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Jaya-Prakason S, Kong YC, Yip CH, See MH, Taib NA, Abdul Satar NF, Jamaris S, Teoh LY, Ibrahim RI, Bhoo-Pathy N. Trends in Presentation, Management, and Survival of Women With Breast Cancer in a Multiethnic, Middle-Income Asian Setting. JCO Glob Oncol 2024; 10:e2400054. [PMID: 39088780 DOI: 10.1200/go.24.00054] [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: 02/05/2024] [Revised: 04/29/2024] [Accepted: 05/28/2024] [Indexed: 08/03/2024] Open
Abstract
PURPOSE Granular data on breast cancer (BC) are pertinent for surveillance, planning, and monitoring of cancer care delivery. We determined the trends in clinical presentation, management, and survival of women with BC in a multiethnic middle-income Asian setting over 15 years. METHODS Data of 7,478 Malaysian women newly diagnosed with invasive BC between 2005 and 2019 from three hospital-based cancer registries were included. Trends in demographic, tumor, and treatment characteristics were compared across period 1 (P1): 2005-2009, period 2 (P2): 2010-2014, and period 3 (P3): 2015-2019. Overall survival and net survival were determined. RESULTS More women in P3 than P1 were older than 60 years at diagnosis. Only a marginal increase in proportion of women with stage I disease was observed (23.7% v 27.2% in P1 and P3, respectively, P = .004). Nonetheless, patients were increasingly presenting with smaller tumors, fewer axillary node involvement, well-differentiated tumors, and hormone receptor expression in recent times. Proportion of women with human epidermal growth factor receptor 2 (HER2)-overexpressed tumors significantly decreased. Among indicated patients, receipt of anticancer therapies was somewhat similar over the calendar periods, except for neoadjuvant chemotherapy and anti-HER2 therapy, where increases in administration were noted. Significant improvements in survival were observed over the 15 years, particularly for HER2-overexpressed BCs. CONCLUSION Although the improvements in BC survival that we have observed validate ongoing cancer control efforts and treatment advances, study findings suggest that more could be done for earlier detection and improved access to effective therapies in our settings.
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Affiliation(s)
- Sharminii Jaya-Prakason
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Yek-Ching Kong
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Cheng-Har Yip
- Ramsay Sime Darby Health Care, Jalan SS12, Subang Jaya, Malaysia
| | - Mee-Hoong See
- Breast Surgery Unit, Department of Surgery, Faculty of Medicine, Universiti Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Nur Aishah Taib
- Breast Surgery Unit, Department of Surgery, Faculty of Medicine, Universiti Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Nur Fadhlina Abdul Satar
- Department of Clinical Oncology, University of Malaya Medical Centre, Jalan Professor Diraja Ungku Aziz, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Suniza Jamaris
- Breast Surgery Unit, Department of Surgery, Faculty of Medicine, Universiti Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Li Ying Teoh
- Breast Surgery Unit, Department of Surgery, Faculty of Medicine, Universiti Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
| | - Rose Irnawaty Ibrahim
- Actuarial Science and Risk Management, Faculty of Science and Technology, Universiti Sains Islam Malaysia (USIM), Nilai, Negeri Sembilan, Malaysia
| | - Nirmala Bhoo-Pathy
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Lembah Pantai, Kuala Lumpur, Malaysia
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Srinivasan S, Keerthivasagam S. Transforming Childhood AML Care in India. J Pediatr Hematol Oncol 2024; 46:276-277. [PMID: 38718311 DOI: 10.1097/mph.0000000000002876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 04/10/2024] [Indexed: 06/25/2024]
Affiliation(s)
- Shyam Srinivasan
- Division of Pediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra
| | - Swaminathan Keerthivasagam
- Department of Medical Oncology Jawaharlal Institute of Postgraduate Medical Education and Research Puducherry, India
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Teufel F, Bulstra CA, Davies JI, Ali MK. Enhancing global access to diabetes medicines: policy lessons from the HIV response. Lancet Diabetes Endocrinol 2024; 12:88-90. [PMID: 38128554 DOI: 10.1016/s2213-8587(23)00359-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Felix Teufel
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; Emory Global Diabetes Research Center of the Woodruff Health Sciences Center and Emory University, Atlanta, GA, USA.
| | - Caroline A Bulstra
- Health Systems Innovation Lab, Department of Global Health and Population, Harvard T H Chan School of Public Health, Harvard University, Boston, MA, USA; Heidelberg Institute of Global Health, Heidelberg University Medical Center, Heidelberg, Germany
| | - Justine I Davies
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA; Emory Global Diabetes Research Center of the Woodruff Health Sciences Center and Emory University, Atlanta, GA, USA; Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA, USA
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Cavalli F, Mikkelsen B, Weiderpass E, Sullivan R, Jaffray D, Gospodarowicz M. World Oncology Forum amplifies its appeal in global fight against cancer. Lancet Oncol 2024; 25:170-174. [PMID: 38301688 DOI: 10.1016/s1470-2045(24)00010-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 02/03/2024]
Affiliation(s)
- Franco Cavalli
- European School of Oncology, Bellinzona, Switzerland; Institute for Oncology Research, 6500 Bellinzona, Switzerland.
| | - Bente Mikkelsen
- UHC/Communicable and Noncommunicable Diseases, World Health Organization Headquarters, Geneva, Switzerland
| | | | | | - David Jaffray
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mary Gospodarowicz
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
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Sullivan R. Cancer medicines: a private vice for public benefit? Ecancermedicalscience 2024; 18:ed131. [PMID: 38425769 PMCID: PMC10901629 DOI: 10.3332/ecancer.2024.ed131] [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: 01/04/2024] [Indexed: 03/02/2024] Open
Abstract
Cancer medicines have become one of the most dominant global medical technologies. They generate huge profits for the biopharmaceutical industry as well as fuel the research and advocacy activities of public funders, patient organisations, clinical and scientific communities and entire federal political ecosystems. The mismatch between the price, affordability and value of many cancer medicines and global need has generated significant policy debate, yet we see little change in behaviours from any of the major actors from public research funders through to regulatory authorities. In this policy analysis we examine whether, considering the money and power inherent in this system, any rationale global consensus and policy can be achieved to deliver affordable and equitable cancer medicines that consistently deliver clinically meaningful benefit.
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Affiliation(s)
- Richard Sullivan
- Institute of Cancer Policy, Centre for Cancer, Society & Public Health, King's College London, London SW1 9RT, UK
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Yuan J, Li M, Jiang X, Lu ZK. National Volume-Based Procurement (NVBP) exclusively for insulin: towards affordable access in China and beyond. BMJ Glob Health 2024; 9:e014489. [PMID: 38232994 PMCID: PMC10806927 DOI: 10.1136/bmjgh-2023-014489] [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: 11/09/2023] [Accepted: 12/05/2023] [Indexed: 01/19/2024] Open
Abstract
Universal access to insulin remains a global public health challenge mainly due to its high price. After unsuccessful healthcare reforms attempting to lower insulin prices over the past several decades, the novel pooled procurement-also known as the national volume-based procurement (NVBP)was initiated exclusively for insulin in China. The NVBP exclusively for insulin represents a unique approach to conquering the challenges in the pooled procurement many low-income and middle-income countries face. In this paper, we described how the pooled procurement mechanism was implemented for insulin in China. Forty-two insulin products from 11 companies were procured, with a median price reduction of 42.08%. The procurement price ranged from US$0.35 to US$1.63 (¥2.35-¥10.97) per defined daily dose (DDD). The median procurement price per DDD was US$$0.54 (¥3.63) for human insulins and US$0.92 (¥6.18) for analogue insulin (p<0.001), respectively. A total of 32 000 medical facilities participated in the procurement, and the pooled demand for insulin was 1.61 billion daily doses, with an estimated saving of US$2.85 billion (¥19 billion) for the first year of the procurement agreement. Insulin affordability and accessibility improved substantially. This study reveals that the NVBP exclusively for insulin could effectively reduce insulin prices and improve access to this essential medicine. Even though the pooled procurement option looks efficient, its long-term impacts on the healthcare system should be closely monitored.
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Affiliation(s)
- Jing Yuan
- Minhang Hospital, School of Pharmacy, Fudan University, Shanghai, China
| | - Minghui Li
- The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Xiangxiang Jiang
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
| | - Zhiqiang Kevin Lu
- College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
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