 1:57-64. [PMID: 28804774 PMCID: PMC5539869 DOI: 10.1200/jgo.2015.000158] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Multidisciplinary tumor boards (MDTBs) are universally recommended, but recent literature has challenged their efficiency. METHODS The American Society of Clinical Oncology (ASCO) conducted a survey of a randomly selected cohort of international ASCO members. The survey was built on SurveyMonkey and was sent via e-mail to a sample of 5,357 members. RESULTS In all, 501 ASCO members practicing outside the United States responded, and 86% of them participated in MDTBs at their own institutions. Those who attended represented a variety of disciplines in 70% to 86% of all MDTBs. The majority of MDTBs held weekly specialty and/or general meetings. Eighty-nine percent of 409 respondents attended for advice on treatment decisions. Survey respondents reported changes of 1% to 25% in treatment plans for 44% to 49% of patients with breast cancer and in 47% to 50% of patients with colorectal cancer. They reported 25% to 50% changes in surgery type and/or treatment plans for 14% to 21% of patients with breast cancer and 12% to 18% of patients with colorectal cancer. Of the 430 respondents 96% said overall benefit to patients was worth the time and effort spent at MDTBs, and 96% said that MDTBs have teaching value. Mini tumor boards held with whatever types of specialists were available were considered valid. In all, 94.8% (425 of 448) said that MDTBs should be required in institutions in which patients with cancer are treated. CONCLUSION MDTBs are commonplace worldwide. A majority of respondents attend them to obtain recommendations, and they report changes in patient management. Change occurred more frequently with nonmedical oncologists and with physicians who had less than 15 years in practice. MDTBs helped practitioners make management decisions. Mini tumor boards may improve time efficiency and are favored when the full team is not available. Suggestions for improving MDTBs included making them more efficient, better selection and preparation of cases, choosing an effective team leader, and improving how time is used, but more research is needed on ways to improve the efficiency of MDTBs.
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Affiliation(s)
- Nagi S El Saghir
- American Society of Clinical Oncology, Alexandria, VA; and Katia E. Khoury, University Hospitals, Cleveland, OH
| | - Raghid N Charara
- American Society of Clinical Oncology, Alexandria, VA; and Katia E. Khoury, University Hospitals, Cleveland, OH
| | - Firas Y Kreidieh
- American Society of Clinical Oncology, Alexandria, VA; and Katia E. Khoury, University Hospitals, Cleveland, OH
| | - Vanessa Eaton
- American Society of Clinical Oncology, Alexandria, VA; and Katia E. Khoury, University Hospitals, Cleveland, OH
| | - Kate Litvin
- American Society of Clinical Oncology, Alexandria, VA; and Katia E. Khoury, University Hospitals, Cleveland, OH
| | - Rania A Farhat
- American Society of Clinical Oncology, Alexandria, VA; and Katia E. Khoury, University Hospitals, Cleveland, OH
| | - Katia E Khoury
- American Society of Clinical Oncology, Alexandria, VA; and Katia E. Khoury, University Hospitals, Cleveland, OH
| | - Juliana Breidy
- American Society of Clinical Oncology, Alexandria, VA; and Katia E. Khoury, University Hospitals, Cleveland, OH
| | - Hani Tamim
- American Society of Clinical Oncology, Alexandria, VA; and Katia E. Khoury, University Hospitals, Cleveland, OH
| | - Toufic A Eid
- American Society of Clinical Oncology, Alexandria, VA; and Katia E. Khoury, University Hospitals, Cleveland, OH
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Becker S. A historic and scientific review of breast cancer: The next global healthcare challenge. Int J Gynaecol Obstet 2015; 131 Suppl 1:S36-9. [DOI: 10.1016/j.ijgo.2015.03.015] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Anderson BO, Ilbawi AM, El Saghir NS. Breast cancer in low and middle income countries (LMICs): a shifting tide in global health. Breast J 2014; 21:111-8. [PMID: 25444441 DOI: 10.1111/tbj.12357] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Cancer control planning has become a core aspect of global health, as rising rates of noncommunicable diseases in low-resource settings have fittingly propelled it into the spotlight. Comprehensive strategies for cancer control are needed to effectively manage the disease burden. As the most common cancer among women and the most likely reason a woman will die from cancer globally, breast cancer management is a necessary aspect of any comprehensive cancer control plan. Major improvements in breast cancer outcomes in high-income countries have not yet been mirrored in low-resource settings, making it a targeted priority for global health planning. Resource-stratified guidelines provide a framework and vehicle for designing programs to promote early detection, diagnosis, and treatment using existing infrastructure and renewable resources. Strategies for evaluating the current state and projecting future burden is a central aspect of developing national strategies for improving breast cancer outcomes at the national and international levels.
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Affiliation(s)
- Benjamin O Anderson
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Departments of Surgery and Global Health-Medicine, University of Washington, Seattle, Washington
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