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Shet T, Tambe S, Phadatare N, Panjwani P, Desai S, Sengar M, Pramesh CS. External Quality Assurance Helps Improve Infrastructure for Testing Breast Biomarkers Across a Lower- and Middle-Income Country: Our Experience With Breast Biomarker Testing in the National Cancer Grid External Quality Assurance System in India. Arch Pathol Lab Med 2024; 148:1028-1034. [PMID: 38153249 DOI: 10.5858/arpa.2023-0260-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 12/29/2023]
Abstract
CONTEXT.— Biomarkers in breast cancer need strict monitoring given their role in patient management. OBJECTIVE.— To study the impact that regular participation in the National Cancer Grid (NCG) external quality assurance (EQA) system has on concordance rates for biomarkers in breast carcinoma. DESIGN.— Tissue microarrays (TMAs) containing breast carcinomas were circulated to participating laboratories that performed immunohistochemistry for breast biomarkers. The returned TMAs were then assessed for test concordance. RESULTS.— A total of 105 laboratories participated in the estrogen receptor (ER) and progesterone receptor (PR) EQA system cycles, and 99 centers participated in the human epidermal growth factor 2 (HER2) EQA system. In the ER EQA in the first cycle only 1 laboratory had a 100% concordance rate, which improved to 59 of 77 (76.6%) and 85 of 97 (87.6%) in the fourth and fifth cycles, respectively. In the PR EQA the 100% pass rate jumped from zero to 52 of 76 (68.4%) in the fourth cycle and 86 of 97 (88.6%) in the last cycle. For HER2 EQA, the 100% pass rates were seen in 7 of 23 laboratories (30.4%) in the first cycle, 49 of 78 laboratories (62.8%) in the fourth cycle, and 48 of 94 laboratories (51.1%) in fifth cycle of EQA. Centers that participated in the NCG EQA system for a longer period often changed testing methodology, with consequent improvement in their laboratory concordance rates. An increasing trend for the use of automated platforms and of the US Food and Drug Administration-approved antibody for HER2 testing was observed. CONCLUSIONS.— Our experience demonstrates that laboratory performance improves with participation in an EQA system even in less perfect settings, and this drives the placement of more proficient practices across the country.
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Affiliation(s)
- Tanuja Shet
- From the Department of Pathology (Shet, Tambe, Phadatare, Panjwani, Desai), National Cancer Grid (Sengar, Pramesh), Tata Memorial Hospital, Mumbai, India
| | - Sonali Tambe
- From the Department of Pathology (Shet, Tambe, Phadatare, Panjwani, Desai), National Cancer Grid (Sengar, Pramesh), Tata Memorial Hospital, Mumbai, India
| | - Nitin Phadatare
- From the Department of Pathology (Shet, Tambe, Phadatare, Panjwani, Desai), National Cancer Grid (Sengar, Pramesh), Tata Memorial Hospital, Mumbai, India
| | - Poonam Panjwani
- From the Department of Pathology (Shet, Tambe, Phadatare, Panjwani, Desai), National Cancer Grid (Sengar, Pramesh), Tata Memorial Hospital, Mumbai, India
| | - Sangeeta Desai
- From the Department of Pathology (Shet, Tambe, Phadatare, Panjwani, Desai), National Cancer Grid (Sengar, Pramesh), Tata Memorial Hospital, Mumbai, India
| | - Manju Sengar
- From the Department of Pathology (Shet, Tambe, Phadatare, Panjwani, Desai), National Cancer Grid (Sengar, Pramesh), Tata Memorial Hospital, Mumbai, India
| | - C S Pramesh
- From the Department of Pathology (Shet, Tambe, Phadatare, Panjwani, Desai), National Cancer Grid (Sengar, Pramesh), Tata Memorial Hospital, Mumbai, India
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Viswanathan VS, Parmar V, Madabhushi A. Towards equitable AI in oncology. Nat Rev Clin Oncol 2024; 21:628-637. [PMID: 38849530 DOI: 10.1038/s41571-024-00909-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 06/09/2024]
Abstract
Artificial intelligence (AI) stands at the threshold of revolutionizing clinical oncology, with considerable potential to improve early cancer detection and risk assessment, and to enable more accurate personalized treatment recommendations. However, a notable imbalance exists in the distribution of the benefits of AI, which disproportionately favour those living in specific geographical locations and in specific populations. In this Perspective, we discuss the need to foster the development of equitable AI tools that are both accurate in and accessible to a diverse range of patient populations, including those in low-income to middle-income countries. We also discuss some of the challenges and potential solutions in attaining equitable AI, including addressing the historically limited representation of diverse populations in existing clinical datasets and the use of inadequate clinical validation methods. Additionally, we focus on extant sources of inequity including the type of model approach (such as deep learning, and feature engineering-based methods), the implications of dataset curation strategies, the need for rigorous validation across a variety of populations and settings, and the risk of introducing contextual bias that comes with developing tools predominantly in high-income countries.
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Affiliation(s)
| | - Vani Parmar
- Department of Breast Surgical Oncology, Punyashlok Ahilyadevi Holkar Head & Neck Cancer Institute of India, Mumbai, India
| | - Anant Madabhushi
- Department of Biomedical Engineering, Emory University and Georgia Institute of Technology, Atlanta, GA, USA.
- Atlanta Veterans Administration Medical Center, Atlanta, GA, USA.
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Dee EC, Pramesh CS, Booth CM, Rubagumya F, Mutebi M, Feliciano EJG, Eala MAB, Cerri GG, Ginsburg O, Gyawali B, Moraes FY. Growing the global cancer care system: success stories from around the world and lessons for the future. J Natl Cancer Inst 2024; 116:1193-1197. [PMID: 38663853 PMCID: PMC11308163 DOI: 10.1093/jnci/djae087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/08/2024] [Accepted: 04/14/2024] [Indexed: 08/09/2024] Open
Abstract
Despite major biomedical advancements in various realms of oncology, the benefits of these developments are not equitably distributed, particularly in underresourced settings. Although much work has described the challenges and systemic barriers in global cancer control, in this article we focus on success stories. This article describes clinical care delivered at Rwanda's Butaro Cancer Center of Excellence, the cancer research collaborations under India's National Cancer Grid, and the efforts of Latin America's Institute of Cancer of São Paulo in advancing cancer care and training. These examples highlight the potential of strategic collaborations and resource allocation strategies in improving cancer care globally. We emphasize the critical role of partnerships between physicians and allied health professionals, funders, and policy makers in enhancing access to treatment and infrastructure, advancing contextualized research and national guidelines, and establishing regional and global collaborations. We also draw attention to challenges faced in diverse global settings and outline benchmarks to measure success in the fight against cancer.
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Affiliation(s)
- Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - C S Pramesh
- National Cancer Grid and Department of Surgical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, MH, India
| | - Christopher M Booth
- Department of Oncology, Queen’s University, Kingston, ON, Canada
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, ON, Canada
| | - Fidel Rubagumya
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, ON, Canada
- Department of Oncology, Rwanda Military Hospital, Kigali, Rwanda
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University, Nairobi, Kenya
| | - Erin Jay G Feliciano
- School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
- Department of Medicine, NYC Health + Hospitals/Elmhurst, Icahn School of Medicine at Mt. Sinai, Queens, NY, USA
| | - Michelle Ann B Eala
- College of Medicine, University of the Philippines, Manila, Philippines
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Giovanni G Cerri
- Department of Radiology and Oncology, University of São Paulo Medical School, São Paulo, Brazil
| | - Ophira Ginsburg
- Center for Global Health, US National Cancer Institute, Rockville, MD, USA
| | - Bishal Gyawali
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, ON, Canada
- Departments of Oncology and Public Health Sciences, Queen’s University, Kingston, ON, Canada
| | - Fabio Ynoe Moraes
- Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, ON, Canada
- Department of Oncology, Kingston General Hospital, Queen’s University, Kingston, ON, Canada
- Latin America Cooperative Oncology Group, Porto Alegre, Brazil
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Mallafré‐Larrosa M, Chandran A, Oswal K, Kataria I, Purushotham A, Sankaranarayanan R, Swaminathan R, Rebello R, Isaac R, Kuriakose M, Sullivan R, Basu P. Improving access to cancer care among rural populations in India: Development of a validated tool for health system capacity assessment. Cancer Med 2024; 13:e7343. [PMID: 39039809 PMCID: PMC11263452 DOI: 10.1002/cam4.7343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 02/13/2024] [Accepted: 03/29/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Cancer burden in India is rapidly growing, with oral, breast, and uterine cervix being the three most commonly affected sites. It has a catastrophic epidemiological and financial impact on rural communities, the vast majority of whom are socio-economically disadvantaged. Strengthening the health system is necessary to address challenges in the access and provision of cancer services, thus improving outcomes among vulnerable populations. OBJECTIVE To develop, test, and validate a health system capacity assessment (HSCA) tool that evaluates the capacity and readiness for cancer services provision in rural India. METHODS A multi-method process was pursued to develop a cancer-specific HSCA tool. Firstly, item generation entailed both a nominal group technique (to identify the health system dimensions to capture) and a rapid review of published and gray literature (to generate items within each of the selected dimensions). Secondly, tool development included the pre-testing of questionnaires through healthcare facility visits, and item reduction through a series of in-depth interviews (IDIs) with key local stakeholders. Thirdly, tool validation was performed through expert consensus. RESULTS A three-step HSCA multi-method tool was developed comprising: (a) desk review template, investigating policies and protocols at the state level, (b) facility assessment protocol and checklist, catering to the Indian public healthcare system, and (c) IDI topic guide, targeting policymakers, healthcare workforce, and other relevant stakeholders. CONCLUSIONS The resulting HSCA tool assesses health system capacity, thus contributing to the planning and implementation of context-appropriate, sustainable, equity-focused, and integrated early detection interventions for cancer control, especially toward vulnerable populations in rural India and other low-resource settings.
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Affiliation(s)
- Meritxell Mallafré‐Larrosa
- Mailman School of Public HealthUniversity of ColumbiaNew YorkNew YorkUSA
- Faculty of Medicine and Health SciencesUniversity of BarcelonaBarcelonaSpain
- Early Detection, Prevention and Infections BranchInternational Agency for Research on Cancer/World Health Organization (IARC)LyonFrance
| | - Arunah Chandran
- Early Detection, Prevention and Infections BranchInternational Agency for Research on Cancer/World Health Organization (IARC)LyonFrance
| | | | - Ishu Kataria
- Center for Global Noncommunicable DiseasesRTI InternationalNew DelhiIndia
| | - Arnie Purushotham
- Institute of Cancer PolicyGlobal Oncology Group Kings College LondonLondonUK
| | | | | | - Rohit Rebello
- Department of Medical OncologyGBH Group of HospitalUdaipurRajasthanIndia
| | | | | | - Richard Sullivan
- Institute of Cancer PolicyGlobal Oncology Group Kings College LondonLondonUK
| | - Partha Basu
- Early Detection, Prevention and Infections BranchInternational Agency for Research on Cancer/World Health Organization (IARC)LyonFrance
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Singh A, Sullivan R, Bavaskar M, Shetty R, Joshi P, Nair S, Gupta S, Chaturvedi P, Badwe R. A prospective health economic evaluation to determine the productivity loss due to premature mortality from oral cancer in India. Head Neck 2024; 46:1263-1269. [PMID: 38622958 DOI: 10.1002/hed.27776] [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: 12/08/2023] [Revised: 03/05/2024] [Accepted: 04/08/2024] [Indexed: 04/17/2024] Open
Abstract
INTRODUCTION India contributes two-thirds of the global mortality due to oral cancer and has a younger population at risk. The societal costs of this premature mortality are barely discussed. METHODS Using the human capital approach, we aimed to estimate the productivity lost due to premature mortality, valued using individual socioeconomic data, related to oral cancer in India. A bottom-up approach was used to prospectively collect data of 100 consecutive patients with oral cancer treated between 2019 and 2020, with a follow-up of 36 months. RESULTS The disease-specific survival for early and advanced stage was 85% and 70%, with a median age of 47 years. With 671 years lost prematurely, the loss of productivity was $41 900/early and $96 044/advanced stage. Based on population level rates, the total cost of premature mortality was $5.6 billion, representing 0.18% of GDP. CONCLUSION India needs to implement tailored strategies to reduce the economic burden from premature mortality.
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Affiliation(s)
- Arjun Singh
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | | | - Manasi Bavaskar
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Rathan Shetty
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Poonam Joshi
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sudhir Nair
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sudeep Gupta
- Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Pankaj Chaturvedi
- Department of Head and Neck Surgery, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Rajendra Badwe
- Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Mumbai, India
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Pandey M, Bramhankar M, Anand A. Exploring the financial burden due to additional mobility among cancer patients: A cross-sectional study based on National Sample Survey. J Cancer Policy 2024; 39:100469. [PMID: 38278353 DOI: 10.1016/j.jcpo.2024.100469] [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: 10/11/2023] [Revised: 12/04/2023] [Accepted: 01/22/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Cancer imposes a substantial economic burden due to treatment costs, supportive care, and loss of productivity. Besides all the affecting factors, major concerns lead to significant financial burdens of cancer treatment, bringing unwanted huge unbearable direct and indirect treatment costs. The aim was to explore the nature of additional mobility/travel required for accessing health care for cancer patients and also to assess financial burden due to additional mobility/travel costs for cancer treatment. METHODS This study employed unit-level cross-sectional data from the 75th round (2017-18) of India's National Sample Survey (NSS). The primary analysis commenced with descriptive and bivariate analyses to explore mean health spending and out-of-pocket expenses. Subsequently, multivariable logistic regression models were utilized to estimate the associations between catastrophic health expenditure, distress financing, and the treatment location. RESULTS The findings highlight distinct healthcare utilization patterns: inpatient treatments predominantly occur within the same district (50.4 %), followed by a different district (38.8 %), and a smaller share in other states (10.8 %). Outpatients largely receive treatment in the same district (65.5 %), followed by a different district (26.8 %), and around 8 % percent in other states. Urban areas show higher inpatient visits within the same district (41.8 %) and different districts (33.5 %). Outpatients, particularly those seeking treatment in other states, experience higher total expenditures, notably with higher out-of-pocket expenses. Distress financing is more common among inpatients (20.6 %) and combined inpatient/outpatient cases (23.9 %), while outpatients exhibit a lower rate (6.8 %). CONCLUSION The findings collectively suggest the importance of developing local healthcare infrastructures to reduce the additional mobility of cancer patients. The policy should focus to train and deploy oncologists in non-urban areas can help bridge the gap in cancer care proficiency and reduce the need for patients to travel long distances for treatment.
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Affiliation(s)
- Mohit Pandey
- International Institute for Population Sciences, India
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Vinod SK, Merie R, Harden S. Quality of Decision Making in Radiation Oncology. Clin Oncol (R Coll Radiol) 2024:S0936-6555(24)00067-0. [PMID: 38342658 DOI: 10.1016/j.clon.2024.02.001] [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: 11/09/2023] [Revised: 01/04/2024] [Accepted: 02/01/2024] [Indexed: 02/13/2024]
Abstract
High-quality decision making in radiation oncology requires the careful consideration of multiple factors. In addition to the evidence-based indications for curative or palliative radiotherapy, this article explores how, in routine clinical practice, we also need to account for many other factors when making high-quality decisions. Foremost are patient-related factors, including preference, and the complex interplay between age, frailty and comorbidities, especially with an ageing cancer population. Whilst clinical practice guidelines inform our decisions, we need to account for their applicability in different patient groups and different resource settings. With particular reference to curative-intent radiotherapy, we explore decisions regarding dose fractionation schedules, use of newer radiotherapy technologies and multimodality treatment considerations that contribute to personalised patient-centred care.
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Affiliation(s)
- S K Vinod
- Cancer Therapy Centre, Liverpool Hospital, South Western Sydney Local Health District, Liverpool, NSW, Australia; South West Sydney Clinical Campuses, School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia.
| | - R Merie
- Icon Cancer Centre, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - S Harden
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Chintapally N, Nuwayhid M, Arroju V, Muddu VK, Gao P, Reddy BY, Sunkavalli C. State of cancer care in India and opportunities for innovation. Future Oncol 2023; 19:2593-2606. [PMID: 37675499 DOI: 10.2217/fon-2023-0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
Cancer is one of the leading causes of morbidity and mortality in India. Despite recent medical and technological advances, the cancer burden in India remains high and continues to rise. Moreover, substantial regional disparities in cancer incidence and access to essential medical resources exist throughout the country. While innovative and effective cancer therapies hold promise for improving patient outcomes, several barriers hinder their development and utilization in India. Here we provide an overview of these barriers, including challenges related to patient awareness, inadequate infrastructure, scarcity of trained oncology professionals, and the high cost of cancer care. Furthermore, we discuss the limited availability of cancer clinical trials in the country, along with an examination of potential avenues to enhance cancer care in India. By confronting these hurdles head-on and implementing innovative, pragmatic solutions, we take an indispensable step toward a future where every cancer patient in the country can access quality care.
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Affiliation(s)
- Neha Chintapally
- Pi Health USA, Cambridge, MA, USA
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | | | | | - Vamshi K Muddu
- Asian Institute of Gastroenterology (AIG) Hospitals, Hyderabad, Telangana, India
| | - Peng Gao
- Pi Health USA, Cambridge, MA, USA
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Dee EC, Eala MAB, Robredo JPG, Ramiah D, Hubbard A, Ho FDV, Sullivan R, Aggarwal A, Booth CM, Legaspi GD, Nguyen PL, Pramesh CS, Grover S. Leveraging national and global political determinants of health to promote equity in cancer care. J Natl Cancer Inst 2023; 115:1157-1163. [PMID: 37402623 PMCID: PMC10560599 DOI: 10.1093/jnci/djad123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/26/2023] [Accepted: 06/22/2023] [Indexed: 07/06/2023] Open
Abstract
Health and politics are deeply intertwined. In the context of national and global cancer care delivery, political forces-the political determinants of health-influence every level of the cancer care continuum. We explore the "3-I" framework, which structures the upstream political forces that affect policy choices in the context of actors' interests, ideas, and institutions, to examine how political determinants of health underlie cancer disparities. Borrowing from the work of PA Hall, M-P Pomey, CJ Ho, and other thinkers, interests are the agendas of individuals and groups in power. Ideas represent beliefs or knowledge about what is or what should be. Institutions define the rules of play. We provide examples from around the world: Political interests have helped fuel the establishment of cancer centers in India and have galvanized the 2022 Cancer Moonshot in the United States. The politics of ideas underlie global disparities in cancer clinical trials-that is, in the distribution of epistemic power. Finally, historical institutions have helped perpetuate disparities related to racist and colonialist legacies. Present institutions have also been used to improve access for those in greatest need, as exemplified by the Butaro Cancer Center of Excellence in Rwanda. In providing these global examples, we demonstrate how interests, ideas, and institutions influence access to cancer care across the breadth of the cancer continuum. We argue that these forces can be leveraged to promote cancer care equity nationally and globally.
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Affiliation(s)
- Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Michelle Ann B Eala
- College of Medicine, University of the Philippines, Manila, Philippines
- Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Janine Patricia G Robredo
- School of Medicine and Public Health, Ateneo de Manila University, Pasig City, Philippines
- Blavatnik Institute of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Duvern Ramiah
- Division of Radiation Oncology, University of the Witwatersrand, Johannesburg and Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - Anne Hubbard
- American Society for Radiation Oncology, Arlington, VA, USA
| | | | - Richard Sullivan
- Kings Health Partners Comprehensive Cancer Centre, King's College London, Institute of Cancer Policy, London, UK
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Clinical Effectiveness Unit, Institute of Cancer Policy, King’s College London, London, UK
| | - Christopher M Booth
- Department of Oncology, Queen’s University, Kingston, ON, Canada
- Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, ON, Canada
| | - Gerardo D Legaspi
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Harvard Cancer Center, Boston, MA, USA
| | - C S Pramesh
- Tata Memorial Hospital, Thoracic Surgery (Surgical Oncology) at Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
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Ranganathan S, Tomar V, Chino F, Jain B, Patel TA, Dee EC, Mathew A. A burden shared: the financial, psychological, and health-related consequences borne by family members and caregivers of people with cancer in India. Support Care Cancer 2023; 31:420. [PMID: 37354234 DOI: 10.1007/s00520-023-07886-1] [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: 02/12/2023] [Accepted: 06/13/2023] [Indexed: 06/26/2023]
Abstract
In India, approximately 1.4 million new cases of cancer are recorded annually, with 26.7 million people living with cancer in 2021. Providing care for family members with cancer impacts caregivers' health and financial resources. Effects on caregivers' health and financial resources, understood as family and caregiver "financial toxicity" of cancer, are important to explore in the Indian context, where family members often serve as caregivers, in light of cultural attitudes towards family. This is reinforced by other structural issues such as grave disparities in socioeconomic status, barriers in access to care, and limited access to supportive care services for many patients. Effects on family caregivers' financial resources are particularly prevalent in India given the increased dependency on out-of-pocket financing for healthcare, disparate access to insurance coverage, and limitations in public expenditure on healthcare. In this paper, we explore family and caregiver financial toxicity of cancer in the Indian context, highlighting the multiple psychosocial aspects through which these factors may play out. We suggest steps forward, including future directions in (1) health services research, (2) community-level interventions, and (3) policy changes. We underscore that multidisciplinary and multi-sectoral efforts are needed to study and address family and caregiver financial toxicity in India.
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Affiliation(s)
| | | | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiation Oncology and Affordability Working Group, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bhav Jain
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Tej A Patel
- University of Pennsylvania, Philadelphia, PA, USA
| | - Edward Christopher Dee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Aju Mathew
- Department of Oncology, MOSC Medical College, Ernakulam, Kerala, 682311, India
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Lin LL, Msadabwe SC, Chiao E. Improving Access to Radiation Therapy Globally To Meet World Health Organization Goals To Eliminate Cervical Cancer. Int J Radiat Oncol Biol Phys 2023; 116:459-462. [PMID: 37179093 PMCID: PMC10172026 DOI: 10.1016/j.ijrobp.2022.12.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/05/2022] [Accepted: 12/17/2022] [Indexed: 05/15/2023]
Affiliation(s)
- Lilie L Lin
- Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas, Houston, Texas.
| | | | - Elizabeth Chiao
- Departments of Epidemiology and General Oncology, MD Anderson Cancer Center, University of Texas, Houston, Texas
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12
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Mungle T, Das N, Pal S, Gogoi MP, Das P, Ghara N, Ghosh D, Arora RS, Bhakta N, Saha V, Krishnan S. Comparative treatment costs of risk-stratified therapy for childhood acute lymphoblastic leukemia in India. Cancer Med 2023; 12:3499-3508. [PMID: 36812120 PMCID: PMC9939102 DOI: 10.1002/cam4.5140] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 07/25/2022] [Accepted: 08/02/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND To evaluate the treatment cost and cost effectiveness of a risk-stratified therapy to treat pediatric acute lymphoblastic leukemia (ALL) in India. METHODS The cost of total treatment duration was calculated for a retrospective cohort of ALL children treated at a tertiary care facility. Children were risk stratified into standard (SR), intermediate (IR) and high (HR) for B-cell precursor ALL, and T-ALL. Cost of therapy was obtained from the hospital electronic billing systems and details of outpatient (OP) and inpatient (IP) from electronic medical records. Cost effectiveness was calculated in disability-adjusted life years. RESULTS One hundred and forty five patients, SR (50), IR (36), HR (39), and T-ALL (20) were analyzed. Median cost of the entire treatment for SR, IR, HR, and T-ALL was found to be $3900, $5500, $7400, and $8700, respectively, with chemotherapy contributing to 25%-35% of total cost. Out-patient costs were significantly lower for SR (p < 0.0001). OP costs were higher than in-patient costs for SR and IR, while in-patient costs were higher in T-ALL. Costs for non-therapy admissions were significantly higher in HR and T-ALL (p < 0.0001), representing over 50% of costs of in-patient therapy. HR and T-ALL also had longer durations of non-therapy admissions. Based on WHO-CHOICE guidelines, the risk-stratified approach was very cost effective for all categories of patients. CONCLUSIONS Risk-stratified approach to treat childhood ALL is very cost-effective for all categories in our setting. The cost for SR and IR patients is significantly reduced through decreased IP admissions for both, chemotherapy and non-chemotherapy reasons.
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Affiliation(s)
- Tushar Mungle
- Clinical Research UnitTata Translational Cancer Research Centre, Tata Medical CenterKolkataIndia
| | - Nandana Das
- Clinical Research UnitTata Translational Cancer Research Centre, Tata Medical CenterKolkataIndia
| | - Saikat Pal
- Tata Consultancy ServicesTata Translational Cancer Research Centre, Tata Medical CenterKolkataIndia
| | - Manash Pratim Gogoi
- Clinical Research UnitTata Translational Cancer Research Centre, Tata Medical CenterKolkataIndia
| | - Parag Das
- Clinical Research UnitTata Translational Cancer Research Centre, Tata Medical CenterKolkataIndia
| | - Niharendu Ghara
- Department of Paediatric Haematology and OncologyTata Medical CenterKolkataIndia
| | - Debjani Ghosh
- Department of Paediatric Haematology and OncologyTata Medical CenterKolkataIndia
| | | | - Nickhill Bhakta
- Department of Global Pediatric MedicineSt Jude Children's Research HospitalMemphisTennesseeUSA
| | - Vaskar Saha
- Clinical Research UnitTata Translational Cancer Research Centre, Tata Medical CenterKolkataIndia
- Department of Paediatric Haematology and OncologyTata Medical CenterKolkataIndia
- Division of Cancer Sciences, Faculty of Biology, Medicine and HealthSchool of Medical Sciences, University of ManchesterManchesterUK
| | - Shekhar Krishnan
- Clinical Research UnitTata Translational Cancer Research Centre, Tata Medical CenterKolkataIndia
- Department of Paediatric Haematology and OncologyTata Medical CenterKolkataIndia
- Division of Cancer Sciences, Faculty of Biology, Medicine and HealthSchool of Medical Sciences, University of ManchesterManchesterUK
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13
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Prabaharan S, Bilimagga RS, Gopinath KS. Evolution of Cancer Care in Karnataka. Indian J Surg Oncol 2022; 13:44-46. [PMID: 36691515 PMCID: PMC9859951 DOI: 10.1007/s13193-022-01587-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/10/2022] [Indexed: 01/26/2023] Open
Abstract
Cancer care in Karnataka started in the nineteenth century with the foundation stone of Victoria Hospital in Bangalore. After that the regional cancer center Kidwai in Bangalore and now almost 44 AERB-approved Radiotherapy centers available all over Karnataka. Karnataka, especially Bangalore, have all the high-end cutting-edge technology for cancer care from robotic surgery, Tomotherapy, and CyberKnife Radiosurgery. With initiatives from the government, in all the medical colleges and private hospitals, poor patients are getting higher-end cancer treatment for free under the Ayushman Bharath scheme. We wish cancer care in Karnataka sees more and more new technologies and treatment to conquer the disease, which human battling for centuries.
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Affiliation(s)
| | | | - K. S. Gopinath
- Surgical Oncology Department, HealthCare Global, Bangalore, India
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14
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Telemedicine and cancer care in India: promises, opportunities and caveats. Future Sci OA 2022; 8:FSO821. [PMID: 36788987 PMCID: PMC9912275 DOI: 10.2144/fsoa-2022-0001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 12/06/2022] [Indexed: 01/11/2023] Open
Abstract
Telemedicine has revolutionized areas of medical practice and care. It has a potential in field of continuum of cancer care in India. SARS-CoV-2 has highlighted the potential use of this tool effectively. Scope of newer applications of telemedicine in field of cancer is reviewed in current paper enlisting benefits to patient, healthcare providers and centers in a developing country like India. Each of them is supported by appropriate evidence and examples. An analysis of strengths and opportunities when compared with weakness and threats brings out how telemedicine can redistribute oncology work force in a rational way and minimize disruption caused by the pandemic. Telemedicine can be utilized in cancer management starting from prevention, screening, diagnosis, treatment and rehabilitation to palliative care.
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15
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Joad ASK, Hota A, Agarwal P, Patel K, Patel K, Puri J, Shin S. “I want to live, but …” the desire to live and its physical, psychological, spiritual, and social factors among advanced cancer patients: evidence from the APPROACH study in India. BMC Palliat Care 2022; 21:153. [PMID: 36045352 PMCID: PMC9429624 DOI: 10.1186/s12904-022-01041-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 08/22/2022] [Indexed: 12/24/2022] Open
Abstract
Abstract
Background
The limited access to palliative care resources along with the social stigma around cancer largely explains the poor quality of life (QoL) of Indian advanced cancer patients. As advanced cancer patients with poor QoL often harbour a desire for hastened death (DHD), it is imperative to understand factors affecting DHD, or the desire to live (DTL) among advanced cancer patients in India. We aim to examine the relationship between DTL and physical, psychological, spiritual, and social factors measuring patients’ QoL alongside their awareness of their late cancer stage.
Methods
We surveyed 200 patients from a tertiary cancer hospital in India to collect their DTL, awareness of cancer stage, demographic characteristics, and standardized measures for patients’ QoL. We used a linear probability regression model to quantify the association between these factors and patients’ DTL among the final sample of 192 patients with no missing information for the variables of interest.
Results
Among the various domains affecting cancer patients’ QoL, we found that the pain severity score (ranging from 0 to 10) and psychological distress score (ranging from 0 to 42) are negatively associated with the DTL. One point increase in each score reduced the DTL by 2.2% (p < 0.05) and 0.7% (p < 0.05), respectively. Our results also showed that patients whose perceived socio-economic status (SES) is poor have a 16% (p < 0.05) lower probability of DTL, compared to those with higher SES (lower middle class, upper middle class, and wealthy). Controlling for caste, religion, gender, age, marital status and years of education, we found psychological distress is statistically higher among patients belonging to this bottom SES.
Conclusions
We found that pain severity, psychological distress and perceived low SES are negatively associated with the desire to live in advanced cancer patients. Future research should focus on developing interventions to improve physical pain and psychological distress, particularly for patients who are socially and economically disadvantaged.
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16
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Jiwnani S, Penumadu P, Ashok A, Pramesh CS. Lung Cancer Management in Low and Middle-Income Countries. Thorac Surg Clin 2022; 32:383-395. [PMID: 35961746 DOI: 10.1016/j.thorsurg.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Lung cancer is an increasing problem in the developing world due to rising trends in smoking, high incidence of air pollution, lack of awareness and screening, delayed presentation, and diagnosis at the advanced stage. Even after diagnosis, there are disparities in access to health care facilities and inequitable distribution of resources and treatment options. In addition, the shortage of trained personnel and infrastructure adds to the challenges faced by patients with lung cancer in these regions. A multi-pronged effort targeting tobacco cessation, health promotion and awareness, capacity building, and value-based care are the need of the hour.
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Affiliation(s)
- Sabita Jiwnani
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, India.
| | - Prasanth Penumadu
- Department of Surgical Oncology, Jawaharlal Institute of Medical Education and Research, JIPMER, 5343, 3rd Floor, SSB, Gorimedu, Pondicherry 605006, India
| | - Apurva Ashok
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Tata Memorial Hospital, 3rd Floor, Dr. E. Borges Road, Parel, Mumbai 400012, India
| | - C S Pramesh
- Division of Thoracic Surgery, Department of Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Tata Memorial Hospital, Main Building, Ground Floor, Dr. E. Borges Road, Parel, Mumbai 400012, India
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17
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Sengar M, Pramesh CS, Mehndiratta A, Shah S, Munshi A, Vijaykumar DK, Puri A, Mathew B, Arora RS, Kumari T P, Deodhar K, Menon S, Epari S, Shetty O, Cluzeau F. Ensuring quality in contextualised cancer management guidelines for resource-constraint settings: using a systematic approach. BMJ Glob Health 2022; 7:bmjgh-2022-009584. [PMID: 35985695 PMCID: PMC9396157 DOI: 10.1136/bmjgh-2022-009584] [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: 05/10/2022] [Accepted: 07/16/2022] [Indexed: 11/03/2022] Open
Abstract
To address the wide variation in access to cancer care in India requires strengthening of infrastructure, trained oncology workforce, and minimisation of out-of-pocket expenditures. However, even with major investments, it is unlikely to achieve the same level of infrastructure and expertise across the country. Therefore, a resource stratified approach driven by evidence-based and contextualised clinical guidelines is the need of the hour. The National Cancer Grid has been at the forefront of delivery of standardised cancer care through several of its initiatives, including the resource-stratified guidelines. Development of new guidelines is resource and time intensive, which may not be feasible and can delay the implementation. Adaptation of the existing standard guidelines using the transparent and well-documented methodology with involvement of all stakeholders can be one of the most reasonable pathways. However, the adaptation should be done keeping in mind the context, resource availability, budget impact, investment needed for implementation and acceptability by clinicians, patients, policymakers, and other stakeholders. The present paper provides the framework for systematically developing guidelines through adaptation and contextualisation. The process can be used for other health conditions in resource-constraint settings.
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Affiliation(s)
- Manju Sengar
- Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - C S Pramesh
- Tata Memorial Centre, Mumbai, India .,Homi Bhabha National Institute, Mumbai, India
| | | | - Sudeep Shah
- P.D. Hinduja Hospital and Medical Research Centre, Mumbai, India
| | | | - D K Vijaykumar
- Amrita Institute of Medical Sciences, Cochin, Kerala, India
| | - Ajay Puri
- Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Beela Mathew
- Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Ramandeep Singh Arora
- Max Institute of Cancer Care, Max Super Speciality Hospital, New Delhi, New Delhi, India
| | - Priya Kumari T
- Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Kedar Deodhar
- Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Santosh Menon
- Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Sridhar Epari
- Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
| | - Omshree Shetty
- Tata Memorial Centre, Mumbai, India.,Homi Bhabha National Institute, Mumbai, India
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18
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Maitre P, Krishnatry R, Chopra S, Gondhowiardjo S, Likonda BM, Hussain QM, Zubizarreta EH, Agarwal JP. Modern Radiotherapy Technology: Obstacles and Opportunities to Access in Low- and Middle-Income Countries. JCO Glob Oncol 2022; 8:e2100376. [PMID: 35839434 PMCID: PMC9812473 DOI: 10.1200/go.21.00376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Low- and middle-income countries (LMICs) have a large burden of cancer with differential population needs and outcomes compared to high-income countries. Access to radiotherapy, especially modern technology, is a major challenge. Modern radiotherapy has been demonstrated with better utility in overall cancer outcomes. We deliberate various challenges and opportunities unique to LMICs' set up for access to modern radiotherapy technology in the light of discussions and deliberations made during the recently concluded annual meeting of Tata Memorial Centre, India. We take examples available from various LMICs in this direction in our manuscript.
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Affiliation(s)
- Priyamvada Maitre
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India,Homi Bhabha National Institute, Mumbai, India
| | - Rahul Krishnatry
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India,Homi Bhabha National Institute, Mumbai, India,Rahul Krishnatry, MD, Department of Radiation Oncology, Tata Memorial Hospital, Ernst Borges Rd, Parel, Mumbai 400012, India; e-mail:
| | - Supriya Chopra
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India,Homi Bhabha National Institute, Mumbai, India
| | - Soehartati Gondhowiardjo
- Department of Radiation Oncology, Faculty of Medicine of Indonesia,Dr Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Beda Mnamala Likonda
- Bugando Medical Centre, Catholic University of Health Sciences, Nyamagana, Mwanza, Tanzania
| | | | - Eduardo H. Zubizarreta
- Applied Radiation Biology and Radiotherapy Section, International Atomic Energy Agency, Vienna, Austria
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India,Homi Bhabha National Institute, Mumbai, India
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19
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Rao SR, Salins N, Goh CR, Bhatnagar S. “Building palliative care capacity in cancer treatment centres: a participatory action research”. Palliat Care 2022; 21:101. [PMID: 35659229 PMCID: PMC9166521 DOI: 10.1186/s12904-022-00989-2] [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: 02/17/2022] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
There is a significant lack of palliative care access and service delivery in the Indian cancer institutes. In this paper, we describe the development, implementation, and evaluation of a palliative care capacity-building program in Indian cancer institutes.
Methods
Participatory action research method was used to develop, implement and evaluate the outcomes of the palliative care capacity-building program. Participants were healthcare practitioners from various cancer institutes in India. Training and education in palliative care, infrastructure for palliative care provision, and opioid availability were identified as key requisites for capacity-building. Researchers developed interventions towards capacity building, which were modified and further developed after each cycle of the capacity-building program. Qualitative content analysis was used to develop an action plan to build capacity. Descriptive statistics were used to measure the outcomes of the action plan.
Results
Seventy-three healthcare practitioners from 31 cancer treatment centres in India were purposively recruited between 2016 and 2020. The outcome indicators of the project were defined a priori, and were audited by an independent auditor. The three cycles of the program resulted in the development of palliative care services in 23 of the 31 institutes enrolled in the program. Stand-alone palliative care outpatient services were established in all the 23 centres, with the required infrastructure and manpower being provided by the organization. Morphine availability improved and use increased in these centres, which was an indication of improved pain management skills among the participants. The initiation and continuation of education, training, and advocacy activities in 20 centres suggested that healthcare providers continued to remain engaged with the program even after the cessation of their training cycle.
Conclusion
This program illustrates how a transformational change at the organizational and individual level can lead to the development of sustained provision of palliative care services in cancer institutes.
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20
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Pramesh CS, Badwe RA, Bhoo-Pathy N, Booth CM, Chinnaswamy G, Dare AJ, de Andrade VP, Hunter DJ, Gopal S, Gospodarowicz M, Gunasekera S, Ilbawi A, Kapambwe S, Kingham P, Kutluk T, Lamichhane N, Mutebi M, Orem J, Parham G, Ranganathan P, Sengar M, Sullivan R, Swaminathan S, Tannock IF, Tomar V, Vanderpuye V, Varghese C, Weiderpass E. Priorities for cancer research in low- and middle-income countries: a global perspective. Nat Med 2022; 28:649-657. [PMID: 35440716 PMCID: PMC9108683 DOI: 10.1038/s41591-022-01738-x] [Citation(s) in RCA: 101] [Impact Index Per Article: 50.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/09/2022] [Indexed: 01/22/2023]
Abstract
Cancer research currently is heavily skewed toward high-income countries (HICs), with little research conducted in, and relevant to, the problems of low- and middle-income countries (LMICs). This regional discordance in cancer knowledge generation and application needs to be rebalanced. Several gaps in the research enterprise of LMICs need to be addressed to promote regionally relevant research, and radical rethinking is needed to address the burning issues in cancer care in these regions. We identified five top priorities in cancer research in LMICs based on current and projected needs: reducing the burden of patients with advanced disease; improving access and affordability, and outcomes of cancer treatment; value-based care and health economics; quality improvement and implementation research; and leveraging technology to improve cancer control. LMICs have an excellent opportunity to address important questions in cancer research that could impact cancer control globally. Success will require collaboration and commitment from governments, policy makers, funding agencies, health care organizations and leaders, researchers and the public.
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Affiliation(s)
- C S Pramesh
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
| | - Rajendra A Badwe
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Nirmala Bhoo-Pathy
- Centre for Epidemiology and Evidence-Based Practice, University of Malaya, Kuala Lumpur, Malaysia
| | - Christopher M Booth
- Departments of Oncology and Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | | | - Anna J Dare
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - David J Hunter
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Satish Gopal
- Centre for Global Health, National Cancer Institute, Rockville, MD, USA
| | - Mary Gospodarowicz
- Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Peter Kingham
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tezer Kutluk
- Faculty of Medicine and Cancer Institute, Hacettepe University, Ankara, Turkey
| | | | | | | | | | | | - Manju Sengar
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | | | | | - Ian F Tannock
- Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario, Canada
| | | | - Verna Vanderpuye
- National Center for Radiotherapy Oncology and Nuclear Medicine and Korle Bu Teaching Hospital, Accra, Ghana
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21
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Aggarwal A, Lievens Y, Sullivan R, Nolte E. What Really Matters for Cancer Care – Health Systems Strengthening or Technological Innovation? Clin Oncol (R Coll Radiol) 2022; 34:430-435. [DOI: 10.1016/j.clon.2022.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/29/2022] [Accepted: 02/15/2022] [Indexed: 12/24/2022]
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22
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Vallath N, Salins N, Ghoshal A, Daniel SM, Damani A, Rajagopal MR, Rewati RR, Bhatnagar S, Pramesh CS. Developing a Screening Tool for Serious Health-related Suffering for Low- and Middle-Income Countries – Phase-1: Domain Identification and Item Generation. Indian J Palliat Care 2022; 28:51-63. [PMID: 35673368 PMCID: PMC9165456 DOI: 10.25259/ijpc_25_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/30/2021] [Indexed: 12/01/2022] Open
Abstract
Objectives: The Lancet Commission on Global Access to Palliative Care and Pain Relief reported significant levels of health-related suffering globally, with the highest incidence in the low- and middle-income countries. The report describes suffering as health-related when it is associated with illness or injury of any kind and suffering as serious when it cannot be relieved without professional intervention and when it compromises physical, social, spiritual, and/or emotional functioning. This paper describes the preliminary development phase of a tool for screening Serious Health-related Suffering (SHS) at individual patient level, suitable to the healthcare settings in India. The study was conducted by the National Cancer Grid-India, with support from the Indian Association of Palliative Care. Materials and Methods: Domain identification and item generation were conducted according to the recommendations for tool development by the American Psychological Association and World Health Organisation quality of life instrument. The consensus for domain questions and associated items was achieved using Delphi, nominal group technique, expert review, and polling. Results: The Phase-1 study for developing the screening tool for SHS contextualised to resource-limited settings generated a bilevel questionnaire. The initial level assesses and scores the physical, emotional, social, spiritual, and financial domains of health-related suffering. The next level assesses seriousness, through functional limitation and patient’s preference. Conclusion: The generation of domains, items, and screening questions for health-related suffering and its seriousness completes the preliminary phase of developing the SHS screening tool applicable to a resource-limited healthcare setting. Field testing of the tool is being conducted as Phase-2 of this study, to validate it in clinical settings.
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Affiliation(s)
- Nandini Vallath
- Division of Palliative Care, National Cancer Grid, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India,
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Udupi, India,
| | - Arunangshu Ghoshal
- Department of Palliative Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India,
| | - Sunitha M. Daniel
- Department Palliative Medicine, Ernakulam General Hospital, Kochi, Kerala, India,
| | - Anuja Damani
- Department of Palliative Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India,
| | - M. R. Rajagopal
- Trivandrum Institute of Palliative Sciences, Thiruvananthapuram, Kerala, India,
| | - Rahul Raman Rewati
- Palliative Care Division, Tata Trusts Cancer Care Program, Alamelu Charitable Foundation, Mumbai, Maharashtra, India,
| | - Sushma Bhatnagar
- Department of Oncoanaesthesia and Palliative Medicine, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India,
| | - C. S. Pramesh
- Director, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India,
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Nethan S, Cherian M, Brain E, Ganguli A, Tullu F, Musolino N, Hariprasad R, Sullivan R, Mehrotra R. Cancer in the older Indian population: Understanding the current context in an emerging economy. J Geriatr Oncol 2021; 13:273-281. [PMID: 34776381 DOI: 10.1016/j.jgo.2021.10.013] [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: 01/21/2021] [Revised: 08/30/2021] [Accepted: 10/25/2021] [Indexed: 10/19/2022]
Abstract
India is considered a demographically young country with over 65% of the population aged below 35 years. However, improvements in maternal and child health, and infectious diseases, have created a rapid epidemiological transition with an aging population (8.6% in 2011) with a projected increase (19% by 2050), equating to 104 million. In addition to the well-articulated issues surrounding the care of the older patients with cancer, the Indian context as an emerging economy provides additional social, political, economic and clinical challenges. This review addresses the key issues and possible solutions germane to both policymakers in India and other emerging economies. Extension of cancer prevention, equal, optimal treatment opportunities, and inclusion in clinical trials, akin to the younger population, must be encouraged. Various national health initiatives require effective implementation, to provide uniform, evidence-based, cancer care across India. Designated geriatric oncology departments, and required care at the primary healthcare level are essential.
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Affiliation(s)
- Suzanne Nethan
- Project ECHO (Extension for Community Healthcare Outcomes) - India, Building No 76 (2nd Floor), Okhla Phase III, Okhla Industrial Area, New Delhi 110020, India.
| | - Meena Cherian
- International Society of Geriatric Oncology (SIOG), International Environmental House 2, Chemin de Balexert 7-9, 1219 Chatelaine, Switzerland.
| | - Etienne Brain
- Department of Clinical Research & Medical Oncology, Institut Curie (Hôpital René Huguenin), 35 Rue Dailly, 92210 St Cloud, France.
| | - Atreyi Ganguli
- WHO India Country Office, 537, A Wing, Nirman Bhawan, Maulana Azad Road, New Delhi 110011, India.
| | - Fikru Tullu
- WHO India Country Office, 537, A Wing, Nirman Bhawan, Maulana Azad Road, New Delhi 110011, India.
| | - Najia Musolino
- International Society of Geriatric Oncology (SIOG), International Environmental House 2, Chemin de Balexert 7-9, 1219 Chatelaine, Switzerland.
| | - Roopa Hariprasad
- Division of Clinical Oncology, Indian Council of Medical Research (ICMR), National Institute of Cancer Prevention & Research (NICPR), I-7, Sector 39, Noida 201301, Uttar Pradesh, India.
| | | | - Ravi Mehrotra
- India Cancer Research Consortium (ICMR-DHR), Ministry of Health and Family Welfare, Department of Health Research, First Floor, Indian Red Cross Society (IRCS) Building, 1, Red Cross Road, New Delhi 110001, India; Centre for Health Innovation and Policy (CHIP) Foundation, 361, Sector 15A, Noida, Uttar Pradesh 201301, India.
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Ranganathan P, Chinnaswamy G, Sengar M, Gadgil D, Thiagarajan S, Bhargava B, Booth CM, Buyse M, Chopra S, Frampton C, Gopal S, Grant N, Krailo M, Langley R, Mathur P, Paoletti X, Parmar M, Purushotham A, Pyle D, Rajaraman P, Stockler MR, Sullivan R, Swaminathan S, Tannock I, Trimble E, Badwe RA, Pramesh CS. The International Collaboration for Research methods Development in Oncology (CReDO) workshops: shaping the future of global oncology research. Lancet Oncol 2021; 22:e369-e376. [PMID: 34216541 PMCID: PMC8328959 DOI: 10.1016/s1470-2045(21)00077-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/27/2021] [Accepted: 02/04/2021] [Indexed: 02/07/2023]
Abstract
Low-income and middle-income countries (LMICs) have a disproportionately high burden of cancer and cancer mortality. The unique barriers to optimum cancer care in these regions necessitate context-specific research. The conduct of research in LMICs has several challenges, not least of which is a paucity of formal training in research methods. Building capacity by training early career researchers is essential to improve research output and cancer outcomes in LMICs. The International Collaboration for Research methods Development in Oncology (CReDO) workshop is an initiative by the Tata Memorial Centre and the National Cancer Grid of India to address gaps in research training and increase capacity in oncology research. Since 2015, there have been five CReDO workshops, which have trained more than 250 oncologists from India and other countries in clinical research methods and protocol development. Participants from all oncology and allied fields were represented at these workshops. Protocols developed included clinical trials, comparative effectiveness studies, health services research, and observational studies, and many of these protocols were particularly relevant to cancer management in LMICs. A follow-up of these participants in 2020 elicited an 88% response rate and showed that 42% of participants had made progress with their CReDO protocols, and 73% had initiated other research protocols and published papers. In this Policy Review, we describe the challenges to research in LMICs, as well as the evolution, structure, and impact of CReDO and other similar workshops on global oncology research.
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Affiliation(s)
- Priya Ranganathan
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
| | - Girish Chinnaswamy
- Division of Paediatric Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Durga Gadgil
- Research Administration Council, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Shivakumar Thiagarajan
- Department of Head and Neck Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | | | - Christopher M Booth
- Departments of Oncology and Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Marc Buyse
- International Drug Development Institute, Louvain-la-Neuve, Belgium; Data Science Institute, Hasselt University, Diepenbeek, Belgium
| | | | - Chris Frampton
- Departments of Medicine and Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Satish Gopal
- Center for Global Health, National Cancer Institute, Rockville, MD, USA
| | | | - Mark Krailo
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ruth Langley
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Prashant Mathur
- National Centre for Disease Informatics and Research, Bengaluru, India
| | - Xavier Paoletti
- University of Versailles Saint-Quentin-en-Yvelines, Versailles, France; Department of Biostatistics, Institut Curie, Saint-Cloud, France; Department of Statistics for Precision Medicine, INSERM U900, Paris, France
| | - Mahesh Parmar
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Arnie Purushotham
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Douglas Pyle
- American Society of Clinical Oncology, Alexandria, VA, USA
| | - Preetha Rajaraman
- US Department of Health and Human Services, Washington, DC, USA; US Embassy, New Delhi, India
| | - Martin R Stockler
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | | | | | - Ian Tannock
- Division of Medical Oncology, Princess Margaret Cancer Centre and University of Toronto, Toronto, ON, Canada
| | - Edward Trimble
- Office of the Director, National Cancer Institute, NIH, US Department of Health and Human Services, Washington, DC, USA
| | - Rajendra A Badwe
- Departments of Administration and Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - C S Pramesh
- Departments of Administration and Surgical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Das AV, Kaliki S. Geographic Distribution of Ocular and Periocular Tumors in India: A Report. Semin Ophthalmol 2021; 37:277-278. [PMID: 34184602 DOI: 10.1080/08820538.2021.1945637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Anthony Vipin Das
- Department of eyeSmart EMR & AEye, L V Prasad Eye Institute, Hyderabad, India
| | - Swathi Kaliki
- The Operation Eyesight Universal Institute for Eye Cancer (SK), L V Prasad Eye Institute, Hyderabad, India
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Singh AG, Chaukar D, Gupta S, Pramesh CS, Sullivan R, Chaturvedi P, Badwe R. A prospective study to determine the cost of illness for oral cancer in India. Ecancermedicalscience 2021; 15:1252. [PMID: 34267808 PMCID: PMC8241452 DOI: 10.3332/ecancer.2021.1252] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Indexed: 12/24/2022] Open
Abstract
India accounts for almost a third of the global burden of oral cancer, a situation worsened by the inability to afford care. When available, aid is often insufficient, and costing is based on informal estimations. This study objectively determines direct healthcare costs of oral cancer in India. The study was performed from a healthcare provider's perspective using a validated bottom-up method. Care pathways were determined by prospectively observing the natural management of 100 oral cancer patients treated between October 2019 and March 2020. Specific costing categories were built across services, and apportioned values for each interaction was averaged. Costs of treatment and service utilisation were obtained using probabilistic sensitivity analyses. The unit cost of treating advanced stages (United States Dollar (USD) 2,717) was found to be 42% greater than early stages (USD1,568). There was an 11% reduction in unit costs with increases in socioeconomic status. Medical equipment accounted for 97.8% of capital costs, with the highest contributor being imaging services. Variable costs for surgery in advanced stages were 1.4 times higher than early stages. Compared to surgery alone, the average cost of treatment increased by 44.6% with adjuvant therapy. These results show that over the next decade, India will incur an economic burden of USD 3 billion towards the direct healthcare of oral cancer. Early detection and prevention strategies leading to 20% reduction in advanced stage disease could save USD 30 million annually. These results are critical to deliver a disease-driven and objective reform for oral cancer care.
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Affiliation(s)
| | | | - Sudeep Gupta
- Tata Memorial Centre and HBNI, Mumbai 400012, India
| | - C S Pramesh
- Tata Memorial Centre and HBNI, Mumbai 400012, India
| | - Richard Sullivan
- Institute of Cancer Policy, Guy’s Hospital, St Thomas Street, London SE1 9RT, UK
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Srivastava A, Jalink M, de Moraes FY, Booth CM, Berry SR, Rubagumya F, Roitberg F, Sengar M, Hammad N. Tracking the Workforce 2020-2030: Making the Case for a Cancer Workforce Registry. JCO Glob Oncol 2021; 7:925-933. [PMID: 34138643 PMCID: PMC8457834 DOI: 10.1200/go.21.00093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/23/2021] [Indexed: 11/29/2022] Open
Abstract
Existing literature has described the projected increase in cancer incidence and the associated deficiencies in the cancer workforce. However, there is currently a lack of research into the necessary policy and planning steps that can be taken to mitigate this issue. Herein, we review current literature in this space and highlight the importance of implementing oncology workforce registries. We propose the establishment of cancer workforce registries using the WHO Minimum Data Set for Health Workforce Registry by adapting the data set to suit the multidisciplinary nature of the cancer workforce. The cancer workforce registry will track the trends of the workforce, so that evidence can drive decisions at the policy level. The oncology community needs to develop and optimize methods to collect information for these registries. National cancer societies are likely to continue to lead such efforts, but ministries of health, licensing bodies, and academic institutions should contribute and collaborate.
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Affiliation(s)
| | - Matthew Jalink
- Department of Oncology, Queen’s University, Kingston, ON, Canada
| | | | | | - Scott R. Berry
- Department of Oncology, Queen’s University, Kingston, ON, Canada
| | - Fidel Rubagumya
- Department of Oncology, Rwanda Military Hospital, Kigali, Rwanda
| | - Felipe Roitberg
- Department of Oncology, University of Sao Paulo, Sao Paulo, Brazil
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National University, Mumbai, India
| | - Nazik Hammad
- Department of Oncology, Queen’s University, Kingston, ON, Canada
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Shinde RS, Pandrowala S, Navalgund S, Pai E, Bhandare MS, Chaudhari VA, Sullivan R, Shrikhande SV. Centralisation of Pancreatoduodenectomy in India: Where Do We Stand? World J Surg 2021; 44:2367-2376. [PMID: 32161986 DOI: 10.1007/s00268-020-05466-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The volume-outcome relationship dictates that high-volume centres lead to improved patient outcomes after pancreatoduodenectomy (PD). We conducted a retrospective review to fathom the situation in India for PD and whether referral to high-volume centres would make a positive impact. METHOD A systematic literature search in MEDLINE was performed, and all articles published from Indian centres from 01.03.2008 to 30.11.2019 were scrutinised. Any series with less than 20 patients, case reports, abstracts, unpublished data and personal communications were excluded. RESULTS A total of 36 unique series including 6226 patients from 24 institutes across India were identified. Amongst the 24 institutes, 2 institutes reported less than 10 cases/year, 11 reported 10-25 cases/year and 11 reported ≥26 cases/year. Overall perioperative morbidity was 42.4%, 43.4% and 41% for centres doing <10, 10-25 and ≥26 cases/year, respectively. Operative mortality also improved with increasing number of cases/year (5.1% vs. 6.6% vs. 3.2%, respectively). CONCLUSION With increasing volume of cases per year, trend towards improved PD outcomes is observed. To optimise the use of healthcare facilities, it would be pragmatic to consider building an organised referral system for complex surgeries to deliver unsurpassed patient care with maximum utilisation of the available healthcare infrastructure.
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Affiliation(s)
- Rajesh S Shinde
- Gastrointestinal and Hepato-Pancreato-Biliary Service, Division of Cancer Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India
| | - Saneya Pandrowala
- Gastrointestinal and Hepato-Pancreato-Biliary Service, Division of Cancer Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India
| | - Sunil Navalgund
- Gastrointestinal and Hepato-Pancreato-Biliary Service, Division of Cancer Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India
| | - Esha Pai
- Gastrointestinal and Hepato-Pancreato-Biliary Service, Division of Cancer Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India
| | - Manish S Bhandare
- Gastrointestinal and Hepato-Pancreato-Biliary Service, Division of Cancer Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India
| | - Vikram A Chaudhari
- Gastrointestinal and Hepato-Pancreato-Biliary Service, Division of Cancer Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India
| | - Richard Sullivan
- Institute of Cancer Policy, King's College London, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Shailesh V Shrikhande
- Gastrointestinal and Hepato-Pancreato-Biliary Service, Division of Cancer Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India.
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Lorenz KA, Mickelsen J, Vallath N, Bhatnagar S, Spruyt O, Rabow M, Agar M, Dy SM, Anderson K, Deodhar J, Digamurti L, Palat G, Rayala S, Sunilkumar MM, Viswanath V, Warrier JJ, Gosh-Laskar S, Harman SM, Giannitrapani KF, Satija A, Pramesh CS, DeNatale M. The Palliative Care-Promoting Access and Improvement of the Cancer Experience (PC-PAICE) Project in India: A Multisite International Quality Improvement Collaborative. J Pain Symptom Manage 2021; 61:190-197. [PMID: 32858163 PMCID: PMC7445485 DOI: 10.1016/j.jpainsymman.2020.08.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/06/2020] [Accepted: 08/20/2020] [Indexed: 11/28/2022]
Abstract
Mentors at seven U.S. and Australian academic institutions initially partnered with seven leading Indian academic palliative care and cancer centers in 2017 to undertake a program combining remote and in-person mentorship, didactic instruction, and project-based learning in quality improvement (QI). From its inception in 2017 to 2020, the Palliative Care-Promoting Accesst and Improvement of the Cancer Experience Program conducted three cohorts for capacity building of 22 Indian palliative care and cancer programs. Indian leadership established a Mumbai QI training hub in 2019 with philanthropic support. In 2020, the project which is now named Enable Quality, Improve Patient care - India (EQuIP-India) focuses on both palliative care and cancer teams. EQuIP-India now leads ongoing Indian national collaboratives and training in QI and is integrated into India's National Cancer Grid. Palliative Care-Promoting Accesst and Improvement of the Cancer Experience demonstrates a feasible model of international collaboration and capacity building in palliative care and cancer QI. It is one of the several networked and blended learning approaches with potential for rapid scaling of evidence-based practices.
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Affiliation(s)
- Karl A Lorenz
- VA Palo Alto Healthcare System, Palo Alto, California, USA; Section of Palliative Care, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA.
| | | | - Nandini Vallath
- Division of Palliative Care, Tata Trusts Cancer Care Program, Mumbai, Maharashtra, India
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesia and Palliative Medicine, Dr B. R. Ambedkar, IRCH, AIIMS, New Delhi, India
| | - Odette Spruyt
- Western Health Network, VCCC, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Rabow
- Division of Palliative Care, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Meera Agar
- Faculty of Health, Palliative Care, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Sydney M Dy
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland, USA; Johns Hopkins School of Medicine, Lutherville, Maryland, USA; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Jayita Deodhar
- Department of Palliative Medicine, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Leela Digamurti
- Department of Palliative Care and Gynaecological Oncology, Homi Bhabha Cancer Hospital and Research Centre, Aganampudi, Visakhapatnam, Andhra Pradesh, India
| | - Gayatri Palat
- Department of Medical Oncology, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
| | - Spandana Rayala
- Department of Medical Oncology, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
| | - M M Sunilkumar
- Trivandrum Institute of Palliative Sciences, Thiruvananthapuram, Kerala, India
| | - Vidya Viswanath
- Department of Palliative Care and Gynaecological Oncology, Homi Bhabha Cancer Hospital and Research Centre, Aganampudi, Visakhapatnam, Andhra Pradesh, India
| | - Jyothi Jayan Warrier
- Department of Medical Oncology, MNJ Institute of Oncology and Regional Cancer Centre, Hyderabad, Telangana, India
| | - Sarbani Gosh-Laskar
- Division of Palliative Care, Department of Medicine, University of California, San Francisco, San Francisco, California, USA; Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Stephanie M Harman
- Section of Palliative Care, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Karleen F Giannitrapani
- VA Palo Alto Healthcare System, Palo Alto, California, USA; Section of Palliative Care, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Anchal Satija
- Department of Onco-Anaesthesia and Palliative Medicine, Dr B. R. Ambedkar, IRCH, AIIMS, New Delhi, India
| | - C S Pramesh
- Tata and the National Cancer Grid, Mumbai, India
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Chandarana MN, Pai PS. Demography and treatment pattern of patients with head and neck carcinoma presenting to a tertiary care center in India: Need for urgent decentralization of cancer care. South Asian J Cancer 2020; 9:38-42. [PMID: 31956620 PMCID: PMC6956577 DOI: 10.4103/sajc.sajc_26_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aims This study aims to report on the demographic profile and treatment pattern of head and neck cancer patients and impact of an early treatment decision on treatment. This study also aims to suggest recommendations to improve treatment compliance. Methods All new patients registered under the head and neck disease management group (DMG) over a period of 3 months at a single center were included. Their demographic details, time to treatment decision, and treatment compliance were determined. The findings were presented to head and neck DMG, and changes were implemented to patient workup with an aim to improve compliance. A reaudit was performed over a period of 3 months and results were compared. Results Two thousand two hundred and forty patients were included in the analysis. Patients with a treatment decision at 1-4 weeks stood at 28.32%, 63.88%, 80.8%, and 89.87%, respectively. Dropout rate was 26%. About 50% of patients planned for surgical intervention could be treated within the institution. After implementation of changes as recommended by DMG, 2418 patients were analyzed and findings were compared to the previous audit. The dropout rate reduced to 17.57%. The number of patients with a treatment decision at 1-4 weeks were 51.26%, 77.42%, 89.46%, and 94.31%, respectively. Conclusion Early treatment decision and referral could significantly improve patient dropout and possibly compliance to treatment. Decentralization of cancer care is urgently needed to manage the high numbers of patients presenting to tertiary care centers. Setting up of new regional cancer centers and increasing infrastructure in the existing centers should be the long-term goals.
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Affiliation(s)
- Mihir N Chandarana
- Department of General Surgery, Forth Valley Royal Hospital, Larbert, Scotland, UK
| | - Prathamesh S Pai
- Department of Head Neck Oncology, Tata Memorial Hospital, Mumbai, India
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Desai SB. Breast cancer pathology reporting in the Indian context: Need for introspection. INDIAN J PATHOL MICR 2020; 63:S3-S4. [PMID: 32108618 DOI: 10.4103/ijpm.ijpm_824_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Sangeeta B Desai
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute (HBNI), Dr. E. Borges Rd, Parel, Mumbai, Maharashtra, India
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Gheorghe A, Chalkidou K, Shamieh O, Kutluk T, Fouad F, Sultan I, Sullivan R. Economics of Pediatric Cancer in Four Eastern Mediterranean Countries: A Comparative Assessment. JCO Glob Oncol 2020; 6:1155-1170. [PMID: 32697668 PMCID: PMC7392699 DOI: 10.1200/go.20.00041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2020] [Indexed: 01/14/2023] Open
Abstract
PURPOSE Cancer is a leading cause of death among children in the Eastern Mediterranean region, where conflict and economic downturn place additional burden on the health sector. In this context, using economic evidence to inform policy decisions is crucial for maximizing health outcomes from available resources. We summarized the available evidence on the economics of pediatric cancer in Jordan, Lebanon, the occupied Palestinian territory, and Turkey. METHODS A scoping review was performed of seven academic databases and gray literature pertaining to pediatric cancer in the four jurisdictions, published between January 1, 2010, and July 17, 2019. Information was extracted and organized using an analytical framework that synthesizes economic information on four dimensions: the context of the health system, the economics of health care inputs, the economics of service provision, and the economic consequences of disease. RESULTS Most of the economic evidence available across the four jurisdictions pertains to the availability of health care inputs (ie, drugs, human resources, cancer registration data, and treatment protocols) and individual-level outcomes (either clinical or health-related quality of life). We identified little evidence on the efficiency or quality of health care inputs and of pediatric cancer services. Moreover, we identified no studies examining the cost-effectiveness of any intervention, program, or treatment protocol. Evidence on the economic consequences of pediatric cancer on families and the society at large was predominantly qualitative. CONCLUSION The available economic evidence on pediatric cancer care in the four countries is limited to resource availability and, to an extent, patient outcomes, with a substantial gap in information on drug quality, service provision efficiency, and cost-effectiveness. Links between researchers and policymakers must be strengthened if pediatric cancer spending decisions, and, ultimately, treatment outcomes, are to improve.
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Affiliation(s)
- Adrian Gheorghe
- Global Health and Development, Imperial College London, London, United Kingdom
| | - Kalipso Chalkidou
- Global Health and Development, Imperial College London, London, United Kingdom
- Center for Global Development Europe, London, United Kingdom
| | - Omar Shamieh
- Center for Palliative and Cancer Care in Conflict, Department of Palliative Care, King Hussein Cancer Center, Amman, Jordan
| | - Tezer Kutluk
- Department of Pediatric Oncology, Hacettepe University, Ankara, Turkey
| | - Fouad Fouad
- Faculty of Health Sciences, Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Iyad Sultan
- Department of Pediatric Oncology, King Hussein Cancer Center, Amman, Jordan
| | - Richard Sullivan
- Institute for Cancer Policy and Conflict & Health Research Group, King's College London, London, United Kingdom
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Vijaykumar DK, Arun S, Abraham AG, Hopman W, Robinson AG, Booth CM. Breast Cancer Care in South India: Is Practice Concordant With National Guidelines? J Glob Oncol 2020; 5:1-7. [PMID: 31260396 PMCID: PMC6613671 DOI: 10.1200/jgo.19.00052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
PURPOSE The National Cancer Grid (NCG) of India has recently published clinical practice guidelines that are relevant in the Indian context. We evaluated the extent to which breast cancer care at a teaching hospital in South India was concordant with NCG guidelines. METHODS All patients who had surgery for breast cancer at a single center from January 2014 to December 2015 were included. Demographic, pathologic, and treatment characteristics were extracted from the electronic medical record. Patients were classified as being concordant with six elements selected from the NCG guideline. The indicators related to appropriate use of sentinel lymph node (SLN) biopsy, lymph node harvest, adjuvant radiotherapy, adjuvant chemotherapy, human epidermal growth factor receptor 2 (HER2) testing, and delivery of adjuvant trastuzumab. RESULTS A total of 401 women underwent surgery for breast cancer; mean age (standard deviation) was 57 (12) years. Lymph node involvement was present in 47% (188 of 401) of the cohort; 23% (94 of 401) had T1 disease. Ninety-two percent (368 of 401) underwent radical modified mastectomy. SLN biopsy was performed in 75% (167 of 222) of eligible patients. Eighty percent (208 of 261) of patients with a positive SLN biopsy or no SLN biopsy had a lymph node harvest of more than 10. Adjuvant chemotherapy with an anthracycline and a taxane was delivered to 67% of patients (118 of 177) with node-positive disease. Adjuvant radiotherapy was delivered to 84% (180 of 213) of patients with breast-conserving surgery, T4 tumors, or 3+ positive lymph nodes. Fluorescent in situ hybridization testing was performed in 59% of patients (43 of 73) with 2+ HER2-positive lymph nodes on immunohistochemistry. Among patients with HER2 overexpression, 40% (36 of 91) received adjuvant trastuzumab. CONCLUSION Concordance with NCG guidelines for breast cancer care ranged from 40% to 84%. Guideline concordance was lowest for those elements of care associated with the highest direct costs to patients.
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Affiliation(s)
- D K Vijaykumar
- Amrita Institute of Medical Sciences and Research Centre, Cochin, India
| | - Sujana Arun
- Amrita Institute of Medical Sciences and Research Centre, Cochin, India
| | - Aswin G Abraham
- Amrita Institute of Medical Sciences and Research Centre, Cochin, India
| | - Wilma Hopman
- Kingston General Hospital Research Institute, Kingston, Ontario, Canada.,Queen's University, Kingston, Ontario, Canada
| | - Andrew G Robinson
- Queen's University Cancer Research Institute, Kingston, Ontario, Canada.,Queen's University, Kingston, Ontario, Canada
| | - Christopher M Booth
- Queen's University Cancer Research Institute, Kingston, Ontario, Canada.,Queen's University, Kingston, Ontario, Canada
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Damani A, Salins N, Ghoshal A, Chowdhury J, Muckaden MA, Deodhar J, Pramesh CS. Provision of palliative care in National Cancer Grid treatment centres in India: a cross-sectional gap analysis survey. BMJ Support Palliat Care 2020; 12:bmjspcare-2019-002152. [PMID: 32518130 DOI: 10.1136/bmjspcare-2019-002152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 04/29/2020] [Accepted: 05/05/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study aimed to identify gaps in palliative care (PC) provision across the National Cancer Grid (NCG) centres in India. METHODS We performed a cross-sectional validated web-based survey on 102 NCG cancer centres (Nov '17 to April '18). The survey questionnaire had seven sections collecting data relating to the capacity to provide cancer care and PC, drug availability for pain and symptom control, education, advocacy, and quality assurance activities for PC. RESULTS Eighty-nine NCG centres responded for this study-72.5% of centres had doctors with generalist PC training, whereas 34.1% of centres had full-time PC physicians; 53.8% had nurses with 6 weeks of PC training; 68.1% of the centres have an outpatient PC and 66.3% have the facility to provide inpatient PC; 38.5% of centres offer home-based PC services; 44% of the centres make a hospice referral and 68.1% of the centres offer concurrent cancer therapy alongside PC. Among the centres, 84.3% have a licence to procure, store and dispense opioids, but only 77.5% have an uninterrupted supply of oral morphine for patients; 61.5% centres have no dedicated funds for PC, 23.1% centres have no support from hospital administration, staff shortage-69.2% have no social workers, 60.4% have no counsellors and 76.9% have no volunteers. Although end-of-life care is recognised, there is a lack of institutional policy. Very few centres take part in quality control measures. CONCLUSIONS The majority of the NCG centres have the facilities to provide PC but suffer from poor implementation of existing policies, funding and human resources.
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Affiliation(s)
- Anuja Damani
- Department of Palliative Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Manipal Comprehensive Cancer Care Centre, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Arunangshu Ghoshal
- Department of Palliative Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | | | - Mary Ann Muckaden
- Department of Palliative Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Jayita Deodhar
- Department of Palliative Medicine, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - C S Pramesh
- Director (Tata Memorial Hospital), Professor of Thoracic Surgery (Surgical Oncology), Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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Gopal S, Sivaram S, Rajaraman P, Trimble EL. Thinking globally about cancer research on World Cancer Day. Indian J Med Res 2020; 151:269-272. [PMID: 32461388 PMCID: PMC7371059 DOI: 10.4103/ijmr.ijmr_198_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- Satish Gopal
- Center for Global Health, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Sudha Sivaram
- Center for Global Health, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Preetha Rajaraman
- Office of Global Affairs, US Department of Health & Human Services, Washington, DC, USA
| | - Edward L. Trimble
- Center for Global Health, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
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Singh S, Mukundan H, Lohia N, Taneja S, Sarin A, Bhatnagar S, Jaiswal P, Trivedi G, Prasher M, Viswanath S. Gliomas: Analysis of disease characteristics, treatment timelines and survival rates from two tertiary care hospitals of India. CLINICAL CANCER INVESTIGATION JOURNAL 2020. [DOI: 10.4103/ccij.ccij_27_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Panda PK, Jalali R. Global Cancer Clinical Trials-Cooperation Between Investigators in High-Income Countries and Low- and Middle-Income Countries. JAMA Oncol 2019; 4:765-766. [PMID: 29566116 DOI: 10.1001/jamaoncol.2017.5856] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Pankaj Kumar Panda
- Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai, India
| | - Rakesh Jalali
- Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai, India
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Denburg AE, Ramirez A, Pavuluri S, McCann E, Shah S, Alcasabas T, Antillon F, Arora R, Fuentes-Alabi S, Renner L, Lam C, Friedrich P, Maser B, Force L, Galindo CR, Atun R. Political priority and pathways to scale-up of childhood cancer care in five nations. PLoS One 2019; 14:e0221292. [PMID: 31425526 PMCID: PMC6699697 DOI: 10.1371/journal.pone.0221292] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 08/02/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Despite increasing global attention to non-communicable diseases (NCDs) and their incorporation into universal health coverage (UHC), the factors that determine whether and how NCDs are prioritized in national health agendas and integrated into health systems remain poorly understood. Childhood cancer is a leading non-communicable cause of death in children aged 0-14 years worldwide. We investigated the political, social, and economic factors that influence health system priority-setting on childhood cancer care in a range of low- and middle-income countries (LMIC). METHODS AND FINDINGS Based on in-depth qualitative case studies, we analyzed the determinants of priority-setting for childhood cancer care in El Salvador, Guatemala, Ghana, India, and the Philippines using a conceptual framework that considers four principal influences on political prioritization: political contexts, actor power, ideas, and issue characteristics. Data for the analysis derived from in-depth interviews (n = 68) with key informants involved in or impacted by childhood cancer policies and programs in participating countries, supplemented by published academic literature and available policy documents. Political priority for childhood cancer varies widely across the countries studied and is most influenced by political context and actor power dynamics. Ghana has placed relatively little national priority on childhood cancer, largely due to competing priorities and a lack of cohesion among stakeholders. In both El Salvador and Guatemala, actor power has played a central role in generating national priority for childhood cancer, where well-organized and -resourced civil society organizations have disrupted legacies of fragmented governance and financing to create priority for childhood cancer care. In India, the role of a uniquely empowered private actor was instrumental in creating political priority and establishing sustained channels of financing for childhood cancer care. In the Philippines, the childhood cancer community has capitalized on a window of opportunity to expand access and reduce disparities in childhood cancer care through the political prioritization of UHC and NCDs in current health system reforms. CONCLUSIONS The importance of key health system actors in determining the relative political priority for childhood cancer in the countries studied points to actor power as a critical enabler of prioritization in other LMIC. Responsiveness to political contexts-in particular, rhetorical and policy priority placed on NCDs and UHC-will be crucial to efforts to place childhood cancer firmly on national health agendas. National governments must be convinced of the potential for foundational health system strengthening through attention to childhood cancer care, and the presence and capability of networked actors primed to amplify public sector investments and catalyze change on the ground.
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Affiliation(s)
- Avram E. Denburg
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Canada
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Adriana Ramirez
- Harvard School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Suresh Pavuluri
- Harvard School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Erin McCann
- Harvard School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Shivani Shah
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
| | | | - Federico Antillon
- School of Medicine, Universidad Franciso Marroquin, Guatemala City, Guatemala
- Unidad Nacional de Oncología Pediátrica, Guatemala City, Guatemala
| | | | | | | | - Catherine Lam
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States of America
| | - Paola Friedrich
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States of America
| | - Brandon Maser
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
| | - Lisa Force
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States of America
| | - Carlos Rodriguez Galindo
- Department of Global Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States of America
| | - Rifat Atun
- Harvard School of Public Health, Harvard University, Boston, Massachusetts, United States of America
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Parambil NA, Philip S, Tripathy JP, Philip PM, Duraisamy K, Balasubramanian S. Community engaged breast cancer screening program in Kannur District, Kerala, India: A ray of hope for early diagnosis and treatment. Indian J Cancer 2019; 56:222-227. [PMID: 31389385 DOI: 10.4103/ijc.ijc_397_18] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Community based programs can assist in early detection and improved survival of breast cancer. AIMS To assess the feasibility and explore challenges of a district-wide door-to-door breast cancer screening program "ASWAS" conducted in Kannur district, Kerala, India from 2011 to 2014. METHODS: Aggregate data from survey records were collected in terms of the population screened, referred, diagnosed, and treated. Case records of breast cancer patients who were identified were reviewed and updated. In-depth interviews were conducted with program stakeholders. The contents of the interview were organized into a strength, weakness, opportunity and threat (SWOT) matrix to describe the screening program. RESULTS A total of 1,049,410 eligible women above 30 years residing in 81 panchayats were visited door-to-door by 8,200 community volunteers; of them, 93% were screened using a symptom-risk factor checklist. Of those referred with symptoms (n = 5353), 81% attended the cancer camp. In total, 23 breast cancer cases were confirmed. 14 (61%) were in early stages, treated, and are disease free at 3-year follow-up. Those in the advanced stage and old age had poor outcomes. SWOT analysis identified political support, female volunteers, community engagement, dedicated fund for treatment, and teamwork as strengths. Weaknesses included poor healthcare access, maintaining volunteer motivation, and issues around sustainability. CONCLUSION Community participation with the engagement of the health system and local self-government are required for implementing a comprehensive cancer screening strategy. Breast-cancer screening program using local volunteers for early detection is feasible in low-income settings, thereby improving survival.
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Affiliation(s)
| | - Sairu Philip
- Department of Community Medicine, Government T.D Medical College, Alappuzha, Kerala, India
| | - Jaya Prasad Tripathy
- International Union Against Tuberculosis and Lung Disease, The Union South East Asia Office, New Delhi, India
| | - Phinse M Philip
- Department of Community Oncology, Malabar Cancer Center, Thalassery, Kerala, India
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Mahantshetty UM. Scale-up of radiotherapy for cervical cancer. Lancet Oncol 2019; 20:888-889. [DOI: 10.1016/s1470-2045(19)30376-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 05/10/2019] [Indexed: 10/26/2022]
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Pramesh CS, Chaturvedi H, Reddy VA, Saikia T, Ghoshal S, Pandit M, Babu KG, Ganpathy KV, Savant D, Mitera G, Sullivan R, Booth CM. Choosing Wisely India: ten low-value or harmful practices that should be avoided in cancer care. Lancet Oncol 2019; 20:e218-e223. [PMID: 30857957 DOI: 10.1016/s1470-2045(19)30092-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/28/2019] [Accepted: 01/29/2019] [Indexed: 12/14/2022]
Abstract
The Choosing Wisely India campaign was an initiative that was established to identify low-value or potentially harmful practices that are relevant to the Indian cancer health-care system. We undertook a multidisciplinary framework-driven consensus process to identify a list of low-value or harmful cancer practices that are frequently undertaken in India. A task force convened by the National Cancer Grid of India included Indian representatives from surgical, medical, and radiation oncology. Each specialty had representation from the private and public sectors. The task force included two representatives from national patient and patient advocacy groups. Of the ten practices that were identified, four are completely new recommendations, and six are revisions or adaptations from previous Choosing Wisely USA and Canada lists. Recommendations in the final list pertain to diagnosis and treatment (five practices), palliative care (two practices), imaging (two practices), and system-level delivery of care (two practices). Implementation of this list and reporting of concordance with its recommendations will facilitate the delivery of high-quality, value-based cancer care in India.
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Affiliation(s)
- C S Pramesh
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India.
| | | | - Vijay Anand Reddy
- Department of Radiation Oncology, Apollo Hospitals, Hyderabad, India
| | - Tapan Saikia
- Department of Medical Oncology, Prince Aly Khan Hospital, Mumbai, India
| | - Sushmita Ghoshal
- Department of Radiation Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - K Govind Babu
- Department of Medical Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, India
| | - K V Ganpathy
- Jeet Association for Support to Cancer Patients, Mumbai, India
| | | | - Gunita Mitera
- Department of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Richard Sullivan
- Institute of Cancer Policy, King's College London, and King's Health Partners Comprehensive Cancer Centre, London, UK
| | - Christopher M Booth
- Department of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, ON, Canada
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Bhatt A, Mehta S, Seshadri RA. The Current Status of Peritoneal Surface Oncology in India. Indian J Surg Oncol 2019; 10:41-48. [PMID: 30886493 PMCID: PMC6397124 DOI: 10.1007/s13193-018-00871-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 12/27/2018] [Indexed: 01/19/2023] Open
Abstract
With the increasing acceptance of cytoreductive surgery and HIPEC as a potentially curative treatment for primary and secondary peritoneal surface malignancies, peritoneal surface oncology has emerged as a distinct sub-specialty of surgical oncology. In the last 10 years, the acceptance of a conceptually different approach towards the management of peritoneal metastases has increased in India. During this period, over 1000 combined procedures have been performed in the country and most of the major cities have centers performing offering this treatment. Indian surgeons have formed collaborative groups to promote research and development of this specialty across the country. This article provides a detailed account of current practices pertaining to peritoneal surface oncology in the country and a future perspective.
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Affiliation(s)
- Aditi Bhatt
- Department of Surgical Oncology, Zydus Hospital, Zydus Hospital Road, SG Highway, Thaltej, Ahmedabad, 380054 India
| | - Sanket Mehta
- Department of Surgical Oncology, Saifee Hospital, Mumbai, India
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Chopra S, Gupta M, Mathew A, Mahantshetty U, Engineer R, Lavanya G, Gupta S, Ghosh J, Thakur M, Deodhar K, Menon S, Rekhi B, Bajpai J, Gulia S, Maheshwari A, Kerkar R, Shylasree TS, Shrivastava SK. Locally advanced cervical cancer: A study of 5-year outcomes. Indian J Cancer 2018; 55:45-49. [PMID: 30147092 DOI: 10.4103/ijc.ijc_428_17] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Cervical cancer is the second most common cancer among Indian women. This present retrospective study was conducted to report patient outcomes with locally advanced cervical cancer treated in the year 2010. Materials and Methods Case records of cervical cancer patients registered from January 1, 2010, to December 31, 2010 were retrieved. A total of 1200 patients were registered, of which 583 received either definitive or adjuvant radiotherapy (RT). Of these, 345 patients who received complete treatment at our hospital were included for outcome analysis. Descriptive statistics were used to summarize patient- and treatment-related variables, and Kaplan-Meier analysis was performed for survival analysis. Results The median age was 56 years (range: 33-90). Squamous carcinoma was the most common histology (91.4%) and the majority were FIGO Stage III (45.4%). Median follow-up of the cohort was 44 months (1-85 months). The 5-year disease-free survival (DFS) across stages was 50%. Most important predictor of DFS was FIGO staging (Stage II vs. Stage III: 62% vs. 45%) and use of concurrent chemoradiotherapy (CTRT) l (RT vs. CTRT: 32% vs. 57%, respectively). Patients aged >70 years had a significantly poor DFS at 5 years; however, did not have any effect on survival. Grade 3 or more late toxicity was seen in only 5% of the patients. Conclusion Five-year DFS of 62% and 45% of Stage II and III patients treated under routine care represents comparable stage-matched results to the rest of the world, respectively.
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Affiliation(s)
- Supriya Chopra
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Meetakshi Gupta
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Ashwathy Mathew
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Umesh Mahantshetty
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Reena Engineer
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - G Lavanya
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Jaya Ghosh
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Meenakshi Thakur
- Department of Radiology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Kedar Deodhar
- Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Santosh Menon
- Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Bharat Rekhi
- Department of Pathology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Seema Gulia
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Amita Maheshwari
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Rajendra Kerkar
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - T S Shylasree
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - S K Shrivastava
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
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Bhatt A, Mehta SS, Zaveri S, Rajan F, Ray M, Sethna K, Katdare N, Patel MD, Kammar P, Prabhu R, Sinukumar S, Mishra S, Rangarajan B, Rangole A, Damodaran D, Penumadu P, Ganesh M, Peedicayil A, Raj H, Seshadri R. Treading the beaten path with old and new obstacles: a report from the Indian HIPEC registry. Int J Hyperthermia 2018; 35:361-369. [PMID: 30300029 DOI: 10.1080/02656736.2018.1503345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The Indian HIPEC registry is a self-funded registry instituted by a group of Indian surgeons for patients with peritoneal metastases (PM) undergoing surgical treatment. This work was performed to • Evaluate outcomes of cytoreductive surgery ± HIPEC in patients enrolled in the registry. • Identify operational problems. METHODS A retrospective analysis of patients enrolled in the registry from March 2016 to September 2017 was performed. An online survey was performed to study the surgeons' attitudes and existing practices pertaining to the registry and identify operational problems. RESULTS During the study period, 332 patients were enrolled in 8 participating centres. The common indication was ovarian cancer for three centres and pseudomyxoma peritonei for three others. The median PCI ranged from 3 to 23. A CC-0/1 resection was obtained in 94.7%. There was no significant difference in the morbidity (p = .25) and mortality (p = .19) rates between different centres. There was a high rate of failure-to-rescue (19.3%) patients with complications and the survival in patients with colorectal PM was inferior. A lack of dedicated personnel for data collection and entry was the main reason for only 10/43 surgeons contributing data. The other problem was the lack of complete electronic medical record systems at all centres. CONCLUSIONS These results validate existing practices and identify country-specific problems that need to be addressed. Despite operational problems, the registry is an invaluable tool for audit and research. It shows the feasibility of fruitful collaboration between surgeons in the absence of any regulatory body or funding for the project.
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Affiliation(s)
- Aditi Bhatt
- a Department of Surgical Oncology , Fortis Hospital , Bangalore , India
| | - Sanket S Mehta
- b Department of Peritoneal surface oncology , Saifee Hospital , Mumbai , India
| | - Shabber Zaveri
- c Department of Surgical Oncology , Manipal Hospital , Bangalore , India
| | - Firoz Rajan
- d Department of Surgical Oncology , Kovai Medical Center , Coimbatore , India
| | - Mukurdipi Ray
- e Department of Surgical Oncology , All India Institute of Medical Sciences , New Delhi , India
| | - Kayomarz Sethna
- f Department of Surgery , Lokmanya Tilak Municipal medical college and general hospital , Mumbai , India
| | - Ninad Katdare
- g Department of Surgical Oncology , SL Raheja hospital , Mumbai , India
| | - Mahesh D Patel
- h Department of Surgical Oncology , Zydus Hospital , Ahmedabad , India
| | - Praveen Kammar
- i Department of Surgical Oncology , Global hospitals , Hyderabad , India
| | - Robin Prabhu
- a Department of Surgical Oncology , Fortis Hospital , Bangalore , India
| | - Snita Sinukumar
- j Department of Surgical oncology , Jehangir Hospital , Pune , India
| | - Suniti Mishra
- k Department of Pathology , Fortis Hospital , Bangalore , India
| | - Bharath Rangarajan
- l Department of Medical oncology , Kovai Medical center , Coimbatore , India
| | - Ashvin Rangole
- m Department of Surgical oncology , CHL, CBCC cancer center , Indore , India
| | - Dileep Damodaran
- n Department of Surgical oncology , MVR cancer center and research Institute , Calicut , India
| | - Prasanth Penumadu
- o Department of Surgical oncology , Jawarharlal Institute of Postgraduate Medical Education and Research (JIPMER) , Puducherry , India
| | - Mandakulutur Ganesh
- p Department of Surgical Oncology , Vaidehi Institute of Medical sciences , Bangalore , India
| | - Abraham Peedicayil
- q Department of Gynecologic Oncology , Christian Medical College , Vellore , India
| | - Hemant Raj
- r Department of Surgical Oncology , Cancer Institute (WIA) , Chennai , India
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Sirohi B, Chalkidou K, Pramesh CS, Anderson BO, Loeher P, El Dewachi O, Shamieh O, Shrikhande SV, Venkataramanan R, Parham G, Mwanahamuntu M, Eden T, Tsunoda A, Purushotham A, Stanway S, Rath GK, Sullivan R. Developing institutions for cancer care in low-income and middle-income countries: from cancer units to comprehensive cancer centres. Lancet Oncol 2018; 19:e395-e406. [PMID: 30102234 DOI: 10.1016/s1470-2045(18)30342-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/26/2018] [Accepted: 04/26/2018] [Indexed: 12/27/2022]
Abstract
Global cancer centres operate across different sizes, scales, and ecosystems. Understanding the essential aspects of the creation, organisation, accreditation, and activities within these settings is crucial for developing an affordable, equitable, and quality cancer care, research, and education system. Robust guidelines are scarce for cancer units, cancer centres, and comprehensive cancer centres in low-income and middle-income countries. However, some robust examples of the delivery of complex cancer care in centres in emerging economies are available. Although it is impossible to create an optimal system to fit the unique needs of all countries for the delivery of cancer care, we summarise what has been published about the development and management of cancer centres in low-income and middle-income countries so far and highlight the need for clinical and political leadership.
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Affiliation(s)
| | - Kalipso Chalkidou
- Imperial College London, London UK; Centre for Global Development, London, UK
| | | | | | - Patrick Loeher
- Indiana University Medical Center, Indianapolis, IN, USA
| | - Omar El Dewachi
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | | | | | | | | | | | - Tim Eden
- University of Manchester, Manchester, UK
| | - Audrey Tsunoda
- Hospital Erasto Gaertner, Instituto de Oncologia do Paraná and Universidade Positivo, Curitiba, Brazil
| | - Arnie Purushotham
- Tata Trusts, Mumbai, India; King's Health Partners Comprehensive Cancer Centre and Institute of Cancer Policy, School of Cancer Sciences, Kings College London, London, UK
| | | | - Goura K Rath
- All India Institute of Medical Sciences, New Delhi, India
| | - Richard Sullivan
- King's Health Partners Comprehensive Cancer Centre and Institute of Cancer Policy, School of Cancer Sciences, Kings College London, London, UK
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Chopra SJ, Mathew A, Maheshwari A, Bhatla N, Singh S, Rai B, Surappa ST, Ghosh J, Sharma D, Bhaumik J, Biswas M, Deodhar K, Popat P, Giri S, Mahantshetty U, Tongaonkar H, Billimaga R, Engineer R, Grover S, Pedicayil A, Bajpai J, Rekhi B, Alihari A, Babu G, Thangrajan R, Menon S, Shah S, Palled S, Kulkarni Y, Gulia S, Naidu L, Thakur M, Rangrajan V, Kerkar R, Gupta S, Shrivastava SK. National Cancer Grid of India Consensus Guidelines on the Management of Cervical Cancer. J Glob Oncol 2018; 4:1-15. [PMID: 30085891 PMCID: PMC6223405 DOI: 10.1200/jgo.17.00152] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Standard guidelines for the management of early and locally advanced cervical cancer are available from various academic consortiums nationally and internationally. However, implementing standard-of-care treatment poses unique challenges within low- and middle-income countries, such as India, where diverse clinical care practices may exist. The National Cancer Grid, a consortium of 108 institutions in India, aims to homogenize care for patients with cervical cancer by achieving consensus on not only imaging and management, but also in addressing potential solutions to prevalent challenges that affect the homogenous implementation of standard-of-care treatment. These guidelines therefore represent a consensus statement of the National Cancer Grid gynecologic cancer expert group and will assist in homogenization of the therapeutic management of patients with cervical cancer in India.
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Affiliation(s)
- Supriya J. Chopra
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Ashwathy Mathew
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Amita Maheshwari
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Neerja Bhatla
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Shalini Singh
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Bhawana Rai
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Shylasree T. Surappa
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Jaya Ghosh
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Dayanand Sharma
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Jaydip Bhaumik
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Manash Biswas
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Kedar Deodhar
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Palak Popat
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Sushil Giri
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Umesh Mahantshetty
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Hemant Tongaonkar
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Ramesh Billimaga
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Reena Engineer
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Surbhi Grover
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Abraham Pedicayil
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Jyoti Bajpai
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Bharat Rekhi
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Aruna Alihari
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Govind Babu
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Rajkumar Thangrajan
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Santosh Menon
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Sneha Shah
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Sidhanna Palled
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Yogesh Kulkarni
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Seema Gulia
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Lavanya Naidu
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Meenakshi Thakur
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Venkatesh Rangrajan
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Rajendra Kerkar
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Sudeep Gupta
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
| | - Shyam K. Shrivastava
- Supriya Chopra, Ashwathy Mathew, Amita Maheshwari, Shylasree T. Surappa, Jaya Ghosh, Kedar Deodhar, Palak Popat, Umesh Mahantshetty, Reena Engineer, Jyoti Bajpai, Bharat Rekhi, Aruna Alihari, Santosh Menon, Sneha Shah, Seema Gulia, Lavanya Naidu, Meenakshi Thakur, Venkatesh Rangrajan, Rajendra Kerkar, Sudeep Gupta, and Shyam K. Shrivastava, Tata Memorial Centre; Hemant Tongaonkar, PD Hinduja Hospital and Research Centre; Yogesh Kulkarni, Kokilaben Dhirubhai Ambani Hospital, Mumbai; Neerja Bhatla and Dayanand Sharma, All India Institute of Medical Oncology, New Delhi; Shalini Singh, Sanjay Gandhi Postgraduate Institute, Lucknow; Bhawana Rai, Postgraduate Institute of Medical Education and Research, Chandigarh; Jaydip Bhaumik, Tata Medical Centre, Kolkata; Manash Biswas, Roorkee Army Hospital, Roorkee; Sushil Giri, Acharya Hariharan Regional Cancer Centre, Cuttack; Ramesh Billimaga, HCG Hospital; Govind Babu, Kidwai Institute of Oncology, Bangalore; Abraham Pedicayil and Sidhanna Palled, Christian Medical College, Vellore; Rajkumar Thangrajan, Cancer Institute Adyar, Chennai, India; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; and Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana
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Servarayan Murugesan C, Manickavasagam K, Chandramohan A, Jebaraj A, Jameel ARA, Jain MS, Venkataraman J. Gastric cancer in India: epidemiology and standard of treatment. Updates Surg 2018; 70:233-239. [PMID: 29611052 DOI: 10.1007/s13304-018-0527-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 03/14/2018] [Indexed: 02/07/2023]
Abstract
India has a low incidence of gastric cancer. It ranks among the top five most common cancers. Regional diversity of incidence is of importance. It is the second most common cause of cancer related deaths among Indian men and women in the age between 15 and 44. Helicobacter pylori carcinogenesis is low in India. Advanced stage at presentation is a cause of concern. Basic and clinical research in India reveals a globally comparable standard of care and outcome. The large population, sociodemographic profile and challenges in health expenditure, however, remain a major challenge for health care policy managers. The newer formation of National Cancer Grid, integration of national databases and the creation of social identification database Aadhaar by The Unique Identification Authority of India are set to enhance the health care provision and optimal outcome.
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Affiliation(s)
- Chandramohan Servarayan Murugesan
- Center for Gastroesophageal Disorders, ESOINDIA, Chennai, India. .,Department of General, GI and Minimal Access Surgery, St. Isabel's Hospital, Chennai, 600010, India.
| | - Kanagavel Manickavasagam
- Center for Gastroesophageal Disorders, ESOINDIA, Chennai, India.,Department of General, GI and Minimal Access Surgery, St. Isabel's Hospital, Chennai, 600010, India
| | | | - Abishai Jebaraj
- Center for Gastroesophageal Disorders, ESOINDIA, Chennai, India.,Department of General, GI and Minimal Access Surgery, St. Isabel's Hospital, Chennai, 600010, India
| | - Abdul Rehman Abdul Jameel
- Department of Gastrointestinal Surgery, Saveetha Medical College, Saveetha University, Thandalam, Chennai, 602105, India
| | - Mayank Shikar Jain
- Institute of Gastroenterology, Gleneagles Global Hospital, Chennai, 600100, India
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Abstract
There is a global mandate even in countries with low resources to improve the accuracy of testing biomarkers in breast cancer viz. oestrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2neu) given their critical impact in the management of patients. The steps taken include compulsory participation in an external quality assurance (EQA) programme, centralized testing, and regular performance audits for laboratories. This review addresses the status of ER/PR and HER2neu testing in India and possible reasons for the delay in development of guidelines and mandate for testing in the country. The chief cause of erroneous ER and PR testing in India continues to be easily correctable issues such as fixation and antigen retrieval, while for HER2neu testing, it is the use of low-cost non-validated antibodies and interpretative errors. These deficiencies can however, be rectified by (i) distributing the accountability and responsibility to surgeons and oncologist, (ii) certification of centres for testing in oncology, and (iii) initiation of a national EQA system (EQAS) programme that will help with economical solutions and identifying the centres of excellence and instill a system for reprimand of poorly performing laboratories.
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Affiliation(s)
- Tanuja Shet
- Department of Histopathology, Tata Memorial Centre, Mumbai, India
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Cancer cervix: Establishing an evidence-based strategy, an experience of a tertiary care centre in India. Curr Probl Cancer 2018; 42:137-147. [PMID: 29433826 DOI: 10.1016/j.currproblcancer.2018.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 01/04/2018] [Indexed: 02/02/2023]
Abstract
Carcinoma cervix is a common cancer among Indian women. Evidence based management is essential for best practice in treatment of carcinoma cervix for its effective control. The current imaging system like CT, MRI and PET CT scans have contributed in identifying the patients for optimal treatment and delivering treatment accurately. For stages IB2 to IV, concurrent chemoradiation is advocated with improvement in overall survival proven with randomized trials. Brachytherapy is an integral part in the radiation treatment. Imaged-guided brachytherapy using MRI is desirable, however less expensive imaging modalities such as CT and ultrasonography has been evaluated. In special situation such as for HIV positive patients and patients with neuroendocrine tumors have role of radiotherapy. For further improvement in control of cancer, it is required to integrate basic research to answer clinically relevant questions.
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Dandekar M, Tuljapurkar V, Dhar H, Panwar A, DCruz AK. Head and neck cancers in India. J Surg Oncol 2017; 115:555-563. [PMID: 28120407 DOI: 10.1002/jso.24545] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 12/27/2016] [Indexed: 01/21/2023]
Abstract
Head and neck cancers constitute a third of the cancer burden in India. These cancers have unique patient characteristics, presentation, and etiological differences from those in the West. Socioeconomic constraints, large patient population, scarcity of trained health workers, and inadequate infrastructure are major challenges faced in the management of these cancers. Despite these constraints, patients are treated with evidence based guidelines that are tailored to the local scenario.
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Affiliation(s)
| | - Vidisha Tuljapurkar
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, 400012, Maharashtra, India
| | - Harsh Dhar
- Department of Head and Neck Surgery, Tata Memorial Hospital, Mumbai, 400012, Maharashtra, India
| | - Aru Panwar
- Department of Otolaryngology- Head and Neck Surgery, 981225 Nebraska Medical Center, Omaha, Nebraska, 68198-1225
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