Journal of Cancer Policy最新文献

Introduction: The NHS Long-term Plan outlines a number of approaches to address delays and diagnose three out of four cancers at an early stage, and yet patients regularly experience delays to diagnosis. Attempts to address such delays include the implementation of a number of rapid diagnosis pathways (RDPs). This realist review explores rapid diagnosis pathways for prostate cancer, identifying approaches to RDPs, as well as generating theories regarding what works, for whom and under which circumstances.

Methods: This is a realist evidence synthesis. The questions and approach are informed by patient and public involvement (PPI). We conducted a scoping review to generate initial programme theories and then refined these through further search processes. As a realist review, we do not focus on a specific data type or outcome, rather we include qualitative and quantitative data to inform theories comprised of contexts, mechanisms, and outcomes (CMO chains).

Results: Six studies were included in our scoping review; twenty studies were included in the second review. The studies include qualitative and quantitative data. We identified three broad themes: Primary care, organizational factors, and patient experience.

Conclusions/ recommendations: We recommend the involvement of adjoining services (e.g. general practice and radiology) in the planning of prostate cancer RDPs and emphasize the importance of clear communication with patients.

Background: Colorectal cancer screening rates are lower among immigrants compared to U.S.-born individuals. This study examined the association between time spent in the U.S. and CRC screening adherence in a diverse sample of immigrants, while considering the role of sociodemographic factors.

Methods: Data from the 2010, 2013, 2015, and 2018 NHIS were analyzed. The sample included 6,298 immigrants aged 50-75. Multivariable logistic regression was used to assess the association between time in the U.S. (<15 years vs. ≥15 years) and CRC screening adherence, adjusting for sociodemographic factors.

Results: Overall, 47.6% of immigrants adhered to CRC screening guidelines. Immigrants residing in the U.S. for 15 years or more had significantly higher odds of screening adherence (AOR = 1.63; 95% CI, 1.29-2.05) compared to those with less than 15 years of residence in the U.S. This association varied by race/ethnicity, with the greatest impact seen among Asian immigrants. Socioeconomic factors, particularly education and having a usual source of care, were also significantly associated with screening adherence.

Conclusions: Time in the U.S. is a significant predictor of CRC screening adherence among immigrants, with those residing 15 years or more showing higher adherence across racial and ethnic groups. Socioeconomic factors, including education, income, health insurance, and having a usual place of care, are strongly associated with screening adherence across all immigrant groups. These findings underscore the need for tailored interventions to enhance screening rates, particularly among recent immigrants and those with limited socioeconomic resources.

India's ambitious goal of eliminating cervical cancer by 2030 faces significant challenges due to the high burden of disease, low screening rates, and sociocultural barriers. Despite the Government's focus on vaccination, addressing cervical cancer requires a more comprehensive approach that is multisectoral and consider practice to policy engagement. Addressing not only vaccination but also social barriers, healthcare infrastructure, and research is key to preventing and controlling this preventable disease. Fragmented health policies with limited coverage for cervical cancer, coupled with societal issues like stigma and limited access to healthcare, particularly in rural areas, pose significant challenges. Moreover, limited awareness of HPV and vaccines hinders progress. To effectively combat cervical cancer, India must prioritize a readiness assessment to evaluate past interventions, economic feasibility, and social issues before launching new programs. Improving healthcare infrastructure, training healthcare workers, and utilizing innovative models like mobile clinics can expand access to care. Public-private partnerships with incentives can also play a crucial role in mobilizing resources. Investing in culturally appropriate public awareness campaigns is essential to educate the population about HPV, cervical cancer, and prevention strategies. A robust pharmacovigilance program is necessary to ensure vaccine safety. Additionally, India should invest in science and technology to support long-term research efforts, while increasing understanding of population-specific predisposing factors for broader-spectrum vaccines and personalized approaches. A dedicated national policy with clear objectives, strategies, and accountability mechanisms is crucial for successful cervical cancer control. Learning from the experiences of other countries can inform policy development.

Introduction: Healthcare service disruptions due to the COVID-19 pandemic may have caused worse health outcomes and resulted in more expensive treatments for patients diagnosed with lung cancer in Alberta, Canada.

Methods: A population-based retrospective cohort design was used to compare 1-year survival, mortality, and health services utilization costs of patients diagnosed with lung cancer pre- (March 17^th, 2018 to March 16^th, 2019), intra- (March 17^th, 2020 to March 16^th, 2021), and post-pandemic (March 17^th, 2021 to March 16^th, 2022). Kaplan-Meier curves and Cox regressions were used for estimating survival and hazard ratios. General linear models with gamma family and log link were used for estimating health services utilization costs. All costs were converted to 2024 Canadian dollars (CA$1~US$0.74).

Results: In total, 2332, 2271, and 2408 individual patients were diagnosed with lung cancer in the pre-, intra-, and post-COVID, respectively. The survival at 365 days after diagnosis was 50%, 49%, and 51% for patients diagnosed with lung cancer pre-, intra-, and post-pandemic, respectively. Multivariate Cox regressions showed that patients diagnosed intra- and post-pandemic had a significantly (15% and 10%) higher probability of death at 1 year after diagnosis as compared to those diagnosed pre-pandemic (intra- vs. pre- HR=1.15, p=0.001 and post- vs. pre- HR=1.10, p=0.023). Patients diagnosed with lung cancer intra-pandemic had the highest health services utilization cost ($59.000) per patient per year, followed by post-pandemic ($55,510) and pre-pandemic ($51,640). Compared to pre-pandemic, the health services utilization cost intra-pandemic was 15.3% ($7,859) higher and post-pandemic was 7.5% ($3,887) higher. Although significantly higher than pre-, post-pandemic patients had a lower hazard ratio and health services utilization cost compared to intra-pandemic.

Conclusions: Lung cancer patients diagnosed during COVID-19 pandemic had significantly increased mortality and health services utilization costs compared to pre-pandemic, however, these impacts improved right post-pandemic.

Leadership as a key building block of a health system plays a crucial role in achieving high performance and helps deliver change and shape the policy agenda and its implementation. Echoing the emerging need for effective leaders in Oncology, the "Improving Cancer Outcomes and Leadership Course" was developed jointly by the European School of Oncology (ESO), the European Cancer Organization (ECO) and Sharing Progress in Cancer Care (SPCC). The course was offered as a hybrid event online and in Warsaw in June 2022. It aimed to introduce early and mid-career cancer healthcare professionals of all disciplines and professions to the expertise required to develop strategic plans, support and collaborate in relevant applied health research, develop implementation approaches and acquire the skill sets required to support leadership and change management within their countries and regions. A total of 47 participants, mainly from Europe, participated and prepared 'case discussions' of organisational challenges or projects aiming to improve health care in their regions. These were deliberated and further developed in 3 break out groups. A qualitative evaluation of the course impact performed 2 years after the course showed that most participants remained in contact with each other, the majority had implemented learnings from the course to help improve cancer outcomes, 87% had further developed their projects that were presented during the breakout sessions and of those 89% felt that the discussions that were held during course had actively helped them to develop and potentially apply these projects. Finally, 77% have thought of or initiated a different project than the one they discussed during the course, based on ideas coming from the discussions during or after the course. Here we describe the course, give three examples of topics discussed in Warsaw and present plans for the future.