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Are C, Murthy SS, Sullivan R, Schissel M, Chowdhury S, Alatise O, Anaya D, Are M, Balch C, Bartlett D, Brennan M, Cairncross L, Clark M, Deo SVS, Dudeja V, D'Ugo D, Fadhil I, Giuliano A, Gopal S, Gutnik L, Ilbawi A, Jani P, Kingham TP, Lorenzon L, Leiphrakpam P, Leon A, Martinez-Said H, McMasters K, Meltzer DO, Mutebi M, Zafar SN, Naik V, Newman L, Oliveira AF, Park DJ, Pramesh CS, Rao S, Subramanyeshwar Rao T, Bargallo-Rocha E, Romanoff A, Rositch AF, Rubio IT, Salvador de Castro Ribeiro H, Sbaity E, Senthil M, Smith L, Toi M, Turaga K, Yanala U, Yip CH, Zaghloul A, Anderson BO. Global Cancer Surgery: pragmatic solutions to improve cancer surgery outcomes worldwide. Lancet Oncol 2023; 24:e472-e518. [PMID: 37924819 DOI: 10.1016/s1470-2045(23)00412-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 11/06/2023]
Abstract
The first Lancet Oncology Commission on Global Cancer Surgery was published in 2015 and serves as a landmark paper in the field of cancer surgery. The Commission highlighted the burden of cancer and the importance of cancer surgery, while documenting the many inadequacies in the ability to deliver safe, timely, and affordable cancer surgical care. This Commission builds on the first Commission by focusing on solutions and actions to improve access to cancer surgery globally, developed by drawing upon the expertise from cancer surgery leaders across the world. We present solution frameworks in nine domains that can improve access to cancer surgery. These nine domains were refined to identify solutions specific to the six WHO regions. On the basis of these solutions, we developed eight actions to propel essential improvements in the global capacity for cancer surgery. Our initiatives are broad in scope, pragmatic, affordable, and contextually applicable, and aimed at cancer surgeons as well as leaders, administrators, elected officials, and health policy advocates. We envision that the solutions and actions contained within the Commission will address inequities and promote safe, timely, and affordable cancer surgery for every patient, regardless of their socioeconomic status or geographic location.
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Affiliation(s)
- Chandrakanth Are
- Division of Surgical Oncology, Department of Surgery, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Shilpa S Murthy
- Division of Surgical Oncology, Department of Surgery, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Richard Sullivan
- Institute of Cancer Policy, School of Cancer Sciences, King's College London, London, UK
| | - Makayla Schissel
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sanjib Chowdhury
- Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Olesegun Alatise
- Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Daniel Anaya
- Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA
| | - Madhuri Are
- Division of Pain Medicine, Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Charles Balch
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, Global Cancer Surgery: pragmatic solutions to improve USA
| | - David Bartlett
- Department of Surgery, Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Murray Brennan
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lydia Cairncross
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Matthew Clark
- University of Auckland School of Medicine, Auckland, New Zealand
| | - S V S Deo
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Vikas Dudeja
- Division of Surgical Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Domenico D'Ugo
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | | | - Armando Giuliano
- Cedars-Sinai Medical Center, University of California, Los Angeles, Los Angeles, CA, USA
| | - Satish Gopal
- Center for Global Health, National Cancer Institute, Washington DC, USA
| | - Lily Gutnik
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andre Ilbawi
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - Pankaj Jani
- Department of Surgery, University of Nairobi, Nairobi, Kenya
| | | | - Laura Lorenzon
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
| | - Premila Leiphrakpam
- Division of Surgical Oncology, Department of Surgery, Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - Augusto Leon
- Department of Surgical Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Kelly McMasters
- Division of Surgical Oncology, Hiram C Polk, Jr MD Department of Surgery, University of Louisville, Louisville, KY, USA
| | - David O Meltzer
- Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University Hospital, Nairobi, Kenya
| | - Syed Nabeel Zafar
- Department of Surgery, University of Wisconsin Hospitals and Clinics, Madison, WI, USA
| | - Vibhavari Naik
- Department of Anesthesiology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | - Lisa Newman
- Department of Surgery, New York-Presbyterian, Weill Cornell Medicine, New York, NY, USA
| | | | - Do Joong Park
- Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - C S Pramesh
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Centre, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Saieesh Rao
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - T Subramanyeshwar Rao
- Department of Surgical Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, India
| | | | - Anya Romanoff
- Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Isabel T Rubio
- Breast Surgical Oncology, Clinica Universidad de Navarra, Madrid, Spain
| | | | - Eman Sbaity
- Division of General Surgery, Department of Surgery, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Maheswari Senthil
- Division of Surgical Oncology, Department of Surgery, University of California, Irvine, Irvine, CA, USA
| | - Lynette Smith
- Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Masakazi Toi
- Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Tokyo, Japan
| | - Kiran Turaga
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Ujwal Yanala
- Surgical Oncology, University of Miami Sylvester Comprehensive Cancer Center, Miami, FL, USA
| | - Cheng-Har Yip
- Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia
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Skelton M, Al-Mash'hadani AK, Abdul-Sater Z, Saleem M, Alsaad S, Kahtan M, Al-Samarai AH, Al-Bakir AM, Mula-Hussain L. War and oncology: cancer care in five Iraqi provinces impacted by the ISIL conflict. Front Oncol 2023; 13:1151242. [PMID: 37213303 PMCID: PMC10196689 DOI: 10.3389/fonc.2023.1151242] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/06/2023] [Indexed: 05/23/2023] Open
Abstract
War and cancer have been intertwined in Iraq for over three decades, a country where the legacies and ongoing impacts of conflict have been commonly associated with both increased cancer rates as well as the deterioration of cancer care. Most recently, the Islamic State of Iraq and the Levant (ISIL) violently occupied large portions of the country's central and northern provinces between 2014 and 2017, causing devastating impacts on public cancer centers across central and northern Iraq. Focusing on the five Iraqi provinces previously under full or partial ISIL occupation, this article examines the immediate and long-term impacts of war on cancer care across three periods (before, during, and after the ISIL conflict). As there is little published data on oncology in these local contexts, the paper relies primarily upon the qualitative interviews and lived experience of oncologists serving in the five provinces studied. A political economy lens is applied to interpret the results, particularly the data related to progress in oncology reconstruction. It is argued that conflict generates immediate and long-term shifts in political and economic conditions that, in turn, shape the rebuilding of oncology infrastructure. The documentation of the destruction and reconstruction of local oncology systems is intended to benefit the next generation of cancer care practitioners in the Middle East and other conflict-affected regions areas in their efforts to adapt to conflict and rebuild from the legacies of war.
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Affiliation(s)
- Mac Skelton
- Institute of Regional and International Studies, American University of Iraq-Sulaimani, Sulaymaniyah, Iraq
- Global Oncology Group, King's College London, London, United Kingdom
| | | | - Zahi Abdul-Sater
- Global Health Institute, American University of Beirut, Beirut, Lebanon
- College of Public Health, Phoenicia University, Mazraat El Daoudiyeh, Lebanon
| | - Mohammed Saleem
- Medical Oncology Department, Kirkuk Oncology and Hematology Center, Kirkuk, Iraq
| | - Saad Alsaad
- Medical Oncology Department, Tikrit Oncology Center, Tikrit, Iraq
| | - Marwa Kahtan
- Medical Oncology Department, Diyala Cancer Center, Baqubah, Iraq
| | | | - Ahmed Moyed Al-Bakir
- Medical Oncology Department, Specialized Oncology and Nuclear Medicine Hospital, Mosul, Iraq
| | - Layth Mula-Hussain
- Radiation Oncology Department, Sultan Qaboos Comprehensive Cancer Care and Research Centre, Muscat, Oman
- Oncology Department, College of Medicine, Ninevah University, Mosul, Iraq
- *Correspondence: Layth Mula-Hussain,
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Malakzai HA, Haidary AM, Gulzar S, Haidari M, Ibrahimkhil AS, Saadaat R, Hakimi A, Sadat Hofiani SM, Rahmani S, Abdul-Ghafar J. Prevalence, Distribution, and Histopathological Features of Malignant Tumors Reported at Tertiary Level in Afghanistan: A 3-Year Study. Cancer Manag Res 2022; 14:2569-2582. [PMID: 36065259 PMCID: PMC9440704 DOI: 10.2147/cmar.s377710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 08/23/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Haider Ali Malakzai
- Department of Pathology and Clinical Laboratory, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan
| | - Ahmed Maseh Haidary
- Department of Pathology and Clinical Laboratory, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan
| | - Saleema Gulzar
- School of Nursing and Midwifery, Aga Khan University (AKU), Karachi, Pakistan
| | - Mujtaba Haidari
- Department of Pathology and Clinical Laboratory, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan
| | | | - Ramin Saadaat
- Department of Pathology and Clinical Laboratory, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan
| | - Ahmadullah Hakimi
- Department of Pathology and Clinical Laboratory, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan
| | - Sayed Murtaza Sadat Hofiani
- Department of Academics and Research, Postgraduate Medical Education (PGME), French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan
| | - Soma Rahmani
- World Health Organization (WHO), United Nations Office for the Coordination of Humanitarian and Economic Assistance Programmes Relating to Afghanistan (UNOCA) Compound, Kabul, Afghanistan
| | - Jamshid Abdul-Ghafar
- Department of Pathology and Clinical Laboratory, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan
- Correspondence: Jamshid Abdul-Ghafar, Tel +93 792827287, Email
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Acuti Martellucci C, Delsoz M, Qaderi S, Madadi S, Bhandari D, Ozaki A, Mousavi SH. Delay in Diagnosis of Cervical Cancer in Afghanistan: A Pilot Cross-Sectional Survey. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:783271. [PMID: 36303966 PMCID: PMC9580783 DOI: 10.3389/frph.2021.783271] [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: 09/25/2021] [Accepted: 11/19/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: The present study aimed to investigate the potential delays in healthcare seeking and diagnosis of women with cervical cancer (CC) in Afghanistan. Methods: Clinical records of three hospitals in Kabul were searched for CC cases, and the women identified were interviewed by a trained physician using a semi-structured questionnaire. The main outcomes were the prevalence of potential delays over 90 days (1) from symptoms onset to healthcare seeking (patient delay), and (2) from first healthcare visit to CC diagnosis (healthcare delay). Information was also collected on: type and stage of CC, diagnostic test utilized, familiarity for CC, signs and symptoms, treatment type, and potential reasons for delaying healthcare seeking. Results: 31 women with CC were identified, however only 11 continued their treatment in the study hospitals or were reachable by telephone, and accepted the interview. The mean age was 51 ± 14 years, and only 18.2% had a previous history of seeking medical care. Patient delay was seen in 90.9% of the women (95% CI: 58.7–99.8), with a median of 304 ± 183 days. Instead, healthcare delay was found in 45.4% (95% CI: 16.7–76.6), with a median of 61 ± 152 days. The main reasons for patient delays were unawareness of the seriousness of the symptoms (70.0%) and unwillingness to consult a healthcare professional (30.0%). None of the women ever underwent cervical screening or heard of the HPV vaccination. Conclusions: Given the global effort to provide quality health care to all CC patients, Afghanistan needs interventions to reduce the delays in the diagnosis of this cancer, for instance by improving all women's awareness of gynecological signs and symptoms.
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Affiliation(s)
| | - Mohammad Delsoz
- Kabul University of Medical Science, Kabul, Afghanistan
- Medical Research Center, Kateb University, Kabul, Afghanistan
| | - Shohra Qaderi
- Medical Research Center, Kateb University, Kabul, Afghanistan
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- *Correspondence: Shohra Qaderi ; orcid.org/0000-0003-4427-5121
| | - Shekiba Madadi
- Medical Research Center, Kateb University, Kabul, Afghanistan
| | | | - Akihiko Ozaki
- Medical Governance Research Institute, Tokyo, Japan
- Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Fukushima, Japan
| | - Sayed Hamid Mousavi
- Medical Research Center, Kateb University, Kabul, Afghanistan
- Afghanistan National Charity Organization for Special Diseases (ANCOSD), Kabul, Afghanistan
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Fadhil I, Alkhalawi E, Nasr R, Fouad H, Basu P, Camacho R, Alsaadoon H. National cancer control plans across the Eastern Mediterranean region: challenges and opportunities to scale-up. Lancet Oncol 2021; 22:e517-e529. [PMID: 34735820 DOI: 10.1016/s1470-2045(21)00410-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/07/2021] [Accepted: 07/12/2021] [Indexed: 12/15/2022]
Abstract
National cancer control planning is crucial for countries in the WHO Eastern Mediterranean region. This region is challenged with an increase in cancer incidence leading to substantial disease burden, premature deaths, and increasing health-care costs in most countries. Huge inequity in cancer control planning and implementation exists between and within the countries. Over half of the countries (12 [55%] of 22) have standalone comprehensive National Cancer Control Plans and six (27%) have non-communicable disease plans that include cancer. The implementation of cancer plans has common challenges related to weak governance structure, few coordination mechanisms within countries, and inadequate human and financial resources. In most countries, the plan is not costed. Yet, the majority of countries (20 [91%]) reported having fully or partially funded plans. Additionally, political instability and conflicts affecting over half of the countries in the Eastern Mediterranean region have enormously affected cancer planning and implementation, both among the affected countries and those that host large numbers of refugees. In this Policy Review, we used the WHO regional framework for action on cancer to systematically analyse the status of cancer control planning and implementation across the six domains of cancer control, from prevention to palliation. We highlight the gaps, and the opportunities for bridging these gaps, to achieve scale-up on implementation of cancer control programmes in the Eastern Mediterranean region.
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Affiliation(s)
- Ibtihal Fadhil
- The Eastern Mediterranean NCD Alliance, Kuwait City, Kuwait.
| | - Eman Alkhalawi
- Department of Family and Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Rihab Nasr
- Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, Cancer Prevention and Control Program, Naef K Basile Cancer Institute, American University of Beirut, Beirut, Lebanon
| | - Heba Fouad
- NCD Surveillance Unit, WHO, Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Partha Basu
- Early Detection, Prevention, and Infections Branch, International Agency for Research on Cancer, WHO, Lyon, France
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