JCO Global Oncology最新文献

Purpose: Outcomes of adolescents and young adults (AYA) with bone sarcomas including osteosarcoma (OGS) and Ewing sarcoma (ES) are affected by various factors including inadvertent previous treatment and poor compliance. We aimed to develop a risk-scoring system derived and validated at a tertiary care cancer center in India.

Methods: All AYA OGS and ES cases treated at our institute with OGS-12 and Ewing's family of tumors-2001 (EFT-2001) protocols from 2011 to 2021 and 2013 to 2018, respectively, were prospectively analyzed. Weighted scores provided to each prognostic variable on the basis of approximate ratios of the beta coefficients of each factor in the multivariable model were summated to divide patients into three clinically discriminatory risk groups, validated by applying separately to derivation, validation, and whole cohorts.

Results: Among 606 (81.0%) of 748 AYA with nonmetastatic OGS, significant factors included in the prognostic model were failure to complete protocol (hazard ratio [HR], 2.65), previous treatment (HR, 2.93), necrosis <90% (HR, 1.63), joint involvement (HR, 2.0), and serum alkaline phosphatase >median (204 U/L; HR, 1.63). Of 104 (39.5%) of 263 AYA with ES, significant factors were failure to complete protocol (HR, 2.84), previous treatment (HR, 6.37), necrosis <100% (HR, 8.73), and tumor size >8 cm (HR, 2.64). For 142 (38.8%) of 366 AYA with metastatic OGS, significant factors were failure to complete protocol (HR, 5.29), metastases not amenable to local treatment (HR, 1.96), necrosis <90% (HR, 1.96), and >10 metastases (HR, 2.44). For 38 (43.6%) of 82 AYA with metastatic extremity ES, significant factors were failure to complete protocol (HR, 3.88) and metastases not amenable to local treatment (HR, 10.6).

Conclusion: We developed simple, effective prognostic models for AYA with bone sarcomas with specific potential relevance for low- and middle-income countries.

Purpose: The under-representation of African countries in cancer clinical trials continues to widen the cancer health disparity. In this study, we assessed health care workers' perspectives on recruitment and retention in cancer clinical trials in Nigeria.

Methods: This study was a convergent parallel mixed-methods design, using a survey for quantitative analysis and focus group discussions (FGDs) for further qualitative investigation. The health care providers that participated in the study were drawn from the ICON-3 Practice-based Research Network across the six geopolitical zones in Nigeria.

Results: Of the 42 providers, 35 completed the survey and 25 participated in the FGDs. The most cited (agreed or strongly agreed) patient-related barriers were lack of understanding of cancer clinical trials (83%), cultural barriers (77%), and lack of financial compensation for study visits (77%). The most cited provider-related barriers were negative attitude of the clinical team (89%), lack of training in good clinical practice (89%), and an overwhelming clinical workload (86%). On trial-related barriers, about 71% agreed or strongly agreed that lack of trial publicity was a barrier. Over 90% of the respondents agreed or strongly agreed that several factors, including the friendliness of the study team (97%) and clarity in the presentation of trial information (97%), are important facilitators. The FGDs unveiled additional themes, including systems-related barriers such as lack of infrastructure, limited research collaboration, and prolonged ethical approval process, and capacity building and community engagement as potential facilitators.

Conclusion: Our study provides providers' perspectives on the barriers and facilitators to the recruitment and retention of participants in cancer clinical trials in a low-resource setting and highlights the need for culturally appropriate recruitment strategies.

Purpose: Limited information exists about medical oncology fellowship programs in Latin America. Our study aimed to clarify unknowns, with the goal of identifying areas for improvement and potential expansion of fellowships.

Materials and methods: Sixteen medical oncologists, each from a different Latin American country, were surveyed using an online questionnaire. Descriptive statistics were used to summarize the collected variables.

Results: In total, 232 fellowship programs exist in the surveyed nations, of which 444 medical oncologists graduate every year. Only Argentina, Brazil, Chile, Mexico, and Peru have more than five active fellowship programs. Honduras and Nicaragua did not report any fellowship programs. These nations-along with Colombia, Ecuador, El Salvador, Guatemala, and Peru-depend on foreign education for the training of their medical oncologists. Only one of every 50 medical graduates pursues a career path in medical oncology, and a mere 2.2% of internal medicine residents transition into the field. Nearly half of the data were collected through word of mouth, as many countries lack official, publicly accessible sources for some of the variables studied.

Conclusion: This study serves as a pioneering effort that future research groups can build upon. We believe that addressing the shortage of medical oncologists in Latin America by increasing the number of locally trained fellows is the most effective way to swiftly and sustainably improve cancer outcomes.

Purpose: We investigated the impact of the funding source (public v private) on the overall survival (OS) of men with prostate cancer in Brazil.

Methods: We retrospectively analyzed patients with prostate cancer from a large hospital registry from the state of São Paulo, Brazil. Patients age 50-99 years diagnosed with prostate acinar adenocarcinoma or adenocarcinoma not otherwise specified (NOS) between January 2014 and December 2017 were eligible. Demographic and clinical features were analyzed alongside the funding source. On the basis of clinical characteristics at diagnosis (lymph node status, distant metastasis, prostate-specific antigen [PSA], and Gleason score), patients were categorized into low-risk, intermediate-risk, high-risk, and metastatic groups.

Results: Of 25,009 patients analyzed, 85% had a public funding source. These patients were slightly older, had greater proportion of adenocarcinoma NOS, and higher PSA levels and risk category. There was a significant difference in OS favoring patients with a private funding source (P < .0001). The estimated OS rates at 5 years were 76.2% (95% CI, 75.6 to 76.9) and 86.9% (95% CI, 85 to 88.7) for the public and private groups, respectively (P < .0001). The funding source was significantly associated with OS independent of age, educational level, and receipt of any treatment in the intermediate-risk (hazard ratio [HR], 2.28 [95% CI, 1.58 to 3.30]; P < .001) and high-risk (HR, 1.36 [95% CI, 1.02 to 1.80]; P = .04) groups, but not in the low-risk (HR, 0.85 [95% CI, 0.60 to 1.21]; P = .38) or metastatic groups (HR, 0.84 [95% CI, 0.64 to 1.11]; P = .23).

Conclusion: The worse OS observed for patients with prostate cancer with a public source of funding underscores the need for actions directed to improve the standards of public health care in Brazil.

Purpose: The number of patients with childhood cancer (CC) in sub-Saharan Africa is expected to rise over the coming years. According to the WHO Initiative for Childhood Cancer, access to care is crucial and must be guided by the needs of patients and their families. Our study explored barriers to CC treatment from a patient's perspective to guide the health care providers.

Methods: From February to September 2021, we conducted a multinational cross-sectional study with a sample from nine population-based cancer registries in nine sub-Saharan countries. Inclusion criteria comprised a cancer diagnosis according to the International Classification of Childhood Cancer, age 0-19 years, and year of diagnosis 2017-2019. A questionnaire was administered asking families about self-perceived barriers accessing surgery, radiotherapy, and chemotherapy. To assess associated factors, we conducted a multivariable regression analysis presenting the results as odds ratios (ORs).

Results: A total of 224 patients with CC was included. The fear of treatment effects and the perceived (poor) health of the child were named most frequently as barriers for all treatment modalities (78.9% and 75.5%, respectively). For chemotherapy, respondents who indicated themselves as rich had lower odds of perceiving the (poor) health of the child as a barrier (OR, 0.06 [95% CI, 0.01 to 0.36]). For radiotherapy, long waiting time and (limited) availability in the country were more commonly barriers (OR, 7.53 [95% CI, 3.38 to 16.78]; OR, 11.11 [95% CI, 2.04 to 60.46], respectively) than for chemotherapy.

Conclusion: Despite known barriers such as the availability of therapy, our study additionally indicates the importance of the patients' and families' perceptions of the disease and its treatment. Further expanding measures of social support for affected families should be regarded as one of the main pillars to assure access to care.

Purpose: Ovarian cancer remains among the most aggressive tumors with the lowest survival probability. Projections are that ovarian cancer will claim more than 8 million lives between 2022 and 2050 without better prevention or control measures.

Methods: We built an Excel-based instrument that uses a prevalence-based cost-of-illness approach and a societal perspective to estimate the burden of ovarian cancer. The instrument leverages data from editions of the World Ovarian Cancer Coalition's Every Woman Study, contains a micro-costing framework to assess the resources and costs of providing care, and uses data from novel systematic reviews and meta-analyses conducted to estimate the effect of ovarian cancer on patient labor productivity outcomes and the time caregivers devote to caring for people living with the disease.

Results: Across 11 countries, we estimated US dollars 70 billion in socioeconomic losses attributable to ovarian cancer. Health expenditures to cover treatment in the first 2 years after diagnosis were 7, 41, and 118 times total health spending per capita in high-, upper-middle-, and low- and lower-middle countries, respectively. Patients spent 3,663 years traveling to or receiving treatment. Women lost labor productivity equivalent to 2.5 million workdays due to ill-health from ovarian cancer, and 9,403 women living with ovarian cancer or survivors were estimated to be missing from the workforce. Caregivers spent 17,112 person-years providing practical support to patients-an average of 33 days per woman living with ovarian cancer.

Conclusion: This study is the first to quantify the social and economic burden of ovarian cancer in 11 countries and highlights its significant cost and defines actions needed to improve ovarian cancer outcomes.

Purpose: Soon after the Russian invasion of Ukraine in February 2022, an initiative was organized to evacuate Ukrainian children with cancer, most initially to Poland. This study assessed the impact of this rapid increase in clinical need on the Polish system of pediatric cancer care.

Methods: This multicenter longitudinal approach was performed among all 19 Polish Pediatric Oncology Centers (PPOCs). We compared PPOC capacity before the invasion with that during the first 11 weeks after the invasion, using three ratios: patients to physicians (PtP), patients to nurses (PtN), and patients to beds (PtB). In addition, we used national data from an ongoing leukemia clinical trial to assess differences between the two study periods in the time required to comply with protocol-indicated medical procedures requiring general anesthesia.

Results: During the study period, 237 Ukrainian refugee children with cancer were treated in PPOCs; 60% of them arrived during the first 21 days of the war. The relative increase in patients varied significantly among the PPOCs, ranging from 42% to 460%. The average PtP, PtN, and PtB ratios increased significantly by 85%, 131%, and 105%, respectively. The portion of patients experiencing a delay in obtaining medical procedures requiring general anesthesia increased from 15% before the war to 18.2% (P = .043).

Conclusion: Because of the large number of Ukrainian children with cancer were evacuated to Poland, capacity of PPOCs was reduced, affecting cancer care for all patients. Maintaining standards of pediatric oncology care in Poland would not be possible without further patient referral to medical facilities around the world by international humanitarian collaborative action.

Purpose: Cultural differences and their effect on international collaboration have been studied in several industries but only recently in health care. Understanding these differences can significantly influence the outcomes of ASCO's international co-operation initiatives focused on quality improvement.

Methods: This manuscript is a scoping literature review examining how cultural differences influence the quality and safety of oncology care, and what strategies can be implemented to improve quality and outcomes in multicultural settings using cultural traits outlined by Hofstede's dimensions of culture. Power distance index (PDI; the ability to speak up without embarrassment) emerged in other industries as the most relevant trait affecting quality and team performance.

Results: Few publications are available addressing such perspective, and the literature to date revealed that cultures with small PDI tend to perform better in health care safety and quality, and leadership behavior is a dominant feature in this condition. New techniques adopting psychological safety practices can mitigate cultural traits like PDI that hinder quality practices in oncology.

Conclusion: The authors consider that psychological safety practices are a culturally sensitive strategy to ASCO's Quality Programs that can mitigate local cultural barriers and develop leadership behaviors that enable safety and quality strategies, and foster more effective international collaboration in ASCO Quality Programs in the future.