JCO Global Oncology最新文献

Purpose: Radiation therapy technologists (RTTs) are central to safe and effective cancer care, yet little is known about the education and training of RTTs in Saudi Arabia. This study aimed to assess the current status of RTT education and training in the country, identify existing gaps, and compare the findings with regional and international benchmarks.

Materials and methods: A survey-based cross-sectional study was conducted from April 5, 2025, to August 15, 2025, targeting RTTs across Saudi Arabia. The survey collected demographic data, educational and training experience, and institutional curriculum information.

Results: Seventy RTTs responded (41% response rate). Among the respondents, 60% were female and 40% male. The majority (64.3%) were Saudi nationals, whereas the remaining 35.7% were non-Saudis. Most respondents held bachelor's degrees (78.6%) and had completed clinical placements for at least 12 months (71.4%). A total of 54.5% of the institutions reported implementing the International Atomic Energy Agency guidelines, either fully or partially. Most RTTs (67.4%) received their education abroad, primarily from the United Kingdom and Australia, although domestic training is gradually expanding. Most respondents worked in major urban centers, with workforce distribution concentrated in Riyadh and Jeddah.

Conclusion: RTT education in Saudi Arabia shows encouraging trends in clinical placement and formal education duration; however, challenges persist regarding curriculum standardization and integration of international guidelines. This study underscores the pressing need to develop a unified national curriculum, enhance faculty development, and expand RTTs' opportunities for professional growth nationwide.

Purpose: Advances in the systemic treatment for advanced clear cell renal cell carcinoma (ccRCC) have led to improvements in survival time. Globally, access to therapies with proven benefit, such as immune checkpoint inhibitors (ICPIs) and tyrosine kinase inhibitors, varies. Our investigation assessed whether patients from New Zealand have differential outcomes compared with their Australian counterparts.

Methods: In this retrospective cohort study, outcomes for patients treated with systemic therapy for advanced ccRCC in New Zealand (Auckland and Waikato) and Australia (Melbourne) were compared. Overall survival (OS) was the primary outcome. Key secondary outcomes included number of lines of systemic therapy received and the proportion of patients receiving an ICPI.

Results: One hundred and eighty-three, 101, and 66 patients were eligible for inclusion from Auckland, Waikato, and Australia, respectively, between 2010 and 2019. Median OS time was longer for the Australian cohort compared with the combined New Zealand cohort (56 v 17 months, hazard ratio, 0.40, P < .0001). Increased receipt of subsequent-line therapies was observed in the Australian cohort (24% v 11% received third line). A higher proportion of patients in the Australian cohort received an ICPI-containing regimen (41% v 13%).

Conclusion: Clinically meaningful differences in survival time were seen for patients treated with systemic therapy for advanced ccRCC between the New Zealand and Australian cohorts. These differences were greater than anticipated, with shorter survival time for patients in New Zealand. This analysis supports efforts to improve access to systemic therapies for patients with advanced ccRCC in New Zealand.

Monitoring clinical outcomes is essential for cancer control. Yet, population-based surveillance systems are scarce in low- and middle-income countries (LMICs). To fill a real-world population-based data gap on cancer outcomes in Colombia, we implemented VIGICANCER in 2009, a nationwide childhood cancer clinical outcomes surveillance system to collect, analyze, and disseminate valid, reliable, and timely population-based information. This Special Article describes the evolution and impact of VIGICANCER, contextualized within the Latin-American population-based data systems landscape. VIGICANCER registers children (<19 years) newly diagnosed with cancer, receiving treatment at 27 participating institutions in 10 Colombian cities. VIGICANCER collects sociodemographic and clinical information, conducting quarterly active follow-up surveillance to document deaths, relapses, second malignancies, treatment abandonment, and loss to follow-up. To date, VIGICANCER has collected comprehensive data from >12,000 patients, covering 55%-60% of the projected new childhood cancer cases nationwide yearly. We describe clinical characteristics, 5-year overall survival (OS), and event-free survival (EFS) in a 14-year cohort of Colombian children with cancer. Kaplan-Meier and log-rank tests were used for survival analyses. From 2009 to 2023, VIGICANCER analyzed 9,986 patients and 3,626 events, including 3,081 deaths. The cohort's median age was 8.6 years (IQR, 4.0-13.7), 55.0% of patients (n = 5,489/9,986) were male, 8.0% (n = 757/9,479) were Black, 3.3% (n = 206/6,165) were Indigenous, and 49.9% (n = 4,849/9,711) had public insurance. Five-year OS and EFS were 63.3% (SE, 0.6) and 57.9% (SE, 0.6), respectively. VIGICANCER yields meaningful and actionable population-based data on the local standard of care, guiding data-driven multilevel interventions to improve survival. VIGICANCER provides a reproducible, equity-focused model for LMIC, demonstrating how real-world data inform cancer control policy to reduce survival disparities and advance the goals of the WHO Global Initiative for Childhood Cancer.

Purpose: Survival outcomes for childhood ALL in low- and middle-income countries (LMICs) have shown gradual improvement, closely following the remarkable outcomes achieved in high-income countries, albeit with some time lag. This has been achieved by decades of efforts since the 1940s.

Methods: We conducted a narrative review of the previous literature, therapeutic innovations, and landmark trials in the evolution of childhood ALL from 1948 to 2025 and drew an analogy of how they have been adapted in the Indian context. The review gives a historical summary of the key therapeutic principles and survival trends over time.

Results: Globally, the principles of multiagent chemotherapy, CNS-directed therapy, risk-stratified intensification, minimal residual disease-guided treatment, and immunotherapy have shaped the backbone of modern ALL management. Each step has contributed to the steady rise in survival from 4% in the 1960s to 96% in the current era. In India, these principles were adopted sequentially with multicentre protocol 841, International Network for Cancer Treatment and Research protocols, and finally the risk-adapted Indian Collaborative Childhood Leukaemia protocol, resulting in improved survival from nearly 10% in the 1970s to 61%-76% in recent trials. However, survival remains approximately 20% lower than global benchmarks because of treatment-related mortality (12%), CNS relapses, and limited access to newer drugs, immunotherapy, and advanced diagnostics. Lately, low-intensity locally adapted regimens and affordable indigenous (CD19) chimeric antigen receptor T-cell therapy offer promise to partly narrow the gap although treatment toxicity and limited blinatumomab access remain challenging.

Conclusion: The care of childhood ALL in India demonstrates how evidence-based protocol adaptations, health system strengthening, and multicentric collaboration can improve outcomes in LMICs despite several challenges, including financial constraints, limited drug access, late presentation, and treatment abandonment.

Purpose: This study sought to evaluate the accuracy of artificial intelligence (AI)-based interpretation of digital surface images of skin lesions to diagnose Kaposi sarcoma (KS) among dark-skinned patients in Uganda.

Methods: Patients were evaluated at skin biopsy services in Uganda because of clinical suspicion of KS. In a cross-sectional design, 482 consecutive participants were enrolled. Lesions were photographed using a digital camera, and punch biopsies were obtained. Histopathologic interpretation was considered the gold standard. Using training (approximately 70% of images) and validation (approximately 10% of images) sets, we developed a prediction model using a rule-based combination of You Only Look Once version 5 and 8 object detection classifiers. We determined sensitivity, specificity, and positive and negative predictive values of the AI-based prediction model in a test set (approximately 20% of images) and compared these with the accuracy of a dermatologist's visual interpretation of images.

Results: Four hundred seventy-two participants (1,385 images) were evaluable. Of these, 36% was female; the median age was 34 years; and 94% had HIV, 332 had KS, and 140 had no KS by histopathology. In the test set, the AI-derived prediction model achieved 89% sensitivity (85%-94%) and 51% specificity (40%-61%) for diagnosing KS; the positive predictive value was 81% (75%-86%), and the negative predictive value was 67% (55%-78%). The area under the receiver operating characteristic curve was 0.72. A dermatologist evaluating the same images, with emphasis on sensitivity, achieved a sensitivity of 93% (89%-96%) and a specificity of 19% (11%-28%).

Conclusion: Among dark-skinned patients in Uganda with lesions suspicious for KS, evaluation of digital surface images by an AI-based prediction model produced moderate accuracy for diagnosing KS. While currently inadequate for clinical use, this inaugural assessment is sufficiently promising to justify future evaluation of larger data sets and evolving technologies.

Purpose: Hepatocellular carcinoma (HCC) is a major cause of cancer mortality in sub-Saharan Africa, with most cases arising from chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infections. Despite Rwanda's national hepatitis guidelines recommending biannual surveillance with abdominal ultrasound (US) and alpha-fetoprotein (AFP) testing, the extent of adherence remains unknown. This study aimed to assess adherence to HCC surveillance guidelines among HBV- and HCV-infected patients at a national referral hospital in Rwanda.

Methods: We conducted a retrospective descriptive study of HBV- and HCV-infected patients attending the Rwanda Military Referral and Teaching Hospital between January 2022 and December 2024. Surveillance adherence was assessed based on the proportion of time covered by abdominal US and AFP testing, with coverage categorized as optimal (100%), intermediate (50%-99%), or poor (<50%).

Results: Among 388 patients (mean age, 41.9 years; 73.4% male), 82.7% were HBV-infected. Over one third (31.4%) and nearly half (44.6%) of the patients never received an US or AFP test, respectively. Only 15.5% achieved optimal US coverage, and 12.1% had optimal AFP coverage. Surveillance coverage was worse in patients age 31-50 years and those residing in Kigali. Paradoxically, patients from rural provinces demonstrated better adherence. Thirteen patients (3.4%) had liver lesions detected on US, although lesion status was undocumented in 44.6% of cases.

Conclusion: Adherence to HCC surveillance guidelines in Rwanda is suboptimal, with significant gaps across age groups and regions. These findings underscore the need for integrating HCC surveillance into routine hepatitis care and leveraging Rwanda's decentralized health system to improve early cancer detection.

Purpose: Virtual follow-up visits have emerged as an alternative to in-person visits for cancer survivorship care, offering potential advantages in accessibility and convenience. Evidence supporting this approach, particularly from the Middle East and North Africa (MENA) region, remains limited. This study compares virtual and in-person follow-up visits among patients withprostate cancer (PCa) after definitive radiotherapy.

Methods: A prospective cross-sectional study was conducted at King Hussein Cancer Center (KHCC), Jordan, using two validated Arabic questionnaires: the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Communication Module (EORTC QLQ-COMU26) to assess patient-provider communication quality, and the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) to assess health-related quality of life (HRQoL). Associations between visit types and patient age, clinic day, distance from hospital, and transportation support were examined.

Results: A total of 248 patients were included, with 118 (48.0%) seen virtually and 130 (52.0%) in person. In-person visits were more common among those younger than 70 years (P = .001), those seen on weekdays (P < .001), as well as those living closer to the hospital or with transportation support (P < .001). Virtual visits demonstrated significantly higher communication scores across all EORTC QLQ-COMU26 domains (P < .001). No significant difference in HRQoL was observed between groups based on total EPIC-CP score (P = .403).

Conclusion: Virtual follow-up visits provided comparable HRQoL outcomes and significantly better communication quality compared with in-person visits. These findings support the value of telemedicine as a patient-centered, cost-effective, and resource-efficient model for follow-up care in PCa, especially when logistical or economic barriers to in-person visits exist.

Purpose: Zambia is among the countries with the highest cervical cancer incidence and mortality rates globally. Stigma can hinder treatment adherence and overall quality of life for patients with cervical cancer. Research on this topic, however, is lacking in Zambia. This study aimed to assess the levels of stigma among patients with cervical cancer in Zambia and examine the association between social support and quality of life.

Methods: We enrolled patients newly diagnosed with cervical cancer at the Cancer Diseases Hospital in Lusaka, Zambia, from July to October 2024. In-person or telephone interviewers collected information on demographic, clinical, and socioeconomic status before treatment. Stigma was assessed using a modified Perceived Stigma Scale, quality of life using the PROMIS-57, and social support with the Multidimensional Scale of Perceived Social Support. Associations between stigma, social support, and quality of life were analyzed using multivariable logistic regression, adjusting for age, education, income, and cancer stage, with significance set at P < .05.

Results: A total of 213 participants were included in the study with a response rate of 96%. Of the total participants, 30.5% were classified as having high stigma. High levels of support from family (odds ratio [OR], 0.44 [95% CI, 0.22 to 0.87]) and friends (OR, 0.43 [95% CI, 0.21 to 0.91]) reduced the odds of stigma. Severe anxiety, depression, fatigue, sleep disturbances, pain, poor physical function, and low social well-being were all strongly associated with higher stigma (all P ≤ .004).

Conclusion: Perceived cervical cancer-related stigma in Zambia is associated with limited social support and poorer quality of life. Programs to strengthen social network support, as well as targeted mental health treatment, are needed to improve the well-being of patients with cervical cancer in Zambia.