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Access of Low-Resource Areas to ASCO Quality Initiatives: Initial Experience and Lessons Learned. 低资源地区参与 ASCO 质量行动:初步经验和教训。
IF 3.2 Q2 ONCOLOGY Pub Date : 2024-10-01 Epub Date: 2024-10-17 DOI: 10.1200/GO.24.00140
Abdul Rahman Jazieh, Jackson Orem, Gerardo Umanzor, Julia Tomkins

With the aim of improving the quality of cancer care globally, ASCO began to offer its quality improvement programs to interested international oncology practices. In this manuscript, we describe the experiences with ASCO quality initiatives in low- and middle-income countries (LMICs). The experience acquired from different practices in Latin America and Africa was reviewed and various action steps were summarized. Encountered challenges and implemented solutions to mitigate these challenges were identified to list as lessons learned for oncology practices in LMICs or low-resource settings to use in their future quality improvement initiatives and providing a proactive approach for those practices considering starting quality improvement programs. Having programs tailored to LMICs may facilitate the participation of more practices and help them take advantage of these programs to enhance patient care. The preliminary data and learning are promising and demonstrate that participation in quality improvement activities can have a positive effect. Although this early experience is encouraging, each country and resource-limited practice will have its own unique challenges as highlighted in this article. Having more practices participate will further enhance the knowledge base, build experience in addressing challenges, and enable oncology patients to reap the benefits worldwide.

为了提高全球癌症治疗的质量,ASCO 开始向感兴趣的国际肿瘤治疗机构提供质量改进计划。在本手稿中,我们介绍了 ASCO 在中低收入国家(LMICs)开展质量计划的经验。我们回顾了从拉丁美洲和非洲不同实践中获得的经验,并总结了各种行动步骤。我们确定了所遇到的挑战以及为缓解这些挑战而实施的解决方案,并将其列为经验教训,供中低收入国家或低资源环境中的肿瘤诊疗机构在未来的质量改进计划中使用,并为那些考虑启动质量改进计划的诊疗机构提供了一种积极的方法。为低收入和中等收入国家量身定做的计划可能会促进更多临床实践的参与,并帮助他们利用这些计划加强对患者的护理。初步数据和学习成果令人鼓舞,表明参与质量改进活动可以产生积极的效果。虽然早期经验令人鼓舞,但正如本文所强调的,每个国家和资源有限的医疗机构都将面临各自独特的挑战。让更多的临床实践参与进来将进一步增强知识基础,积累应对挑战的经验,并让全球肿瘤患者从中受益。
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引用次数: 0
Building an Effective International Medical Evacuation Program for Ukrainian Patients With Cancer Amid Prolonged Military Conflict. 在长期军事冲突中为乌克兰癌症患者制定有效的国际医疗后送计划。
IF 3.2 Q2 ONCOLOGY Pub Date : 2024-10-01 Epub Date: 2024-10-10 DOI: 10.1200/GO-24-00363
Inesa Huivaniuk, Viacheslav Kopetskyi, Taras Ivanykovych, Andrei Nikiforchin, Darya Kizub, Marta Antoniv, Ali Dzhemiliev, Brittany Powell, Saar Yaniuta, Arman Kacharian, Anna Podolianko, Nelya Melnitchouk

Purpose: During military conflicts, the immediate response to a severely disrupted health care system often overlooks the needs of patients with cancer who require continuous specialized care. The full-scale Russian invasion of Ukraine in February 2022 was no exception, leaving many Ukrainian patients without access to essential care.

Materials and methods: We conducted a retrospective cohort study to assess the impact of the MedEvac program, facilitating the transfer of Ukrainian patients with cancer to European Union (EU) institutions for treatment, and to describe its components. Patient data from the Ministry of Health of Ukraine (MOH) database (April 2022-April 2023) were analyzed.

Results: Of 639 applications in the MOH database, 339 (53.1%) had sufficient data for analysis and, of those, 281 (82.9%) were evacuated to EU hospitals. Median age of evacuated patients was 47 (IQR, 38-58) years and most were newly diagnosed (94.0%, n = 264). Predominantly, patients were evacuated for systemic cancer therapy (81.9%, n = 230). Multivariate logistic regression analysis revealed that a good performance status (Eastern Cooperative Oncology Group 0-2) was the most significant factor associated with evacuation (odds ratio [OR], 9.64 [95% CI, 3.08 to 30.23]). Patients with melanoma were more likely to be evacuated, even after adjustment for performance status (OR, 2.56 [95% CI, 1.14 to 5.72]), while patients with head and neck cancer were significantly less so (OR, 0.20 [95% CI, 0.06 to 0.72]).

Conclusion: MedEvac program provides a viable model for medical evacuation and management of patients with cancer amid prolonged military conflict, highlighting the importance of international cooperation and setting a precedent for other crisis responses. Continuous evaluation and adaptation are essential to ensure the program's effectiveness and sustainability.

目的:在军事冲突期间,对受到严重破坏的医疗保健系统的即时反应往往会忽视需要持续专业护理的癌症患者的需求。2022 年 2 月俄罗斯全面入侵乌克兰也不例外,导致许多乌克兰患者无法获得基本医疗服务:我们开展了一项回顾性队列研究,以评估 MedEvac 计划的影响,该计划为乌克兰癌症患者转往欧盟(EU)机构接受治疗提供了便利,我们还对其组成部分进行了描述。研究分析了乌克兰卫生部(MOH)数据库中的患者数据(2022 年 4 月至 2023 年 4 月):在卫生部数据库的 639 份申请中,339 份(53.1%)有足够的数据可供分析,其中 281 份(82.9%)被转送到欧盟医院。后送患者的中位年龄为 47(IQR,38-58)岁,大部分为新诊断患者(94.0%,n = 264)。撤离患者主要是为了接受系统性癌症治疗(81.9%,n = 230)。多变量逻辑回归分析显示,良好的表现状态(东部合作肿瘤学组 0-2)是与撤离相关的最重要因素(几率比 [OR],9.64 [95% CI,3.08 至 30.23])。黑色素瘤患者更有可能被后送,即使在对表现状态进行调整后也是如此(OR,2.56 [95% CI,1.14 至 5.72]),而头颈部癌症患者被后送的几率明显较低(OR,0.20 [95% CI,0.06 至 0.72]):MedEvac计划为长期军事冲突中癌症患者的医疗后送和管理提供了一个可行的模式,强调了国际合作的重要性,并为其他危机应对措施开创了先例。持续评估和调整对确保该计划的有效性和可持续性至关重要。
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引用次数: 0
Medical Tourism for Cancer Treatment: Trends, Trajectories, and Perspectives From African Countries. 癌症治疗医疗旅游:非洲国家的趋势、轨迹和前景》。
IF 3.2 Q2 ONCOLOGY Pub Date : 2024-10-01 Epub Date: 2024-10-24 DOI: 10.1200/GO.24.00131
Fidel Rubagumya, Laura Carson, Daniel Afolayan, Eulade Rugengamanzi, Godwin Abdiel Nnko, Omar Abdihamid, Verna Vanderpuye, Nazik Hammad

Purpose: Cancer continues to be a significant public health concern. Sub-Saharan Africa (SSA) struggles with a lack of proper infrastructure and adequate cancer care workforce. This has led to some countries relying on referrals of cancer care to countries with higher income levels. In some instances, patients refer themselves. Some countries have made it their goal to attract patients from other countries, a term that has been referred to as medical tourism. In this article, we explore the current status of oncology-related medical tourism in SSA.

Methods: This was a cross-sectional study. The study participants included oncologists, surgeons, and any other physicians who take care of patients with cancer. A predesigned questionnaire was distributed through African Organization for Research and Training in Cancer member mailing list and through study team personal contacts and social media.

Results: A total of 52 participants from 17 African countries with a 1.6:2 male to female ratio responded to the survey. Most (55.8%) of the respondents were from Eastern African countries. The majority (92%) of study participants reported that they knew patients who referred themselves abroad, whereas 75% referred patients abroad, and the most common (94%) referral destination was India. The most common (93%) reason for referral was perception of a higher quality of care in foreign health institutions.

Conclusion: The findings suggest the need to improve local health care systems including building trust of the system among general population. The study highlights potential financial toxicity, and it adds to the current emphasis on return of investment on homegrown workforce and cancer treatment infrastructure.

目的:癌症仍然是一个重大的公共卫生问题。撒哈拉以南非洲地区(SSA)因缺乏适当的基础设施和充足的癌症护理队伍而苦苦挣扎。这导致一些国家依赖向收入水平较高的国家转诊癌症患者。在某些情况下,病人会自己转诊。一些国家将吸引其他国家的患者作为自己的目标,这就是所谓的医疗旅游。本文探讨了撒哈拉以南非洲地区与肿瘤相关的医疗旅游现状:这是一项横断面研究。研究参与者包括肿瘤学家、外科医生和其他任何照顾癌症患者的医生。研究人员通过非洲癌症研究与培训组织成员邮件列表、研究小组的个人联系方式和社交媒体分发了事先设计好的调查问卷:共有来自 17 个非洲国家的 52 名参与者参与了调查,男女比例为 1.6:2。大多数受访者(55.8%)来自东非国家。大多数(92%)研究参与者称,他们认识的病人都是自己转诊到国外的,而75%的人是将病人转诊到国外的,最常见(94%)的转诊目的地是印度。最常见(93%)的转诊原因是认为国外医疗机构的医疗质量更高:研究结果表明,有必要改善当地的医疗保健系统,包括建立普通民众对该系统的信任。该研究强调了潜在的经济毒性,并进一步强调了当前对本土劳动力和癌症治疗基础设施投资回报的重视。
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引用次数: 0
Development and Evaluation of Project Management Training for Cancer Research in Sub-Saharan Africa. 撒哈拉以南非洲癌症研究项目管理培训的开发与评估。
IF 3.2 Q2 ONCOLOGY Pub Date : 2024-10-01 Epub Date: 2024-10-31 DOI: 10.1200/GO.24.00088
Elima Jedy-Agba, Caroline Andrews, Emeka Odiaka, Temitope Olukomogbon, Hayley Irusen, Isabella Rockson, Temilade Sorungbe, Marjorie Quarchie, Mohamed Jalloh, Alash'le Abimiku, Timothy R Rebbeck

Purpose: Globally, there were 19.3 million new cancer cases and 10 million cancer deaths, with the African continent contributing approximately 1.1 million new cases and over 700,000 deaths to the global cancer burden in 2020. High quality research is required to understand the etiology and risk factors for common cancers in the region to develop context specific strategies aimed at minimizing the future cancer burden in Africa. Our study addresses a significant gap in the knowledge and resources available for training a project management (PM) workforce for cancer research in Africa.

Methods: We developed and evaluated a training program to strengthen the research capacity of project managers involved in cancer research in Africa. This workshop was held in collaboration with the Men of African Descent and Carcinoma of the Prostate (MADCaP) Consortium. The PM working group of the MADCaP Consortium had previously developed a project manager toolkit to provide a structured approach to PM for cancer research in Africa. We implemented and evaluated this training toolkit in a hybrid workshop in Nigeria.

Results: Among 29 participants from 10 African institutions, PM skills improved after training by 16.6% compared with pretraining levels. In a 1-year follow-up survey, training skills remained better (80.8%) than before the training (70.8%). The training program successfully upskilled the trainees with a significant improvement in knowledge of PM practices including planning, execution, monitoring, and evaluation of projects. The majority (80%) reported an excellent training experience.

Conclusion: PM skills training can be successfully implemented in Africa with long-term retention of knowledge geared toward developing a workforce critical for the implementation of cancer research in the region.

目的:2020 年,全球新增癌症病例 1,930 万例,癌症死亡人数 1,000 万,其中非洲大陆新增癌症病例约 110 万例,癌症死亡人数超过 70 万。我们需要开展高质量的研究,以了解该地区常见癌症的病因和风险因素,从而制定针对具体情况的战略,最大限度地减轻非洲未来的癌症负担。我们的研究填补了非洲癌症研究项目管理(PM)人才培训方面的知识和资源空白:我们制定并评估了一项培训计划,以加强非洲癌症研究项目管理人员的研究能力。该研讨会是与非洲裔男性前列腺癌(MADCaP)联盟合作举办的。MADCaP 联合会的项目管理工作组之前开发了一个项目管理工具包,为非洲癌症研究的项目管理提供了一种结构化方法。我们在尼日利亚举办的混合研讨会上实施并评估了这一培训工具包:结果:在来自 10 个非洲机构的 29 名参与者中,项目管理技能在培训后比培训前提高了 16.6%。在为期一年的跟踪调查中,培训技能(80.8%)仍比培训前(70.8%)有所提高。培训计划成功地提高了受训人员的技能,使他们在项目管理实践(包括项目规划、执行、监控和评估)方面的知识有了显著提高。大多数学员(80%)表示培训体验非常好:项目管理技能培训可在非洲成功实施,并能长期保留知识,从而培养出一支对该地区癌症研究实施至关重要的人才队伍。
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引用次数: 0
Machine Learning to Predict Interim Response in Pediatric Classical Hodgkin Lymphoma Using Affordable Blood Tests. 使用经济实惠的血液化验工具通过机器学习预测小儿典型霍奇金淋巴瘤的中期反应
IF 3.2 Q2 ONCOLOGY Pub Date : 2024-10-01 Epub Date: 2024-10-24 DOI: 10.1200/GO.23.00435
Jennifer A Geel, Artsiom Hramyka, Jan du Plessis, Yasmin Goga, Anel Van Zyl, Marc G Hendricks, Thanushree Naidoo, Rema Mathew, Lizette Louw, Amy Carr, Beverley Neethling, Tanya M Schickerling, Fareed Omar, Liezl Du Plessis, Elelwani Madzhia, Vhutshilo Netshituni, Katherine Eyal, Thandeka V Z Ngcana, Tom Kelsey, Daynia E Ballott, Monika L Metzger

Purpose: Response assessment of classical Hodgkin lymphoma (cHL) with positron emission tomography-computerized tomography (PET-CT) is standard of care in well-resourced settings but unavailable in most African countries. We aimed to investigate correlations between changes in PET-CT findings at interim analysis with changes in blood test results in pediatric patients with cHL in 17 South African centers.

Methods: Changes in ferritin, lactate dehydrogenase (LDH), erythrocyte sedimentation rate (ESR), albumin, total white cell count (TWC), absolute lymphocyte count (ALC), and absolute eosinophil count were compared with PET-CT Deauville scores (DS) after two cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine in 84 pediatric patients with cHL. DS 1-3 denoted rapid early response (RER) while DS 4-5 denoted slow early response (SER). Missing values were imputed using the k-nearest neighbor algorithm. Baseline and follow-up blood test values were combined into a single difference variable. Data were split into training and testing sets for analysis using Python scikit-learn 1.2.2 with logistic regression, random forests, naïve Bayes, and support vector machine classifiers.

Results: Random forest analysis achieved the best validated test accuracy of 73% when predicting RER or SER from blood samples. When applied to the full data set, the optimal model had a predictive accuracy of 80% and a receiver operating characteristic AUC of 89%. The most predictive variable was the differences in ALC, contributing 21% to the model. Differences in ferritin, LDH, and TWC contributed 15%-16%. Differences in ESR, hemoglobin, and albumin contributed 11%-12%.

Conclusion: Changes in low-cost, widely available blood tests may predict chemosensitivity for pediatric cHL without access to PET-CT, identifying patients who may not require radiotherapy. Changes in these nonspecific blood tests should be assessed in combination with clinical findings and available imaging to avoid undertreatment.

目的:利用正电子发射计算机断层扫描(PET-CT)对典型霍奇金淋巴瘤(cHL)进行反应评估是资源丰富地区的标准治疗方法,但在大多数非洲国家却无法实现。我们旨在研究南非 17 个中心的 cHL 儿童患者在中期分析时 PET-CT 结果的变化与血液检测结果变化之间的相关性:方法:在对 84 名儿童 cHL 患者进行两个周期的多柔比星、博来霉素、长春新碱和达卡巴嗪治疗后,将铁蛋白、乳酸脱氢酶 (LDH)、红细胞沉降率 (ESR)、白蛋白、白细胞总数 (TWC)、淋巴细胞绝对计数 (ALC) 和嗜酸性粒细胞绝对计数的变化与 PET-CT 多维尔评分 (DS) 进行比较。DS 1-3 表示快速早期反应(RER),DS 4-5 表示缓慢早期反应(SER)。缺失值采用 k 最近邻算法进行归类。基线和随访血液测试值合并为一个差值变量。数据被分成训练集和测试集,使用 Python scikit-learn 1.2.2 和逻辑回归、随机森林、奈夫贝叶斯和支持向量机分类器进行分析:在预测血液样本中的 RER 或 SER 时,随机森林分析取得了 73% 的最佳验证测试准确率。当应用于完整数据集时,最佳模型的预测准确率为 80%,接受者操作特征 AUC 为 89%。最具预测性的变量是 ALC 的差异,对模型的贡献率为 21%。铁蛋白、LDH 和 TWC 的差异占 15%-16%。血沉、血红蛋白和白蛋白的差异占 11%-12%:结论:低成本、可广泛使用的血液检测项目的变化可预测未接受 PET-CT 治疗的小儿 cHL 的化疗敏感性,从而识别出可能不需要放疗的患者。这些非特异性血液检测指标的变化应结合临床结果和现有影像学资料进行评估,以避免治疗不当。
{"title":"Machine Learning to Predict Interim Response in Pediatric Classical Hodgkin Lymphoma Using Affordable Blood Tests.","authors":"Jennifer A Geel, Artsiom Hramyka, Jan du Plessis, Yasmin Goga, Anel Van Zyl, Marc G Hendricks, Thanushree Naidoo, Rema Mathew, Lizette Louw, Amy Carr, Beverley Neethling, Tanya M Schickerling, Fareed Omar, Liezl Du Plessis, Elelwani Madzhia, Vhutshilo Netshituni, Katherine Eyal, Thandeka V Z Ngcana, Tom Kelsey, Daynia E Ballott, Monika L Metzger","doi":"10.1200/GO.23.00435","DOIUrl":"10.1200/GO.23.00435","url":null,"abstract":"<p><strong>Purpose: </strong>Response assessment of classical Hodgkin lymphoma (cHL) with positron emission tomography-computerized tomography (PET-CT) is standard of care in well-resourced settings but unavailable in most African countries. We aimed to investigate correlations between changes in PET-CT findings at interim analysis with changes in blood test results in pediatric patients with cHL in 17 South African centers.</p><p><strong>Methods: </strong>Changes in ferritin, lactate dehydrogenase (LDH), erythrocyte sedimentation rate (ESR), albumin, total white cell count (TWC), absolute lymphocyte count (ALC), and absolute eosinophil count were compared with PET-CT Deauville scores (DS) after two cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine in 84 pediatric patients with cHL. DS 1-3 denoted rapid early response (RER) while DS 4-5 denoted slow early response (SER). Missing values were imputed using the k-nearest neighbor algorithm. Baseline and follow-up blood test values were combined into a single difference variable. Data were split into training and testing sets for analysis using Python scikit-learn 1.2.2 with logistic regression, random forests, naïve Bayes, and support vector machine classifiers.</p><p><strong>Results: </strong>Random forest analysis achieved the best validated test accuracy of 73% when predicting RER or SER from blood samples. When applied to the full data set, the optimal model had a predictive accuracy of 80% and a receiver operating characteristic AUC of 89%. The most predictive variable was the differences in ALC, contributing 21% to the model. Differences in ferritin, LDH, and TWC contributed 15%-16%. Differences in ESR, hemoglobin, and albumin contributed 11%-12%.</p><p><strong>Conclusion: </strong>Changes in low-cost, widely available blood tests may predict chemosensitivity for pediatric cHL without access to PET-CT, identifying patients who may not require radiotherapy. Changes in these nonspecific blood tests should be assessed in combination with clinical findings and available imaging to avoid undertreatment.</p>","PeriodicalId":14806,"journal":{"name":"JCO Global Oncology","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11529834/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Barriers to Follow-Up of an Abnormal Clinical Breast Examination in Uttar Pradesh, India: A Qualitative Study. 印度北方邦临床乳房异常检查随访障碍:定性研究。
IF 3.2 Q2 ONCOLOGY Pub Date : 2024-10-01 Epub Date: 2024-10-10 DOI: 10.1200/GO.24.00001
Erica Liebermann, Vaibhav Patwardhan, Gulnoza Usmanova, Nadeem Aktar, Shivani Agrawal, Parag Bhamare, Maura McCarthy, Ophira Ginsburg, Somesh Kumar

Purpose: To understand key barriers to diagnostic follow-up for women with an abnormal clinical breast examination (CBE) at the primary care level in the Uttar Pradesh state in India. We also explored acceptability of mobile phones to address barriers to CBE follow-up for women.

Materials and methods: We conducted 28 semistructured in-depth interviews with 12 women with an abnormal CBE at the primary health facility who did not have diagnostic follow-up, four community health workers, nine health care providers from health facilities in rural and urban settings, and three state-level decision makers. Interviews were audiorecorded, transcribed verbatim, and translated from Hindi to English. Thematic analysis was conducted using Dedoose qualitative software. Themes were organized by multilevel barriers to follow-up.

Results: Key barriers to CBE follow-up included knowledge, fear, and stigma about breast cancer; women's health not being prioritized in the family; discomfort seeing male providers; and difficulty navigating the diagnostic facility. Despite community education and outreach efforts by community health workers (known as Accredited Social Health Activists), lack of awareness of breast cancer and the importance of follow-up for abnormal CBE remains a barrier to early detection. Despite widespread access to mobile phones, perceived acceptability varied among stakeholders regarding mobile phone use for breast health education and communication with clients.

Conclusion: Knowledge, cultural, and health system barriers challenge women's ability to follow recommendations for diagnostic follow-up of an abnormal CBE. Multilevel and gender-responsive strategies are needed to address these barriers. Our results suggest that mobile phones could be used to further improve breast health awareness, patient navigation, and tracking, and further research is needed.

目的:了解印度北方邦基层医疗机构对临床乳房检查(CBE)异常妇女进行诊断随访的主要障碍。我们还探讨了用手机解决妇女 CBE 随访障碍的可接受性:我们进行了 28 次半结构式深度访谈,访谈对象包括 12 名在基层医疗机构发现 CBE 异常但未进行诊断随访的妇女、4 名社区卫生工作者、9 名来自农村和城市医疗机构的医疗服务提供者以及 3 名邦级决策者。对访谈进行了录音、逐字记录并从印地语翻译成英语。使用 Dedoose 定性软件进行了主题分析。结果:结果:CBE 随访的主要障碍包括对乳腺癌的了解、恐惧和污名化;女性健康在家庭中未被优先考虑;看男医生不舒服;以及在诊断设施中的导航困难。尽管社区卫生工作者(被称为 "经认可的社会健康活动家")开展了社区教育和外联工作,但人们对乳腺癌以及异常 CBE 随访的重要性缺乏认识,这仍然是早期发现的一个障碍。尽管移动电话已广泛普及,但各利益相关方对使用移动电话进行乳腺健康教育和与客户沟通的接受程度不尽相同:结论:知识、文化和医疗系统方面的障碍对妇女遵循CBE异常诊断跟踪建议的能力构成了挑战。要消除这些障碍,需要采取多层次和促进性别平等的策略。我们的研究结果表明,手机可用于进一步提高乳腺健康意识、患者导航和跟踪,还需要进一步的研究。
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引用次数: 0
Barriers to Implementing a Quality Improvement Program in Low- and Middle-Income Countries: Adequacy of Resources. 中低收入国家实施质量改进计划的障碍:资源的充足性。
IF 3.2 Q2 ONCOLOGY Pub Date : 2024-10-01 Epub Date: 2024-10-24 DOI: 10.1200/GO.24.00114
Debanjan Pain, Emily MacDuffie, Yehoda M Martei, Megan Kassick, Daniel J Ikeda, Lawrence N Shulman, Lina Loaiza Salazar, Dayssy Diaz Pardo, Shona Nag, Surbhi Grover

Low- and middle-income countries (LMICs) report disproportionally worse cancer mortality. Current global cancer control efforts focus predominantly on expanding access to multimodality treatment for patients, whereas less attention has been spent on implementing strategies to ensure sustained quality assessment and improvement across the cancer care continuum. The goal of this focused review was to examine specific resource barriers to the development and implementation of quality improvement programs in LMICs. In this article, we use a nonsystematic review process to discuss the existing literature on four resource barriers within the context of cancer care delivery in LMICs, focusing on staff, time allocated for quality improvement work, research infrastructure, and funding. We provide possible solutions to address these barriers and share examples of specific quality improvement initiatives implemented across different world regions. Possible solutions to address these resource barriers include investment in human resources by increasing recruitment and training of the workforce, engagement of medical trainees and patients in quality improvement work, establishment of cancer registries and electronic medical records, and prioritization by large international funding agencies to invest in quality improvement research in LMICs. This review highlights four prevalent resources barriers to quality improvement in LMICs. Using examples from Botswana, Colombia, India, and Rwanda, we demonstrate solutions that may help overcome these barriers.

中低收入国家(LMICs)的癌症死亡率高得不成比例。目前全球癌症控制工作的重点主要集中在扩大患者获得多模式治疗的机会上,而较少关注如何实施战略以确保在整个癌症治疗过程中持续进行质量评估和改进。本次重点综述的目的是研究在低收入和中等收入国家制定和实施质量改进计划的具体资源障碍。在本文中,我们采用了非系统性综述的方法,讨论了在低收入国家癌症医疗服务中存在的四种资源障碍的现有文献,重点关注人员、分配给质量改进工作的时间、研究基础设施和资金。我们提供了解决这些障碍的可行方案,并分享了世界不同地区实施的具体质量改进措施的实例。解决这些资源障碍的可行方案包括:通过增加人员招聘和培训进行人力资源投资;让医学学员和患者参与质量改进工作;建立癌症登记册和电子病历;大型国际资助机构优先投资于低收入和中等收入国家的质量改进研究。本综述重点介绍了阻碍低收入与中等收入国家质量改进的四种普遍存在的资源障碍。通过博茨瓦纳、哥伦比亚、印度和卢旺达的实例,我们展示了有助于克服这些障碍的解决方案。
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引用次数: 0
Intersectionality Between Country, Gender and Funding in Authorship for Phase III Trials Presented at the ASCO Annual Meeting 2022. 在 2022 年 ASCO 年会上发表的《III 期试验作者身份中的国家、性别和资金交叉性》。
IF 3.2 Q2 ONCOLOGY Pub Date : 2024-10-01 Epub Date: 2024-10-03 DOI: 10.1200/GO.24.00238
Laure-Anne Teuwen, Joanna Young, Saleh Alessy, Berna C Özdemir, Diah Martina, Sharif Folorunso, Maria T Bourlon, Hans Prenen, Eva Segelov

Purpose: Multiple disparities have been recognized in the area of location, gender, and funding for leadership in oncology clinical trials. Understanding their intersectionality is crucial to be able to formulate policies and actions, to ensure research is representative of the global oncology community. Here, data from phase III trials presented at the ASCO Annual Meeting of 2022 (ASCO22) were analyzed.

Methods: The location of institution, gender of lead and senior authors, and funding source for solid tumor phase III trial abstracts presented at the ASCO22 were analyzed. World Bank analytical grouping version 2021-2022 was used to describe regions and countries as high (HIC), upper-middle (UMIC), lower-middle (LoMIC), and low-income (LIC).

Results: Across 239 phase III abstracts, lead and senior authors respectively represented HIC institutions in 83% and 85%, UMIC in 13% and 12%, and LoMIC in 4% and 3%. No authors worked in LICs or sub-Saharan Africa. Women accounted for 29% of lead and 23% of senior authors. This distribution persisted across regions, with women as lead authors ranging from 19% (UMIC) to 31% (HIC), and as senior authors from 7% (UMIC) to 25% (HIC). Industry funded 62% of trials, academia 17%, and others 15%; 6% lacked funding. Industry funding was highest in HIC trials (66% for lead and senior authors), followed by UMICs (55% lead, 53% senior) and LoMICs (11% lead, 0% senior). Industry-sponsored trials were proportionally equally represented among female and male senior authors (63% each).

Conclusion: There is marked intersectionality in leadership of oncology clinical trials presented at the world's largest oncology conference.

目的:人们已经认识到,在肿瘤学临床试验的地点、性别和领导资金方面存在多种差异。了解这些差异的交叉性对于制定政策和行动、确保研究能够代表全球肿瘤学界至关重要。本文分析了在 2022 年 ASCO 年会(ASCO22)上展示的 III 期试验数据:方法:分析了在 ASCO22 上发表的实体瘤 III 期试验摘要的机构所在地、主要作者和资深作者的性别以及资金来源。世界银行 2021-2022 年版分析分组将地区和国家分为高收入国家(HIC)、中上游国家(UMIC)、中下游国家(LoMIC)和低收入国家(LIC):结果:在 239 篇 III 期论文摘要中,主要作者和资深作者分别有 83% 和 85% 来自高收入国家,13% 和 12% 来自中上收入国家,4% 和 3% 来自低收入国家。没有作者在低收入国家或撒哈拉以南非洲工作。女性占主要作者的 29%,占资深作者的 23%。这种分布在不同地区持续存在,女性作为主要作者的比例从19%(UMIC)到31%(HIC)不等,女性作为资深作者的比例从7%(UMIC)到25%(HIC)不等。工业界资助了62%的试验,学术界资助了17%,其他资助了15%;6%的试验缺乏资助。产业资助比例最高的是HIC试验(66%为第一作者和资深作者),其次是UMIC试验(55%为第一作者,53%为资深作者)和LoMIC试验(11%为第一作者,0%为资深作者)。行业赞助的试验在女性和男性资深作者中的比例相当(各占 63%):结论:在全球最大的肿瘤学会议上发表的肿瘤临床试验的领导者存在明显的交叉性。
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引用次数: 0
Development and Validation of a Clinical Prediction Model for Paclitaxel Hypersensitivity Reaction on the Basis of Real-World Data: Pac-HSR Score. 基于真实世界数据的紫杉醇超敏反应临床预测模型的开发与验证:Pac-HSR 评分。
IF 3.2 Q2 ONCOLOGY Pub Date : 2024-10-01 Epub Date: 2024-10-17 DOI: 10.1200/GO-24-00318
Sunatee Sa-Nguansai, Radasar Sukphinetkul

Purpose: Paclitaxel is effective chemotherapy against various cancers but can cause hypersensitivity reaction (HSR). This study aimed to identify predictors associated with paclitaxel HSR and develop a clinical prediction model to guide clinical decisions.

Methods: Data were collected from the medical records database of Rajavithi Hospital. Patients with cancer treated with paclitaxel from 2015 to 2022 were included, and a multivariable logistic regression analysis identified predictors associated with paclitaxel HSR. The scoring system was transformed and calibrated on the basis of diagnostic parameters. Discrimination and calibration performances were assessed. Internal validation was conducted using bootstrap resampling with 1,000 replications.

Results: This study involved 3,708 patients with cancer, with an incidence of paclitaxel HSR of 10.11%. An 11-predictor-based Pac-HSR scoring system was developed, involving the following factors: younger age; poor Eastern Cooperative Oncology Group performance status; previous history of paclitaxel HSR; medication allergy history; chronic obstructive airway disease; lung and cervical cancers; high actual dose of paclitaxel; no diphenhydramine premedication; low hemoglobin level; high WBC count; and high absolute lymphocyte count. The C-statistics was 0.73 (95% CI, 0.70 to 0.76), indicating acceptable discrimination. The P value of the Hosmer-Lemeshow goodness-of-fit test was 0.751. The ratio of observed and expected values was 1.00, indicating good calibration. At a cutoff point of 8, specificity was 75.28% and sensitivity was 57.07%. Internal validation indicated good performance with minimal bias, and decision curve analysis demonstrated improved prediction with the use of this scoring system in clinical decision making.

Conclusion: This study developed the 11-predictor-based Pac-HSR scoring system for predicting paclitaxel HSR in patients with cancer. High-risk patients identified by this score should be prioritized for close monitoring and early treatment prophylaxis.

目的:紫杉醇是治疗多种癌症的有效化疗药物,但可引起超敏反应(HSR)。本研究旨在确定与紫杉醇超敏反应相关的预测因素,并建立临床预测模型以指导临床决策:方法:从 Rajavithi 医院的病历数据库中收集数据。纳入了2015年至2022年接受紫杉醇治疗的癌症患者,并通过多变量逻辑回归分析确定了与紫杉醇HSR相关的预测因素。根据诊断参数对评分系统进行了转换和校准。评估了识别和校准性能。使用自举重采样法进行了1000次重复,进行了内部验证:这项研究涉及 3708 名癌症患者,紫杉醇 HSR 发生率为 10.11%。研究建立了一个基于 11 个预测因子的 Pac-HSR 评分系统,其中包括以下因素:年龄较小;东部合作肿瘤学组(Eastern Cooperative Oncology Group)表现较差;既往紫杉醇 HSR 病史;药物过敏史;慢性阻塞性气道疾病;肺癌和宫颈癌;紫杉醇实际剂量高;无苯海拉明预处理;低血红蛋白水平;高白细胞计数;高绝对淋巴细胞计数。C 统计量为 0.73(95% CI,0.70 至 0.76),表明区分度可以接受。Hosmer-Lemeshow 拟合优度检验的 P 值为 0.751。观察值与预期值的比值为 1.00,表明校准效果良好。在截断点为 8 时,特异性为 75.28%,灵敏度为 57.07%。内部验证表明该评分系统性能良好,偏差极小,决策曲线分析表明在临床决策中使用该评分系统可提高预测效果:本研究开发了基于 11 个预测因子的 Pac-HSR 评分系统,用于预测癌症患者的紫杉醇 HSR。通过该评分确定的高危患者应优先进行密切监测和早期预防治疗。
{"title":"Development and Validation of a Clinical Prediction Model for Paclitaxel Hypersensitivity Reaction on the Basis of Real-World Data: Pac-HSR Score.","authors":"Sunatee Sa-Nguansai, Radasar Sukphinetkul","doi":"10.1200/GO-24-00318","DOIUrl":"https://doi.org/10.1200/GO-24-00318","url":null,"abstract":"<p><strong>Purpose: </strong>Paclitaxel is effective chemotherapy against various cancers but can cause hypersensitivity reaction (HSR). This study aimed to identify predictors associated with paclitaxel HSR and develop a clinical prediction model to guide clinical decisions.</p><p><strong>Methods: </strong>Data were collected from the medical records database of Rajavithi Hospital. Patients with cancer treated with paclitaxel from 2015 to 2022 were included, and a multivariable logistic regression analysis identified predictors associated with paclitaxel HSR. The scoring system was transformed and calibrated on the basis of diagnostic parameters. Discrimination and calibration performances were assessed. Internal validation was conducted using bootstrap resampling with 1,000 replications.</p><p><strong>Results: </strong>This study involved 3,708 patients with cancer, with an incidence of paclitaxel HSR of 10.11%. An 11-predictor-based Pac-HSR scoring system was developed, involving the following factors: younger age; poor Eastern Cooperative Oncology Group performance status; previous history of paclitaxel HSR; medication allergy history; chronic obstructive airway disease; lung and cervical cancers; high actual dose of paclitaxel; no diphenhydramine premedication; low hemoglobin level; high WBC count; and high absolute lymphocyte count. The C-statistics was 0.73 (95% CI, 0.70 to 0.76), indicating acceptable discrimination. The <i>P</i> value of the Hosmer-Lemeshow goodness-of-fit test was 0.751. The ratio of observed and expected values was 1.00, indicating good calibration. At a cutoff point of 8, specificity was 75.28% and sensitivity was 57.07%. Internal validation indicated good performance with minimal bias, and decision curve analysis demonstrated improved prediction with the use of this scoring system in clinical decision making.</p><p><strong>Conclusion: </strong>This study developed the 11-predictor-based Pac-HSR scoring system for predicting paclitaxel HSR in patients with cancer. High-risk patients identified by this score should be prioritized for close monitoring and early treatment prophylaxis.</p>","PeriodicalId":14806,"journal":{"name":"JCO Global Oncology","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142465990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Genetic Signatures: CD44 Single-Nucleotide Polymorphisms Affect Cell Surface Expression and Elevate Risk in Head and Neck Squamous Cell Carcinoma. 遗传特征:CD44 单核苷酸多态性影响细胞表面表达并增加头颈部鳞状细胞癌的风险。
IF 3.2 Q2 ONCOLOGY Pub Date : 2024-10-01 Epub Date: 2024-10-31 DOI: 10.1200/GO.24.00084
Muhammad Kashif, Shah Jahan, Sadia Minhas, Ali Amar, Romeeza Tahir, Haseeb Nisar, Faheem Shehzad, Abdul Hanan Nagi, Nadeem Afzal

Purpose: This study aimed to investigate the impact of single-nucleotide polymorphisms (SNPs) in the CD44 gene, specifically in the 3'UTR region (rs13347) and intronic region (rs187115), on the cell surface expression of CD44 protein and the risk of development of head and neck squamous cell carcinoma (HNSCC).

Materials and methods: The study involved analysis of 85 samples and 85 healthy controls. Immunohistochemistry (IHC) and flow cytometry were used to assess cell surface protein expression using CD44 antibody. DNA from formalin-fixed paraffin-embedded tissue sections was isolated and amplified using targeted primers. Sanger sequencing of the resultant amplified products was performed to determine the genotypes of the CD44 rs13347 and rs187115 SNPs. GTEx and RegulomeDB were queried to evaluate the genotypic effects of these variants on target gene expression and regulation.

Results: A comparison between patients with HNSCC and healthy controls revealed a significant association between CD44 rs13347 and an increased risk of HNSCC in all the analyzed models, especially the TT genotype showed a significantly higher risk with an odds ratio of 8.69 (95% CI, 2.35 to 32.09; P = .0003). However, no significant association was found between CD44 rs187115 and HNSCC in any of the models analyzed (all P > .05). Other notable findings included significant associations between CD44 rs13347 genotype and age (P = .031), number of CD44-positive tumor cells (P = .049), CD44 staining intensity (SI; P = .039), and CD44 immunoreactivity score (IRS) status (P = .019).

Conclusion: The T allele and homozygous TT genotype of CD44 rs13347 SNP were associated with increased susceptibility to HNSCC and decreased proportion of CD44-positive tumor cells, low SI, and reduced IRS.

目的:本研究旨在探讨CD44基因中的单核苷酸多态性(SNPs),尤其是3'UTR区(rs13347)和内含子区(rs187115)的单核苷酸多态性对CD44蛋白的细胞表面表达以及头颈部鳞状细胞癌(HNSCC)发病风险的影响:研究分析了 85 个样本和 85 个健康对照组。采用免疫组织化学(IHC)和流式细胞术,使用 CD44 抗体评估细胞表面蛋白的表达。从福尔马林固定石蜡包埋的组织切片中分离DNA,并使用目标引物进行扩增。对扩增产物进行 Sanger 测序,以确定 CD44 rs13347 和 rs187115 SNPs 的基因型。对 GTEx 和 RegulomeDB 进行了查询,以评估这些变异对靶基因表达和调控的基因型影响:在所有分析模型中,HNSCC 患者与健康对照组的比较显示 CD44 rs13347 与 HNSCC 风险增加有显著关联,尤其是 TT 基因型的风险显著增加,几率比为 8.69 (95% CI, 2.35 to 32.09; P = .0003)。然而,在所有分析模型中,CD44 rs187115 与 HNSCC 之间均未发现明显关联(所有 P > .05)。其他值得注意的发现包括 CD44 rs13347 基因型与年龄(P = .031)、CD44 阳性肿瘤细胞数量(P = .049)、CD44 染色强度(SI;P = .039)和 CD44 免疫反应性评分(IRS)状态(P = .019)之间的显着关联:结论:CD44 rs13347 SNP 的 T 等位基因和同源 TT 基因型与 HNSCC 易感性增加、CD44 阳性肿瘤细胞比例降低、SI 低和 IRS 降低有关。
{"title":"Genetic Signatures: <i>CD44</i> Single-Nucleotide Polymorphisms Affect Cell Surface Expression and Elevate Risk in Head and Neck Squamous Cell Carcinoma.","authors":"Muhammad Kashif, Shah Jahan, Sadia Minhas, Ali Amar, Romeeza Tahir, Haseeb Nisar, Faheem Shehzad, Abdul Hanan Nagi, Nadeem Afzal","doi":"10.1200/GO.24.00084","DOIUrl":"10.1200/GO.24.00084","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to investigate the impact of single-nucleotide polymorphisms (SNPs) in the <i>CD44</i> gene, specifically in the 3'UTR region (rs13347) and intronic region (rs187115), on the cell surface expression of CD44 protein and the risk of development of head and neck squamous cell carcinoma (HNSCC).</p><p><strong>Materials and methods: </strong>The study involved analysis of 85 samples and 85 healthy controls. Immunohistochemistry (IHC) and flow cytometry were used to assess cell surface protein expression using CD44 antibody. DNA from formalin-fixed paraffin-embedded tissue sections was isolated and amplified using targeted primers. Sanger sequencing of the resultant amplified products was performed to determine the genotypes of the <i>CD44</i> rs13347 and rs187115 SNPs. GTEx and RegulomeDB were queried to evaluate the genotypic effects of these variants on target gene expression and regulation.</p><p><strong>Results: </strong>A comparison between patients with HNSCC and healthy controls revealed a significant association between <i>CD44</i> rs13347 and an increased risk of HNSCC in all the analyzed models, especially the TT genotype showed a significantly higher risk with an odds ratio of 8.69 (95% CI, 2.35 to 32.09; <i>P</i> = .0003). However, no significant association was found between <i>CD44</i> rs187115 and HNSCC in any of the models analyzed (all <i>P</i> > .05). Other notable findings included significant associations between <i>CD44</i> rs13347 genotype and age (<i>P</i> = .031), number of CD44-positive tumor cells (<i>P</i> = .049), CD44 staining intensity (SI; <i>P</i> = .039), and CD44 immunoreactivity score (IRS) status (<i>P</i> = .019).</p><p><strong>Conclusion: </strong>The T allele and homozygous TT genotype of <i>CD44</i> rs13347 SNP were associated with increased susceptibility to HNSCC and decreased proportion of CD44-positive tumor cells, low SI, and reduced IRS.</p>","PeriodicalId":14806,"journal":{"name":"JCO Global Oncology","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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JCO Global Oncology
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