JCO Global Oncology最新文献

Purpose: To evaluate the impact of a patient navigation program (PNP) on treatment delays among patients with GI cancers at the Rwanda Military Referral and Teaching Hospital (RMRTH).

Methods: PNP is a personalized support model implemented at RMRTH on April 1, 2023, to guide patients with a cancer diagnosis through the health care system. We used a quasi-experimental study design and included all patients diagnosed and treated for esophageal, gastric, or colorectal cancer in pre- and postimplementation of PNP at RMRTH. The outcomes of interest were measured in days: treatment interval from pathology report to treatment initiation. Data were abstracted from patients' medical records and analyzed using STATA version 19. The Wilcoxon rank-sum test was performed. Treatment intervals were used in the time series analysis, and the Dickey-Fuller Test was used to test stationarity.

Results: A total of 151 patients, with 85 patients in the post-PNP group, were included. The mean age (years) at diagnosis was similar (59.4 ± 13.5 years in the pre-PNP and 59 ± 14.18 years in the post-PNP group). Most patients (80.0% pre-PNP group and 80.9% post-PNP group) presented with stage III/IV. Neoadjuvant chemotherapy was the most common initial treatment (48.5% pre-PNP and 54.1% post-PNP). The median treatment interval decreased from 53.5 days (IQR, 26-129) in the pre-PNP group to 32 days (IQR, 14-63) in the post-PNP group (P < .001). The reductions in treatment delays were significant over time following the implementation of the PNP (P = .004).

Conclusion: PNP reduced treatment delays among patients with GI cancers at RMRTH. Despite the important findings, some limitations remain; hence, further studies are recommended to provide more comprehensive evidence. Integrating PNP into national cancer control strategies is essential to strengthen care coordination and ensure timely access to cancer treatment in low-resource settings like Rwanda.

Purpose: Leadership is essential for addressing global challenges in cancer care. Equipped with leadership skills, health care providers can respond effectively to complex oncology issues in diverse settings, including resource-constrained environments. The Princess Margaret Global Oncology Leadership Development (GOLD) program provides accessible, interdisciplinary leadership training to support this. Each year, roughly 165 clinical fellows train at the Princess Margaret Cancer Centre, most of whom are internationally trained. GOLD offers leadership training to any fellow interested in global oncology, supporting their ability to tackle complex challenges worldwide. This study describes the development, implementation, and outcomes of the first 5 years of the GOLD program.

Methods: GOLD is a hybrid, multiformat leadership training program integrating experiential learning, mentorship, and systems-level thinking. It is offered free of charge and is open to all fellows in oncology to eliminate common barriers such as selection/promotion bias, travel, and cost. McNemar's test and T-tests were used to compare rankings with pre- and postprogram survey and session evaluations. Inductive thematic analysis was conducted to analyze semistructured interviews.

Results: Participants (53% female, 47 countries represented) showed statistically significant improvements in confidence across 24 leadership competencies. No associations were found between confidence gains and participants' geographic or economic backgrounds. Thematic analysis identified four key themes: improved preparedness for leadership roles, sustained global networking and mentorship, enhanced understanding of leadership across diverse contexts, and growth in intrapersonal skills.

Conclusion: The GOLD program demonstrates the effectiveness of inclusive, experiential leadership training in oncology. By removing barriers to access and prioritizing diversity, it supports a new generation of global cancer leaders. Ongoing evaluation and adaptation will ensure that the program remains relevant across diverse sociocultural and economic contexts, contributing to more equitable and effective leadership in cancer care worldwide.

Purpose: Bangladesh, a lower-middle-income country in South Asia, faces a rapidly rising cancer burden. In the absence of a population-based cancer registry (PBCR), monitoring national patterns remains challenging and constrains evidence-informed policymaking. We analyzed temporal trends in cancer distribution at the country's largest national cancer hospital to inform priorities for a cancer control strategy.

Methods: We conducted a retrospective analysis of 82,209 histologically and/or clinically confirmed cancer cases diagnosed or treated at the National Institute of Cancer Research & Hospital, between January 2014 and December 2020. Demographic and clinical data were extracted from hospital records, and cancers were grouped according to their primary anatomic site. Annual distributions and sex-specific patters of the 10 most common cancers were examined, and temporal changes were illustrated using trend diagrams.

Results: Over 7 years, the most common cancers were of the respiratory system (19.6%-22.5%), digestive organs (18.8%-22.8%), and breast (12%-14.9%). Comparison between 2014 and 2020 revealed notable increases in the proportion of digestive organ cancers (+3.6%), hematopoietic and reticuloendothelial malignancies (+1%), and breast cancer (+0.8%), whereas respiratory cancers (-2.3%), lymph node cancers (-1.1%), and bone and cartilage cancers (-1%) decreased. A marked spike in female genital cancers was observed in 2015 (11.84% v 9.9% average across other years). Findings should be interpreted in the context of hospital-based case mix and referral patterns.

Conclusion: In this large tertiary cancer hospital in Bangladesh, respiratory system, digestive organ, and breast cancers represented the highest burden, with rising proportions of proportional increases in digestive, hematopoietic, and breast cancers and declines in respiratory and lymph node cancers, provide early signals of an evolving cancer landscape. While not population-representative, these trends highlight the urgent need to establish government-supported PBCRs in well-defined subnational regions to inform effective cancer control strategies for Bangladesh.

Purpose: Although most children diagnosed with cancer live in low- and middle-income countries (LMICs), research exploring decision making in these settings remains sparse. When children present with advanced cancer in LMICs, local centers may lack resources to provide treatment required to achieve cure. Existing treatment guidelines often do not account for contextual and resource variations influencing decision making. This qualitative study sought to understand physician approaches to treatment decision making for children presenting with advanced cancer at diagnosis in LMICs.

Methods: Semistructured interviews were conducted with 36 physicians caring for children with cancer across all world regions and representing diverse income levels. Interviews were conducted in English, audio-recorded, and transcribed. Inductive content analysis focused on decision-making approaches.

Results: Most participants were female (n = 24; 67%), older than 36 years (n = 32; 89%), and practiced at centers caring for >100 new childhood cancer cases annually (n = 26; 72%) in lower-middle-income countries (n = 20; 55%). A spectrum of cancers were reported as advanced at diagnosis, with no single diagnosis predominating. Physicians generally recommended four treatment approaches (eg, curative-intent, non-curative-intent, referral, or limited chemotherapy trial), resulting in seven outcome pathways based on whether a family accepted, challenged, or declined the proposed treatment. Four decision-making approaches (eg, physician-led, family-led, participatory, or externally influenced) informed determinations of goals of care focused on optimizing prognostic outcomes, providing individualized care, and committing to treating all children, irrespective of differences in patient/family circumstances.

Conclusion: Physicians caring for children with cancer in LMICs navigate complex treatment decision making, considering diverse treatment paths and goals. Pragmatic, evidence-based interventions are needed to guide decision making, flexible to local constraints.

Purpose: African ancestry and family history (FHx) of prostate cancer (CaP) are among the few established CaP risk factors. Few studies have evaluated the association of FHx of CaP with the risk of this disease in African men.

Methods: Using the Men of African Descent and Carcinoma of the Prostate (MADCaP) network, we evaluated the association of self-reported FHx of CaP in fathers and brothers in a case-control study of 2,505 prostate cancer cases and 2,222 age-matched controls ascertained from seven centers across Africa. We compared the association of FHx and a 451-SNP polygenic risk score (PRS).

Results: Compared with controls, CaP cases had a higher proportion of fathers and/or brothers with a history of CaP overall, as well as in men age <60 or ≥60 years, and in those with/without aggressive CaP (P < .001). A CaP diagnosis in fathers was associated with an odds ratio (OR) of 3.90 (95% CI, 2.66 to 5.72), 3.13 (95% CI, 2.02 to 4.86) in brothers, and 3.41 (95% CI, 2.51 to 4.64) in fathers and/or brothers. A one-unit PRS change was associated with an OR of 1.92 (95% CI, 1.72 to 2.13). Estimates for the PRS effect did not change substantially when FHx was included in the model.

Conclusion: FHx is a strong predictor of CaP in African men. PRS is also associated with CaP largely independently of FHx. FHx may not always be reliably reported in Africa but the magnitude of recall or reporting bias is unlikely to have negated the observed association.

Purpose: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are clinically significant in patients with cancer, as chemotherapy can trigger viral reactivation, leading to liver failure, treatment interruption, or death. Despite this risk, routine viral screening in patients with solid tumors remains inconsistent across institutions and guidelines. The purpose is to determine the frequency of viral screening and the prevalence of HBV, HCV, and HIV infections-and to assess the rate of viral reactivation-in a large cohort of newly diagnosed adult patients with cancer receiving chemotherapy.

Materials and methods: A retrospective, multicenter cohort study was conducted across 15 oncology centers in Turkey. Data from 15,942 adults with solid tumors receiving parenteral chemotherapy between January 2018 and December 2022 were analyzed. Patients with primary liver cancer or those receiving non-immunosuppressive therapies were excluded.

Results: Among 15,942 patients (median age, 58 years [range, 16-94]; 51.4% male), hepatitis B surface antigen (HBsAg) testing was performed in 90.3%, anti-HCV in 71.7%, and anti-HIV in 64.0%. HBV infection was identified in 4.5% (n = 645), with only 42.9% receiving antiviral prophylaxis. HBV reactivation occurred in 4.0% of HBsAg-positive patients (n = 26). Anti-HCV positivity was found in 0.4% (n = 46), of whom 17.4% had detectable HCV RNA and received treatment. HIV infection was rare (0.06%; n = 6), and no cases of viral reactivation were observed.

Conclusion: This large multicenter study highlights persistent gaps in viral screening and prophylaxis among patients with solid tumors. Despite lower HBV reactivation rates-likely due to partial prophylaxis-preventable complications still occurred. Despite increases in vaccination and prophylaxis, reactivation rates remain a significant problem. Standardized national protocols for prechemotherapy viral screening and timely antiviral therapy are essential to improve patient safety and treatment outcomes.

Purpose: Geographical and racial diversity may influence endometrial cancer (EC) prognosis, yet its impact remains underexplored. In South Africa (SA), the rising incidence of EC underscores the need to investigate potential biologic differences. Molecular classification of EC offers valuable prognostic insights that could help address disparities and improve care. This study evaluated the prevalence and prognostic significance of molecular subtypes in a South African high-intermediate and high-risk EC cohort.

Materials and methods: We included 133 patients with high-intermediate and high-risk EC diagnosed in SA between January 2017 and December 2021. Clinical, demographic (including self-identified race), and follow-up data were collected. Central pathology review assessed histotype, grade, lymphovascular space invasion, and International Federation of Gynecology and Obstetrics 2009 stage. Molecular subtyping followed the WHO 2020 algorithm using targeted next-generation sequencing and immunohistochemistry for p53, mismatch repair (MMR) proteins, and ER. Shallow whole-genome sequencing (sWGS) assessed genome-wide copy number alterations.

Results: Among 131 patients with complete molecular classification, the most common subtype was p53-abnormal (p53abn, n = 71; 54.2%), followed by MMR-deficient (MMRd, n = 30; 22.9%), no specific molecular profile (NSMP, n = 21; 16.0%), and POLE-ultramutated (POLEmut, n = 9; 6.9%). Nonendometrioid EC (NEEC) predominated (n = 82; 61.7%). High-grade endometrioid EC and NEEC were more frequent in non-White patients (P = .030). Molecular subtypes were significantly associated with overall recurrence (P = .029), with no recurrences in POLEmut ECs and the worst outcomes in p53abn ECs. sWGS revealed higher CN burdens in p53abn ECs, with recurrent focal alterations involving CCNE1 amplification and RB1 loss.

Conclusion: To our knowledge, this study is the first to demonstrate the prognostic value of EC molecular classification in a South African cohort. These findings support the global relevance of molecular EC subtyping. The urgent need for access to molecular diagnostics or cost-effective alternatives in resource-limited settings is highlighted.

Purpose: Few data describe the modern epidemiology of pediatric HIV-associated cancers in sub-Saharan Africa, home to over 80% of the world's children living with HIV. This study evaluated the incidence of cancers among these children over 15 years after widespread antiretroviral therapy (ART) adoption in Malawi.

Methods: We conducted a retrospective population-based cohort study leveraging multiple independent data sources comprehensive of all cancer diagnoses among children living with HIV in Northern and Central Malawi between 2010 and 2024. HIV-associated cancers were defined as those cancers with well-established epidemiologic associations with HIV. Cumulative incidence and average annual percent change were estimated using joinpoint regression. Next, we conducted a subcohort analysis within the country's largest pediatric HIV clinic to evaluate cancer risk factors using log-binomial regression.

Results: Among 1,686 pediatric cancer diagnoses, 184 (10.9%) occurred in children with HIV. Kaposi sarcoma (KS) accounted for 96% of cases. The cumulative incidence of HIV-associated malignancies fell from 4.7 cases per million children in 2010 to 1.2 per million in 2024, representing an 84% decline from its peak in 2013 and an average annual percent decline of 13% (P < .001). KS dropped from the third- to seventh-most common childhood cancer in the region. Notably, 58% of affected children were ART-naïve at diagnosis. Initiating ART in infancy reduced the risk of KS by 69% (P < .001). Other HIV-associated cancers were rare, comprising 0.4% of all cases diagnosed.

Conclusion: National ART expansion substantially reduced pediatric HIV-associated cancers in Malawi, achieving declines comparable with those seen in high-income countries. Sustained early diagnosis and ART linkage remain essential to sustain progress.

Purpose: While the prevalence of human papillomavirus (HPV)-associated head and neck squamous cell carcinoma (HNSCC), specifically in the oropharynx subsite, is increasing in western populations, limited data exist on prevalence in sub-Saharan Africa. This study describes the prevalence and associated risk factors of HPV association among individuals with HNSCC presenting to Muhimbili National Hospital, the largest public tertiary referral center in Tanzania, a country in East Africa.

Methods: Participants with HNSCC presenting between July 2020 and June 2022 were prospectively recruited in this cross-sectional study. Tumor samples were tested for HPV DNA polymerase chain reaction (PCR) and p16 immunohistochemistry (IHC). Multivariate logistic regression models assessed potential risk factors for HPV.

Results: Among 121 individuals diagnosed with HNSCC, the median age was 55 years (IQR, 47-68 years), 76.0% (92/121) were male, and 10.9% (13/119 tested) were HIV positive. Among all cases of HNSCC, the prevalence of HPV was 14.6% (95% CI, 7.5 to 21.6) using PCR testing and 23.6% (95% CI, 15.5 to 31.7) using p16 IHC as a surrogate marker. For the oropharynx subsite, 23.1% (95% CI, 0.2 to 46.0) of specimens using PCR testing and 28.6% (95% CI, 4.9 to 52.2) using p16 IHC tested positive (Kappa 3.0 [95% CI, -51.1 to 57.1]; McNemar P value = .66). Factors independently associated with HPV positivity were oropharynx subsite (odds ratio [OR], 6.4 [95% CI, 1.0 to 40.6], P = .048), nonsmokers (OR, 6.4 [95% CI, 1.1 to 35.4], P = .035), and unmarried individuals (OR, 10.6 [95% CI, 2.4 to 47.3], P = .002). HPV association in HNSCC did not significantly differ by HIV status or sexual activity.

Conclusion: HPV association in HNSCC, specifically of the oropharyngeal subsite, is lower in this cohort from Tanzania compared with western populations. Additional regional data are needed to inform clinical care guidelines and vaccination policies.