JCO Global Oncology最新文献

Purpose: Patients with adolescent and young adult (AYA) cancer are recognized as a vulnerable subpopulation in high-income countries (HICs). Although survival gaps between HIC and low- and middle-income country (LMIC) children with cancer are well described, LMIC AYAs have been neglected. We conducted a systematic review to describe cancer outcomes among LMIC AYAs.

Methods: We captured English language studies published from 2010 onward reporting LMIC AYA cancer survival outcomes. LMICs were defined according to World Bank 2019 classifications, whereas AYAs were defined as diagnosed between age 15 and 39 years. Cohorts were considered AYA if >75% of patients were AYA, the mean/median age and standard deviation were between 15 and 39 years, or the range was within 5 years of the AYA range (ie, 10-45 years). Cohort characteristics were abstracted, including country, cancer type, and cancer outcomes.

Results: Of 6,207 studies identified by the search strategy, 658 underwent full-text review; 60 met inclusion criteria. No low-income countries were represented. Forty-four (73.3%) studies were conducted in upper-middle-income countries (UMICs) although these represented only 12 of 55 countries currently classified as UMICs. The most common cancers studied were acute lymphoblastic leukemia (n = 13 studies), breast cancer (n = 5), and osteosarcoma (n = 3). Five-year overall survival was highly variable, ranging from 39% to 63% for ALL, 60%-85% for breast cancer, and 47%-83% for osteosarcoma.

Conclusion: Although three billion AYAs reside in LMICs, their cancer outcomes are neglected in the current literature. Existing data indicate variable survival, ranging from comparable with HIC outcomes to substantially inferior. These studies, however, represent only a limited number of LMICs and are biased toward UMICs. Systematic efforts to describe and improve LMIC AYA cancer outcomes are required.

Purpose: Constitutional mismatch repair deficiency (CMMRD) is a genetic cancer predisposition syndrome among children and young adults. This study aimed to evaluate the frequency of CMMRD among patients with pediatric high-grade glioma (pHGG) in a single tertiary care center in Pakistan, a country with high consanguinity rates.

Patients and methods: We reviewed the data of patients age <18 years with pHGG, anaplastic astrocytoma, and diffuse midline glioma (DMG) with CMMRD testing between 2016 and 2023. CMMRD testing was done using the Aronson et al criteria. A few patients were sent to Sick Kids, Toronto, to review the mismatch repair protein stains via multigene panels.

Results: Forty-seven patients were identified, with a median age of 11 years (IQR, 8-16). Headache (89.4%) was the most common symptom. Thirty-seven patients had hemispheric tumors; 12.8% and 8.5% had posterior fossa and midline tumors, respectively. Histopathology revealed 70.2% glioblastoma, 23.4% anaplastic astrocytoma, and 6.4% DMG. CMMRD was positive in 15 of 47 patients (31.9%). Eight patients had loss of PMS2. Three had loss of PMS2 and MLH1; two had loss of MSH6, one had loss of MSH6 and MSH2, and only one patient had loss of MSH2. Consanguinity and family history of malignancy correlated with CMMRD (P = .009, P = .031, respectively). Two-year overall survival of all patients was 23.4% (median follow-up, 0.59 years [95% CI, 0.000 to 1.171]). Two-year overall survival of mismatch repair deficiency-positive patients was 20% (median follow-up, 0.910 years [95 CI, 0.380 to 1.440]).

Conclusion: We found a high frequency of CMMRD among patients with pHGG, particularly with positive consanguinity. Our study highlights the significance of genetic testing and surveillance. It is essential to develop low and middle income country-tailored protocols due to limited access and financial constraints associated with using immune checkpoint inhibitors.

Purpose: The demographic transition toward aging heralds an increase in the number of geriatric patients with cancer in India. Comprehensive geriatric assessment (CGA) is a sine qua non for treatment planning and shared decision making in these patients. We aimed to study the prevalence of malnutrition and the associated risk factors in geriatric patients with solid organ cancer.

Methods: In this observational study, treatment-naïve geriatric patients with cancer underwent CGA. We performed a Mini Nutritional Assessment (MNA) to diagnose malnutrition. Data analysis was done using descriptive statistics, Pearson's chi-square, Spearman correlation, and multivariable regression analysis to assess the factors associated with malnutrition.

Results: One hundred forty-two patients were included in the analysis. The median age was 67 (range, 60-88) years, with a male preponderance of 73.2% (n = 104) and a stage IV disease of 75.4% (n = 107). Most patients, 91.6% (n = 130), had abnormal MNA scores. Nearly one third of the patients, 35.2% (n = 50), were underweight (BMI <18.5 kg/m²). Poor performance status (PS) was seen in 66.2% (n = 94) of the patients. Poor appetite 79.6% (n = 113) was the most common risk factor, followed by addictions (74.6%, n = 106), chronic constipation (35.9%, n = 51), and polypharmacy (21.8%, n = 31). Cognitive impairment and depression were seen in 35.2% (n = 50) and 57.1% (n = 81) of the patients, respectively. The study found a significant correlation of MNA with age (P = .048), depression (P < .001), PS (P < .001), functional decline (P < .001), and cognition (P < .001).

Conclusion: There exists a widespread prevalence of malnutrition and amenable risk factors in geriatric patients with cancer. Nutritional assessment is essential, and interventions should be implemented to improve clinical outcomes.

Purpose: Cancer incidence is rising worldwide and estimated to double by 2040. A systematic method of allocating resources and prioritizing cancer control efforts is needed. We aimed to develop and test a simple metric to quantify disparities in cancer mortality.

Methods: We extracted country-specific incidence and mortality rates for 33 cancers from 185 countries using data from Global Cancer Observatory (GLOBOCAN) 2020. Mortality-to-incidence ratios (MIRs) were calculated for each cancer in every country. Delta MIRs (dMIRs) were calculated as the difference between a country's MIR and the MIR of the highest performing country for each cancer. dMIR was validated against human development index (HDI), gender development index (GDI), and life expectancy index (LEI) using scatter plots, correlation coefficients, and linear regression.

Results: Among 185 countries in the GLOBOCAN 2020 data set, mortality and incidence estimates were available for 54 high-income, 47 upper-middle-income, 54 lower-middle-income, and 27 low-income countries. The United States was the highest performing country for 10 of the 33 cancer subtypes, and South Korea was the highest performing country for eight cancer subtypes. Significant variation in dMIR was observed across the globe. The highest dMIRs were in sub-Saharan Africa and Southeast Asia, and the lowest dMIRs were in North America, Western Europe, and Australasia. dMIR showed strong correlations with HDI, GDI, and LEI.

Conclusion: In conclusion, dMIR is a novel and robust metric that can be used to track disparities in global cancer mortality and prioritize cancer control initiatives. We benchmarked cancer care performance for 33 cancers across 182 countries and provide country- and cancer-specific priority lists.

The evolution of radiation therapy in Uganda has been a journey marked by significant milestones and persistent challenges. Since the inception of radiotherapy services in 1988-1989, there has been a concerted effort to enhance cancer treatment services. The early years were characterized by foundational developments, such as the installation of the first teletherapy units, low-dose-rate brachytherapy units, and conventional simulators, and the recognition of radiation oncologists and medical physicist professionals laid the groundwork for radiotherapy treatment modalities. With more support from the International Atomic Energy Agency, the acquisition of dosimetry equipment, treatment planning systems, and additional professional training signaled a new era in the fight against cancer. As we entered the second decade of the millennium, the Uganda Cancer Institute (UCI) witnessed a progression in sophisticated radiotherapy services, including high-dose-rate brachytherapy, initiation of intensity modulated radiation therapy (IMRT)/volumetric modulated arc therapy (VMAT), and use of artificial intelligence. These advancements improved the efficiency/precision of treatments and the time patients spent undergoing therapy. Around the second decade of radiotherapy services, about 600 new patients with cancer were annually treated compared with about 2,600 in 2023. Currently, an average of 1,440 brachytherapy insertions are done annually compared with 300 insertions for the first 20 years. Despite the technological strides, the UCI faced numerous obstacles, including limited equipment, knowledge gaps in appropriate tumor/organs at risk segmentations, treatment planning, and protocols. However, international support and collaboration efforts have led to significant improvement in the precision and effectiveness of treatments. Currently, about 51% of all patients are treated with image-guided techniques-IMRT/VMAT (42%) and three-dimensional conformal radiation treatment (10%). The Government has commenced the decentralization of radiotherapy services to other regions. This review can be a learning lesson for the more than 25 countries in Africa and other low-middle-income countries globally that do not have access to radiotherapy and/or are in the process of starting such facilities.

Purpose: In this study, we aimed to evaluate the association between the Extension for Community Healthcare Outcomes-Palliative Care (ECHO-PC; ECHO Model-Based comprehensive educational and telementoring intervention) for health care professionals (HCPs) and change in patient-reported quality-of-life (QOL; Functional Assessment of Cancer Therapy-General [FACT-G]) among patients with advanced cancer. We also examined the association between ECHO-PC and changes in symptom distress (Edmonton Symptom Assessment Scale [ESAS]), patient experience and satisfaction, and caregiver distress scores.

Methods: ECHO-PC Clinic sessions were conducted twice a month for 1 year by an interdisciplinary team of PC clinicians at the MD Anderson Cancer Center, with participation of experts in PC in sub-Saharan Africa, using standardized curriculum on the basis of PC needs in the region. Study participants included palliative HCPs from ECHO participating programs in Kenya, Nigeria, Ghana, and South Africa. HCPs, their patients, and caregivers were assessed at baseline, 3, 6, 9, and 12 months of the study for QOL (FACT-G), ESAS-Symptom Distress Score (prorated) (SDS), patient experience, satisfaction (FAMCARE-P-16-patient), and caregiver distress (FAMCARE-caregiver).

Results: Two hundred seventy patients completed the assessments. Fifty-eight percent was female, the mean age was 56 years, and most common cancer type was breast cancer (24.3%). Multivariate generalized linear mixed model analysis found that ECHO-PC intervention was associated with significant improvement in QOL and symptom distress (FACT-G total score, P = .0433; FACT-G physical well-being, P < .013; FACT-G emotional well-being, P = .0232, and ESAS-SDS, P < .0001). No significant changes were found in patient experience, satisfaction, and caregiver distress scores.

Conclusion: Our preliminary study found that the ECHO-PC intervention was significantly associated with improvement in patient outcomes including QOL and symptom distress scores. Further studies are needed.

Purpose: The availability of drugs and national public policies for patients with rare cancers, including sarcomas, varies in different parts of the world.

Methods: In this manuscript, we have conducted a comprehensive analysis to evaluate rare cancer policies in Latin American countries' national policy documents. Additionally, we have reviewed the approvals for sarcoma drugs in selected Latin American countries and compared them with US Food and Drug Administration (FDA) and European Medicines Agency (EMA) approvals.

Results: The documents reviewed showed a lack of explicit focus on rare cancers, with no mention in 70% of the countries analyzed. Drug approval data reveal that in the last 15 years, the FDA and EMA have approved 19 and 13 drugs for sarcoma, whereas their Latin American counterparts, namely ANVISA, ANMAT, and COFEPRIS, approved six, eight, and seven drugs, respectively.

Conclusion: Our data suggest that improving rare cancer and sarcoma care in Latin America requires enhanced collaboration for better rare cancer policies.