ecancermedicalscience最新文献

Amidst the global disparities in providing Paediatric Palliative Care (PPC), the compounded realities in the Eastern Mediterranean region intensify the need for palliative care for children with cancer. This region hosts 12% of children needing PPC worldwide within limited specialised services, training and resources exacerbated by political instabilities. Immediate effective responses may reside in promoting interdisciplinary capacity-building combined with action planning among healthcare professionals, stakeholders and advocates for patients and their families. In response to these pressing needs, the First Regional Interdisciplinary PPC Workshop was held in-person in Rabat, Morocco on 6-8 November 2024, aiming to strengthen regional interdisciplinary healthcare professionals' capacity through training and collaborative action planning to improve PPC integration in cancer treatment. Eighty-five attendees representing 15 countries including regional healthcare professionals, international experts, foundation representatives and policymakers united in the commitment to promote PPC integration and enhance the quality of life for children with palliative care needs, particularly those with cancer living in this region. Over 3 days, participants engaged in training, discussions and action planning. Day one provided essential skills to deliver PPC at the patient care level (micro-level), day two discussed institutional implementation of PPC services (meso-level), day three tackled national and regional endeavours to promote PPC integration (macro-level). At the conclusion of the workshop, participants gained knowledge and confidence in various PPC skills. They shared their plans to establish PPC teams/units, apply symptom management and communication skills, train colleagues within their settings, conduct research and maintain networking to encourage collaboration opportunities. The workshop marked a pivotal step to deepen understanding of the PPC landscape and resources in the region. This impactful experience laid the foundations for different opportunities in practice, research, policy and advocacy to accelerate PPC integration in the Eastern Mediterranean region, fostering collective efforts to improve childhood cancer care globally.

Background: Atezolizumab is an immune checkpoint inhibitor that has been approved for several neoplasms including advanced hepatocellular carcinoma. It is also capable of inducing adverse events involving the nervous system in susceptible individuals.

Case presentation: We report a case of myasthenia gravis, occurring in a 64-year-old patient diagnosed with hepatocellular carcinoma, who within a few months of the first-line combination use of Atezolizumab and Bevacizumab, developed worsening muscular weakness. She was managed with plasma exchange and intravenous immunoglobulin with minimal response initially, but later on, deteriorated and succumbed to the condition.

Conclusion: Although uncommon, the use of Atezolizumab can either give rise to or worsen a pre-existing, latent neurological condition. These neurological immune-mediated adverse events can prove to be debilitating or even life-threatening if not timely treated, thus warranting prompt investigation by the physicians for proper diagnosis and management.

Background: Every year, about 400,000 children are diagnosed with cancer around the world, 90% of them in developing countries. In Brazil, it is estimated that 7,900 cases are expected by 2023, making cancer the second leading cause of death in this age group. Therefore, this study is relevant for strengthening health surveillance and developing strategies to combat childhood and adolescent malignant neoplasms.

Objective: To describe the profile of cancer incidence and mortality in the child and adolescent population of Belém and Ananindeua between 2010 and 2019.

Methods: This is a descriptive study, with a quantitative approach, using data obtained from the Population-Based Cancer Registry (RCBP), referring to cancer incidence and mortality in individuals aged 0-19 residing in Belém and Ananindeua. The following variables were analysed: age, sex, race, morphology and case outcome. The data were organised in Microsoft Excel, using the formula: incidence = (number of new cases/total population) × 100,000. The analyses were descriptive, with emphasis on absolute and relative frequencies.

Results: A total of 846 new cases of malignant neoplasms were registered among the population aged 0-19. The most frequent morphology was leukaemia, with 42.31 cases per 100,000 inhabitants, followed by malignant tumours of the central nervous system, with 17.92, lymphomas, with 15.82 and bone tumours, with 12.27. The incidence is higher among males, with a large number of cases occurring in the age group 15-19. As for the outcome, 66.1% had no information on the patient's vital status, 29.6% had a confirmed death and only 4.4% had a vital status of alive.

Conclusion: The epidemiological data on childhood and adolescent malignant neoplasms in Belém and Ananindeua was detailed, providing more information on the subject. However, it was difficult to obtain some information from the RCBP system.

Introduction: Healthy habits such as regular physical activity, a balanced diet and tobacco abstinence are associated with better health-related quality of life (HRQoL) in cancer survivors. However, there is limited evidence on this relationship in Latin American countries, where socioeconomic and cultural factors may influence adherence to healthy behaviours.

Objectives: To evaluate the relationship between adherence to healthy lifestyle recommendations and HRQoL in cancer survivors in Uruguay.

Materials and methods: A cross-sectional study was conducted with 241 early-stage cancer survivors treated at two hospitals in Uruguay. Adherence to healthy habits was assessed using a questionnaire based on the American Cancer Society recommendations. HRQoL was measured using the RAND-36 questionnaire. Categorical variables were analysed using the chi-square test, while continuous variables were analysed using Student's t-test or the Mann-Whitney test. The correlation between SF-36 dimensions and healthy habits was assessed using Spearman's coefficient.

Results: The median age was 66.7 years and 55.2% were women. The most common cancers were breast (31.1%), colorectal (28.2%) and prostate (26.6%). A total of 62.7% of participants adhered to three or more healthy habits. Adherent patients showed significantly higher HRQoL scores, particularly in physical function (62.68 versus 45.67, p < 0.001), energy/fatigue (64.83 versus 45.89, p < 0.001) and emotional well-being (69.43 versus 53.02, p < 0.001). Adherence to multiple healthy habits was significantly correlated with improvements in physical and mental domains, with energy/fatigue showing the strongest correlation (rs = 0.66, p < 0.001).

Conclusion: Adherence to healthy habits has a cumulative positive impact on the HRQoL of cancer survivors. This study highlights the need to design comprehensive interventions to promote healthy behaviours in this population, contributing to the global evidence on cancer care and underscoring its importance in developing countries.

Background: Palliative care research (PCR) plays a critical role in improving the quality of life for patients with serious illness, yet its global distribution and focus areas remain uneven. Understanding the trends and impact of PCR over the past decade can inform future research priorities and policy development.

Methods: We conducted a bibliometric analysis of publications indexed in the Web of Science related to PCR between 2013 and 2022. Articles were identified using a comprehensive filter based on title keywords and specialist journals, and were further classified by research domain, disease area and study type.

Results: The volume of PCR publications has grown over the past decade, increasing from 0.29% of all biomedical research outputs in 2013-14 to 0.62% in 2021-22. Countries with the highest levels of PCR output-primarily European and Anglophone nations-also ranked highly on the Economist Intelligence Unit's Quality of Death Index. Using eight different bibliometric indicators, we assessed the impact of countries' PCR outputs; while rankings varied by metric, European countries such as the Netherlands, Belgium, the United Kingdom and Ireland consistently performed strongly. Cancer emerged as the dominant disease focus, although many studies also addressed co-morbid conditions including COVID-19 in recent years. A significant proportion of PCR also examined the impact of illness on patients' families and caregivers.

Conclusion: The findings highlight cancer as a major area of focus and need within PCR. However, research outputs remain disproportionately concentrated in high-income countries, revealing a persistent gap in low- and middle-income settings.

Recommendations: To address the growing global burden of cancer and serious illness, palliative care should be integrated as a core component of national cancer control plans. This integration must be supported by a targeted research agenda that emphasises implementation and scaling of palliative care models, particularly in low- and middle-income countries. Policymakers and research funders should prioritise holistic, patient-centred approaches and ensure that impact measurement reflects meaningful outcomes for patients and families.

Mutations in the BRCA1 and BRCA2 genes significantly increase the risk of hereditary cancers, mainly of the breast and ovary, but also of other cancers such as those of the pancreas, prostate and cervix. In carriers of these mutations, multiple primary malignancies (MPM) represent a complex clinical challenge, influenced by genetic and environmental factors, as well as previous cancer treatments. The case reports a patient with a BRCA1 mutation with a family history of breast and ovarian cancer and who developed cervical cancer then recurrent triple-negative breast cancer treated with mastectomy, radiotherapy, chemotherapy and Poly (Adenosine diphosohate-ribose) polymérase inhibitors. This case underlines the interplay between different malignancies in the context of breast cancer mutations and the importance of specific and personalised treatment of patients with multiple primary malignancies.

Metastasis of renal cell carcinoma (RCC) to the head and neck region is rare. The metastases of RCC are radioresistant with surgery as the primary treatment modality. Here, we present a case of a 73-year-old male who presented with left facial swelling which on biopsy and immunohistochemistry showed metastatic RCC. The patient was re-evaluated again and the left renal primary was found out.

Background: Head and neck squamous cell carcinoma is often treated with radiotherapy, frequently combined with chemotherapy, to improve overall survival (OS). Despite advancements, locoregional control (LRC) remains a significant challenge, with 15%-50% of patients experiencing locoregional recurrence, negatively impacting OS and quality of life. Hypoxia within tumor cells is a critical factor contributing to treatment failure, necessitating higher radiation doses to achieve similar therapeutic effects as in normoxic cells. This study aims to investigate the role of dose escalation using [18F] fluoromisonidazole (FMISO) positron emission tomography/computed tomography (PET CT) to target hypoxic sub-volumes in head and neck cancer (HNC) to improve LRC.

Methods: The dose-escalated hypoxia-adjusted radiotherapy trial is an open-label, parallel, randomised, single-centre, phase II study. Patients with HNC will undergo [18F]. FMISO PET CT to identify hypoxic regions. Normoxic patients will be labeled as Arm 1 and will not be part of the primary assessment. Patients with hypoxia will be stratified into two arms (2 and 3). Arm 2 will receive standard radiotherapy of 70 Gy in 2 Gy fractions, while Arm 3 will receive an additional boost to the hypoxic sub-volumes, delivering a total of 80 Gy (Phase 2). All patients in Arms 2 and 3 will also receive concurrent chemotherapy with cisplatin. Patients will be monitored weekly for treatment tolerance, with acute adverse events recorded according to National Cancer Institute Common Terminology Criteria for Adverse Events v5.0. The primary endpoint is LRC, defined as the time from randomisation to the first histopathologically confirmed relapse of locoregional disease. Secondary endpoints include OS, locoregional relapse-free survival, acute and late toxicity and patient-reported outcomes assessed using the European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-H&N35 questionnaires.

Discussion: This study addresses a critical gap in the management of HNC by targeting hypoxic regions within tumours, potentially improving LRC and, consequently, OS. The use of [18F] FMISO PET CT for identifying hypoxic sub-volumes allows for tailored radiation dose escalation, which could overcome the radioresistance associated with hypoxia. By comparing outcomes among standard radiotherapy (Arm 2) and dose-escalated treatment (Arm 3), this trial aims to establish a more effective therapeutic strategy for HNC patients.

Trial registration: This trial is registered with the Clinical Trials Registry of India (CTRI/2024/04/065373), registered on 08^th April 2024 on ctri.nic.in and clinicaltrials.gov (NCT06087614) registered on 18th September 2023 on clinicaltrials.gov.

Introduction: Cancer care in Sri Lanka is predominantly provided through its state health system which is free at the point of delivery. We performed a budget impact analysis of novel cancer drugs with a view to enabling better prioritising of their procurement.

Methods: Median survival gain was obtained for each indication of a novel cancer drug by a review of the literature. The direct cost of drug procurement was obtained from the Ministry of Health of Sri Lanka and the cost per life year gained was computed for each indication. Two thresholds - per capita gross domestic product (GDP) per life year gained (GDP × 1 = US$3815) and three times per capita GDP per life year gained (GDP × 3 = US$11445) were considered to determine cost effectiveness. The cumulative annual cost of these treatments was subsequently determined.

Results: Data obtained on 42 novel cancer drugs spanning across 90 indications were included in the analysis. The cumulative annual treatment cost when the threshold was set at GDP × 1 was United States Dollar (US$) 6 million and it increased to US$ 13.2 million if the threshold was expanded (GDP × 3 = US$11445). Only 27 indications met the (GDP × 3 = US$11445) threshold while there were 18 drugs that did not meet the thresholds for any indication. Without a threshold, if every eligible patient were to receive treatment as currently indicated, the total cost would reach almost US$ 300 million per year.

Conclusion: Budget impact analyses and defining cost-effectiveness thresholds will lead to considerable savings and help prioritise the procurement of novel agents in the state health system in Sri Lanka.

Background: Zambia faces the double burden of rising cancer incidence and a disproportionate volume of mortality from delayed presentations. The Ministry of Health Zambia acknowledged cancer research as a key pillar of cancer control in the National Cancer Control Strategic Plan 2022-2026, but there remains a paucity of country-specific evidence to inform strategies, implementation, monitoring and evaluation of research activities. Our study aimed to map and critically analyse the existing cancer research landscape to inform national planning.

Methods: We adopted a two-stage mixed-method research. First, we conducted a systematic review, including 76 Zambian cancer studies published between 2012 and 2022, adhering to PRISMA guidance. Second, we conducted an in-person modified consensus meeting in Ndola, Zambia attended by 31 domestic and international stakeholders, to co-develop priorities and strategies based on gaps and facilitators identified through the systematic review.

Results: The year-on-year cancer research output in Zambia had risen and diversified beyond cervical cancer but prevention, palliative care and health economic studies were lacking. Delay in deciding to seek care was most studied (n = 17, 63.0%), especially in cervical cancer. Research activities were mostly retrospective (n = 47/76, 61.8%) with only one randomised controlled trial identified. Greater than 90% (n = 10/11, 90.9%) of the most prolific research funders were international, predominantly from the United States and the United Kingdom, and Zambian researchers were under-represented as first and last authors at 43% (n = 33/76) and 45% (n = 34/76), respectively. The existing national cervical cancer registry, active global collaboration and adoption of technology were facilitators to be leveraged to build research capacity through multi-level, stakeholder-specific strategies.

Conclusion: To strengthen research capacity, sustained commitment to priorities through the implementation of co-developed strategies is required at individual, organisational and institutional levels. This paradigm shift is necessary to deliver evidence-based cancer care tailored to the needs of Zambians with emphasis on value and quality.