Pub Date : 2024-01-04DOI: 10.1016/j.jcpo.2023.100465
David Nelson , Peter Selby , Ros Kane , Ava Harding-Bell , Amanda Kenny , Kathie McPeake , Samuel Cooke , Todd Hogue , Kathy Oliver , Mark Gussy , Mark Lawler
Existing evidence often indicates higher cancer incidence and mortality rates, later diagnosis, lower screening uptake and poorer long-term survival for people living in rural compared to more urbanised areas. Despite wide inequities and variation in cancer care and outcomes across Europe, much of the scientific literature explicitly exploring the impact of rurality on cancer continues to come from Australia and North America. The European Code of Cancer Practice or “The Code” is a citizen and patient-centred statement of the most salient requirements for good clinical cancer practice and has been extensively co-produced by cancer patients, cancer professionals and patient advocates. It contains 10 key overarching Rights that a cancer patient should expect from their healthcare system, regardless of where they live and has been strongly endorsed by professional and patient cancer organisations as well as the European Commission. In this article, we use these 10 fundamental Rights as a framework to argue that (i) the issues and needs identified in The Code are generally more profound for rural people with cancer; (ii) addressing these issues is also more challenging in rural contexts; (iii) interventions and support must explicitly account for the unique needs of rural residents living with and affected by cancer and (iv) new innovative approaches are urgently required to successfully overcome the challenges faced by rural people with cancer and their caregivers. Despite equitable healthcare being a key European policy focus, the needs of rural people living with cancer have largely been neglected.
{"title":"Implementing the European code of cancer practice in rural settings","authors":"David Nelson , Peter Selby , Ros Kane , Ava Harding-Bell , Amanda Kenny , Kathie McPeake , Samuel Cooke , Todd Hogue , Kathy Oliver , Mark Gussy , Mark Lawler","doi":"10.1016/j.jcpo.2023.100465","DOIUrl":"10.1016/j.jcpo.2023.100465","url":null,"abstract":"<div><p>Existing evidence often indicates higher cancer incidence and mortality rates, later diagnosis, lower screening uptake and poorer long-term survival for people living in rural compared to more urbanised areas. Despite wide inequities and variation in cancer care and outcomes across Europe, much of the scientific literature explicitly exploring the impact of rurality on cancer continues to come from Australia and North America<strong>.</strong> The European Code of Cancer Practice or “The Code” is a citizen and patient-centred statement of the most salient requirements for good clinical cancer practice and has been extensively co-produced by cancer patients, cancer professionals and patient advocates. It contains 10 key overarching Rights that a cancer patient should expect from their healthcare system, regardless of where they live and has been strongly endorsed by professional and patient cancer organisations as well as the European Commission. In this article, we use these 10 fundamental Rights as a framework to argue that (i) the issues and needs identified in The Code are generally more profound for rural people with cancer; (ii) addressing these issues is also more challenging in rural contexts; (iii) interventions and support must explicitly account for the unique needs of rural residents living with and affected by cancer and (iv) new innovative approaches are urgently required to successfully overcome the challenges faced by rural people with cancer and their caregivers. Despite equitable healthcare being a key European policy focus, the needs of rural people living with cancer have largely been neglected.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213538323000826/pdfft?md5=041eb7a84e9498cb5febb9240951844f&pid=1-s2.0-S2213538323000826-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139111275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-02DOI: 10.1016/j.jcpo.2023.100466
Rachel J. Keogh , Harry Harvey , Claire Brady , Edel Hassett , Seán J. Costelloe , Martin J. O’Sullivan , Maria Twomey , Mary Jane O’Leary , Mary R. Cahill , Aideen O’Riordan , Caroline M. Joyce , Ger Moloney , Aileen Flavin , Richard M Bambury , Deirdre Murray , Kathleen Bennett , Maeve Mullooly , Seamus O’Reilly
Introduction
Cyberattacks represent a growing threat for healthcare delivery globally. We assess the impact and implications of a cyberattack on a cancer center in Ireland.
Methods
On May 14th 2021 (day 0) Cork University Hospital (CUH) Cancer Center was involved in the first national healthcare ransomware attack in Ireland. Contingency plans were only present in laboratory services who had previously experienced information technology (IT) failures. No hospital cyberattack emergency plan was in place. Departmental logs of activity for 120 days after the attack were reviewed and compared with historical activity records. Daily sample deficits (routine daily number of samples analyzed – number of samples analyzed during cyberattack) were calculated. Categorical variables are reported as median and range. Qualitative data were collected via reflective essays and interviews with key stakeholders from affected departments in CUH.
Results
On day 0, all IT systems were shut down. Radiotherapy (RT) treatment and cancer surgeries stopped, outpatient activity fell by 50%. hematology, biochemistry and radiology capacity fell by 90% (daily sample deficit (DSD) 2700 samples), 75% (DSD 2250 samples), and 90% (100% mammography/PET scan) respectively. Histopathology reporting times doubled (7 to 15 days). Radiotherapy (RT) was interrupted for 113 patients in CUH. The median treatment gap duration was six days for category 1 patients and 10 for the remaining patients. Partner organizations paused all IT links with CUH. Outsourcing of radiology and radiotherapy commenced, alternative communication networks and national conference calls in RT and Clinical Trials were established. By day 28 Email communication was restored. By day 210 reporting and data storage backlogs were cleared and over 2000 computers were checked/replaced.
Conclusion
Cyberattacks have rapid, profound and protracted impacts. While laboratory and diagnostic deficits were readily quantified, the impact of disrupted/delayed care on patient outcomes is less readily quantifiable. Cyberawareness and cyberattack plans need to be embedded in healthcare.
Policy Summary
Cyberattacks pose significant challenges for healthcare systems, impacting patient care, clinical outcomes, and staff wellbeing. This study provides a comprehensive review of the impact of the Conti ransomware attack on cancer services in Cork University Hospital (CUH), the first cyberattack on a national health service. Our study highlights the widespread disruption caused by a cyberattack including shutdown of information technology (IT) services, marked reduction in outpatient activity, temporary cessation of essential services such as radiation therapy. We provide a framework for other institutions for mitigating the impact of a cyberattack, underscoring the need for a
{"title":"Dealing with digital paralysis: Surviving a cyberattack in a National Cancer center","authors":"Rachel J. Keogh , Harry Harvey , Claire Brady , Edel Hassett , Seán J. Costelloe , Martin J. O’Sullivan , Maria Twomey , Mary Jane O’Leary , Mary R. Cahill , Aideen O’Riordan , Caroline M. Joyce , Ger Moloney , Aileen Flavin , Richard M Bambury , Deirdre Murray , Kathleen Bennett , Maeve Mullooly , Seamus O’Reilly","doi":"10.1016/j.jcpo.2023.100466","DOIUrl":"10.1016/j.jcpo.2023.100466","url":null,"abstract":"<div><h3>Introduction</h3><p>Cyberattacks represent a growing threat for healthcare delivery globally. We assess the impact and implications of a cyberattack on a cancer center in Ireland.</p></div><div><h3>Methods</h3><p>On May 14th 2021 (day 0) Cork University Hospital (CUH) Cancer Center was involved in the first national healthcare ransomware attack in Ireland. Contingency plans were only present in laboratory services who had previously experienced information technology (IT) failures. No hospital cyberattack emergency plan was in place. Departmental logs of activity for 120 days after the attack were reviewed and compared with historical activity records. Daily sample deficits (routine daily number of samples analyzed – number of samples analyzed during cyberattack) were calculated. Categorical variables are reported as median and range. Qualitative data were collected via reflective essays and interviews with key stakeholders from affected departments in CUH.</p></div><div><h3>Results</h3><p><span><span>On day 0, all IT systems were shut down. Radiotherapy (RT) treatment and cancer surgeries stopped, outpatient activity fell by 50%. </span>hematology<span>, biochemistry and radiology<span> capacity fell by 90% (daily sample deficit (DSD) 2700 samples), 75% (DSD 2250 samples), and 90% (100% mammography/PET scan) respectively. Histopathology reporting times doubled (7 to 15 days). Radiotherapy (RT) was interrupted for 113 patients in CUH. The median treatment gap duration was six days for category 1 patients and 10 for the remaining patients. Partner organizations paused all IT links with CUH. Outsourcing of radiology and radiotherapy commenced, alternative communication networks and national conference calls in RT and </span></span></span>Clinical Trials were established. By day 28 Email communication was restored. By day 210 reporting and data storage backlogs were cleared and over 2000 computers were checked/replaced.</p></div><div><h3>Conclusion</h3><p>Cyberattacks have rapid, profound and protracted impacts. While laboratory and diagnostic deficits were readily quantified, the impact of disrupted/delayed care on patient outcomes is less readily quantifiable. Cyberawareness and cyberattack plans need to be embedded in healthcare.</p></div><div><h3>Policy Summary</h3><p>Cyberattacks pose significant challenges for healthcare systems, impacting patient care, clinical outcomes, and staff wellbeing. This study provides a comprehensive review of the impact of the Conti ransomware attack on cancer services in Cork University Hospital (CUH), the first cyberattack on a national health service. Our study highlights the widespread disruption caused by a cyberattack including shutdown of information technology (IT) services, marked reduction in outpatient activity, temporary cessation of essential services such as radiation therapy. We provide a framework for other institutions for mitigating the impact of a cyberattack, underscoring the need for a","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2024-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139098905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-15DOI: 10.1016/j.jcpo.2023.100464
Ivana Nikčević Kovačević , Adrijana Vujović , Milica Stanišić , Jovana Vuković-Leković , Iris Lansdorp-Vogelaar , Dominika Novak Mlakar , Carlo Senore , Judit Józwiak-Hagymásy , György Széles , Zoltán Vokó , Marcell Csanádi
Background
Implementation of organized cancer screening programs comes with many challenges and barriers, which may inhibit the achievement of the screening activities’ desired benefits. In this paper we outline a plan for improving the colorectal cancer (CRC) screening system in Montenegro.
Methods
We formulated a roadmap, which was generally defined as a country-specific strategic plan to improve cancer screening programs. The roadmap development was an iterative, step-by-step process. First, we described the current screening program, then identified and described key barriers, and finally proposed actions to overcome them. Multiple sources of information (e.g., documents, expert opinions) were collected and processed by local and international stakeholders.
Results
The CRC screening program was implemented between 2013–2019 by gradually increasing the invitation of the target population. Key barriers of the implementation were defined: 1) Lack of colonoscopy capacity in the northern part of the country; 2) Inadequate information technology systems; 3) Inadequate public promotion of screening. The defined actions were related to overcoming lack of available resources (e.g., financial, human and technological), to improve the policy environment and the knowledge, and to facilitate information sharing.
Conclusion
The collaboration between local stakeholders of CRC screening and researchers experienced in planning and evaluating screening programs resulted in the first comprehensive description of CRC screening in Montenegro, detailed understanding of key barriers that emerged during implementation and a carefully designed list of actions. The implementation of these actions and the evaluation of whether barriers were solved will be captured in the upcoming period by maintaining this collaboration.
{"title":"Roadmap to improve the organized cancer screening programs – The case of colorectal cancer screening in Montenegro","authors":"Ivana Nikčević Kovačević , Adrijana Vujović , Milica Stanišić , Jovana Vuković-Leković , Iris Lansdorp-Vogelaar , Dominika Novak Mlakar , Carlo Senore , Judit Józwiak-Hagymásy , György Széles , Zoltán Vokó , Marcell Csanádi","doi":"10.1016/j.jcpo.2023.100464","DOIUrl":"10.1016/j.jcpo.2023.100464","url":null,"abstract":"<div><h3>Background</h3><p>Implementation of organized cancer screening programs comes with many challenges and barriers, which may inhibit the achievement of the screening activities’ desired benefits. In this paper we outline a plan for improving the colorectal cancer (CRC) screening system in Montenegro.</p></div><div><h3>Methods</h3><p>We formulated a roadmap, which was generally defined as a country-specific strategic plan to improve cancer screening programs. The roadmap development was an iterative, step-by-step process. First, we described the current screening program, then identified and described key barriers, and finally proposed actions to overcome them. Multiple sources of information (e.g., documents, expert opinions) were collected and processed by local and international stakeholders.</p></div><div><h3>Results</h3><p>The CRC screening program was implemented between 2013–2019 by gradually increasing the invitation of the target population. Key barriers of the implementation were defined: 1) Lack of colonoscopy capacity in the northern part of the country; 2) Inadequate information technology systems; 3) Inadequate public promotion of screening. The defined actions were related to overcoming lack of available resources (e.g., financial, human and technological), to improve the policy environment and the knowledge, and to facilitate information sharing.</p></div><div><h3>Conclusion</h3><p>The collaboration between local stakeholders of CRC screening and researchers experienced in planning and evaluating screening programs resulted in the first comprehensive description of CRC screening in Montenegro, detailed understanding of key barriers that emerged during implementation and a carefully designed list of actions. The implementation of these actions and the evaluation of whether barriers were solved will be captured in the upcoming period by maintaining this collaboration.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213538323000814/pdfft?md5=5fd89540d0273730f231299d7e1c03e2&pid=1-s2.0-S2213538323000814-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138795610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-06DOI: 10.1016/j.jcpo.2023.100463
Peter R. Scholten , Lukas J.A. Stalpers , Iris Bronsema , Rob M. van Os , Henrike Westerveld , Luc R.C.W. van Lonkhuijzen
Objectives
patients with cancer who smoke have more side effects during and after treatment, and a lower survival rate than patients with cancer who quit smoking. Supporting patients with cancer to quit smoking should be standard care. The aim of this systematic review was to determine the most effective smoking cessation method for patients diagnosed with cancer.
Methods
PubMed, Embase, Web of Science and Google Scholar were systematically searched. Included were randomized controlled trials and observational studies published after January 2000 with any smoking cessation intervention in patients with any type of cancer. Result of these studies were evaluated in a meta-analysis.
Results
A total of 18,780 papers were retrieved. After duplicate removal and exclusion based on title and abstract, 72 publications were left. After full text screening, 19 (randomized) controlled trials and 20 observational studies were included. The overall methodological quality of the included studies, rated by GRADE criteria, was very low. Two out of 21 combined intervention trials showed a statistical significant effect. Meta-analysis of 18 RCTs and 3 observational studies showed a significant benefit of combined modality interventions (OR 1.67, 95% C.I.: 1.24–2.26, p = 0.0008) and behavioural interventions (OR 1.33, 95% C.I.: 1.02 – 1.74, p = 0.03), but not for single modality pharmacological interventions (OR 1.11; 95% C.I.: 0.69–1.78, p = 0.66).
Conclusion
A combination of pharmacological and behavioural interventions may be the most effective intervention for smoking cessation in patients with cancer.
{"title":"The effectiveness of smoking cessation interventions after cancer diagnosis: A systematic review and meta-analysis","authors":"Peter R. Scholten , Lukas J.A. Stalpers , Iris Bronsema , Rob M. van Os , Henrike Westerveld , Luc R.C.W. van Lonkhuijzen","doi":"10.1016/j.jcpo.2023.100463","DOIUrl":"https://doi.org/10.1016/j.jcpo.2023.100463","url":null,"abstract":"<div><h3>Objectives</h3><p>patients with cancer who smoke have more side effects during and after treatment, and a lower survival rate than patients with cancer who quit smoking. Supporting patients with cancer to quit smoking should be standard care. The aim of this systematic review was to determine the most effective smoking cessation method for patients diagnosed with cancer.</p></div><div><h3>Methods</h3><p>PubMed, Embase, Web of Science and Google Scholar were systematically searched. Included were randomized controlled trials and observational studies published after January 2000 with any smoking cessation intervention in patients with any type of cancer. Result of these studies were evaluated in a meta-analysis.</p></div><div><h3>Results</h3><p>A total of 18,780 papers were retrieved. After duplicate removal and exclusion based on title and abstract, 72 publications were left. After full text screening, 19 (randomized) controlled trials and 20 observational studies were included. The overall methodological quality of the included studies, rated by GRADE criteria, was very low. Two out of 21 combined intervention trials showed a statistical significant effect. Meta-analysis of 18 RCTs and 3 observational studies showed a significant benefit of combined modality interventions (OR 1.67, 95% C.I.: 1.24–2.26, p = 0.0008) and behavioural interventions (OR 1.33, 95% C.I.: 1.02 – 1.74, p = 0.03), but not for single modality pharmacological interventions (OR 1.11; 95% C.I.: 0.69–1.78, p = 0.66).</p></div><div><h3>Conclusion</h3><p>A combination of pharmacological and behavioural interventions may be the most effective intervention for smoking cessation in patients with cancer.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213538323000802/pdfft?md5=30bd12ea2dd2c95fa8f0af9078874086&pid=1-s2.0-S2213538323000802-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138558918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-12-05DOI: 10.1016/j.jcpo.2023.100461
Abdel-Azez Abusamak , Mohammad Abusamak , Mohammed Al-Abbadi , Abdallah Rayyan , Omar Oran , Ghulam Rehman Mohyuddin , Amar H. Kelkar , Aaron M. Goodman , Rajshekhar Chakraborty , Edward R.Scheffer Cliff , Samer Al Hadidi
Background
Subjective minimizing language in oncology conferences may undermine patient-centered care and hinder comprehensive treatment strategies. Subjective terms like "safe," "tolerable," and "well-tolerated" can vary in interpretation among individuals, making it difficult to compare results across trials and potentially downplaying significant risks and limitations associated with treatments.
Methods
This study evaluates subjective minimizing language in major oncology conferences and its use in adverse event reporting. We conducted a search of three electronic databases, ASCO, ASH, and ESMO, for published abstracts from January 1, 2019, to December 31, 2021. This study included prospective cohort studies or clinical trials in humans that used safety terms like "safe," "well-tolerated," "tolerable," "no new safety signal," or "no new safety concern" in the abstract text.
Results
Out of 34,975 reviewed records, 5299 (15.2%) abstracts used subjective minimizing language terms. The analysis included 2797 (52.8%) abstracts meeting the inclusion criteria. The majority of studies were Phase 1 trials (45.5%), followed by Phase 2 (29.6%) and Phase 3 trials (7.4%). Solid tumors accounted for the most common disease category (56.5%), followed by malignant hematology following (37.1%). Subjective minimizing terms like "safe" (69.2%), "well-tolerated" (53.2%), "tolerable" (25.6%), and "no new safety signal/concerns" (10%) were used frequently. Of the abstracts using subjective minimizing language (n = 2797), 81.9% reported data on any grade adverse events (AEs). Grade I/II AEs were reported in 62.6% of abstracts, Grade III/IV AEs in 78%, and Grade V AEs (death related to AEs) in 8.8%. Discontinuation due to AEs occurred in 11.4% (SD 9.5%) of studies using subjective minimizing language terms.
Conclusions
Frequent use of subjective minimizing language in major oncology conferences' abstracts may obscure interpretation of study results and the safety of novel treatments. Researchers and clinicians should provide precise and standardized information to avoid overstatement of benefits and understand the true impact of interventions on patients' safety and well-being.
{"title":"Use of subjective minimizing language at hematology and oncology conferences: A systematic review","authors":"Abdel-Azez Abusamak , Mohammad Abusamak , Mohammed Al-Abbadi , Abdallah Rayyan , Omar Oran , Ghulam Rehman Mohyuddin , Amar H. Kelkar , Aaron M. Goodman , Rajshekhar Chakraborty , Edward R.Scheffer Cliff , Samer Al Hadidi","doi":"10.1016/j.jcpo.2023.100461","DOIUrl":"https://doi.org/10.1016/j.jcpo.2023.100461","url":null,"abstract":"<div><h3>Background</h3><p>Subjective minimizing language in oncology<span> conferences may undermine patient-centered care and hinder comprehensive treatment strategies. Subjective terms like \"safe,\" \"tolerable,\" and \"well-tolerated\" can vary in interpretation among individuals, making it difficult to compare results across trials and potentially downplaying significant risks and limitations associated with treatments.</span></p></div><div><h3>Methods</h3><p><span><span>This study evaluates subjective minimizing language in major oncology conferences and its use in adverse event reporting. We conducted a search of three electronic databases, ASCO, </span>ASH<span>, and ESMO<span>, for published abstracts from January 1, 2019, to December 31, 2021. This study included prospective cohort studies or </span></span></span>clinical trials in humans that used safety terms like \"safe,\" \"well-tolerated,\" \"tolerable,\" \"no new safety signal,\" or \"no new safety concern\" in the abstract text.</p></div><div><h3>Results</h3><p>Out of 34,975 reviewed records, 5299 (15.2%) abstracts used subjective minimizing language terms. The analysis included 2797 (52.8%) abstracts meeting the inclusion criteria. The majority of studies were Phase 1 trials (45.5%), followed by Phase 2 (29.6%) and Phase 3 trials (7.4%). Solid tumors<span> accounted for the most common disease category (56.5%), followed by malignant hematology following (37.1%). Subjective minimizing terms like \"safe\" (69.2%), \"well-tolerated\" (53.2%), \"tolerable\" (25.6%), and \"no new safety signal/concerns\" (10%) were used frequently. Of the abstracts using subjective minimizing language (n = 2797), 81.9% reported data on any grade adverse events (AEs). Grade I/II AEs were reported in 62.6% of abstracts, Grade III/IV AEs in 78%, and Grade V AEs (death related to AEs) in 8.8%. Discontinuation due to AEs occurred in 11.4% (SD 9.5%) of studies using subjective minimizing language terms.</span></p></div><div><h3>Conclusions</h3><p>Frequent use of subjective minimizing language in major oncology conferences' abstracts may obscure interpretation of study results and the safety of novel treatments. Researchers and clinicians should provide precise and standardized information to avoid overstatement of benefits and understand the true impact of interventions on patients' safety and well-being.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138581974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Understanding the factors that are associated with new molecular entity (NME) cancer drug approvals as a single agent and in combination, and European Society for Medical Oncology (ESMO) scores, can aid in identifying suitable factors to consider in trial designs for future drugs. In addition, the association between the various outcomes can aid in determining benefit when surrogate outcomes are used in approval consideration.
Objective
This study aims to (1) use the measures used in evaluating clinical trials by ESMO scores to determine the differences in the characteristics of 2013–2022 Food and Drug Administration (FDA) oncology NME drug approvals for those approved for use in combination or as a monotherapy, and (2) analyze the association between survival outcomes and the response rate for monotherapy NME drugs and/or drugs approved in combination.
Design
Cross-sectional analysis.
Setting
US FDA Oncology Drug Approvals (2013–2022)
Participants
US FDA Oncology Drug Approvals (2013–2022)
Exposures
Trial-level characteristics (tumor types, basis of approval, randomized or not, phase) and associations between overall survival (OS), progression-free survival (PFS), or overall response rate (ORR) and whether NME drugs were approved as monotherapy or in combination .
Results
Drugs approved for use as a monotherapy are less likely to be approved using a randomized study (p < 0.001) and more likely to be approved via the accelerated pathway (p = 0.012) and be open-label (p < 0.001). Drugs approved for use as a combination or monotherapy significantly differed on their approval basis (p = 0.002), phase of trial at the time of approval (p = 0.02), and ESMO scores (p = 0.02). There was low correlation between response rate and either PFS or OS metrics. However, nearly all of the drugs with large improvements in OS (> 5months) were drugs with robust ORR.
Conclusions and relevance
Drugs approved as monotherapy with a low response rate are likely to have marginal benefit in OS and PFS.
重要性了解与新分子实体(NME)癌症药物单药和联合批准相关的因素，以及欧洲肿瘤医学学会(ESMO)评分，可以帮助确定未来药物试验设计中考虑的合适因素。此外，当替代结果用于批准考虑时，各种结果之间的关联可以帮助确定获益。本研究旨在(1)利用ESMO评分评估临床试验的方法，确定2013-2022年FDA (Food and Drug Administration, FDA)批准的肿瘤NME药物在联合或单一治疗方面的特点差异;(2)分析单一治疗NME药物和/或联合批准的NME药物的生存结局与缓解率之间的关联。DesignCross-sectional分析。美国FDA肿瘤药物批准(2013-2022):暴露水平的特征(肿瘤类型、批准基础、随机与否、分期)和总生存期(OS)、无进展生存期(PFS)或总缓解率(ORR)之间的关系，以及NME药物是被批准作为单一疗法还是联合疗法。结果批准用作单一疗法的药物在随机研究中被批准的可能性较小(p <0.001)，更有可能通过加速途径获得批准(p = 0.012)和开放标签(p <0.001)。被批准作为联合或单一疗法使用的药物在其批准基础(p = 0.002)、批准时的试验阶段(p = 0.02)和ESMO评分(p = 0.02)上存在显著差异。反应率与PFS或OS指标之间的相关性较低。然而，几乎所有对OS有显著改善的药物(>5个月)均为ORR较强的药物。结论和相关性:被批准为单药治疗的低缓解率药物可能在OS和PFS中具有边际效益。
{"title":"Characteristics and outcomes of new molecular oncology drug approvals, in combination or monotherapy","authors":"Sruthi Ranganathan , Alyson Haslam , Jordan Tuia , Vinay Prasad","doi":"10.1016/j.jcpo.2023.100462","DOIUrl":"10.1016/j.jcpo.2023.100462","url":null,"abstract":"<div><h3>Importance</h3><p>Understanding the factors that are associated with new molecular entity (NME) cancer drug<span> approvals as a single agent and in combination, and European Society for Medical Oncology (ESMO) scores, can aid in identifying suitable factors to consider in trial designs for future drugs. In addition, the association between the various outcomes can aid in determining benefit when surrogate outcomes are used in approval consideration.</span></p></div><div><h3>Objective</h3><p><span>This study aims to (1) use the measures used in evaluating clinical trials<span> by ESMO scores to determine the differences in the characteristics of 2013–2022 Food and Drug Administration (FDA) oncology NME drug approvals for those approved for use in combination or as a </span></span>monotherapy, and (2) analyze the association between survival outcomes and the response rate for monotherapy NME drugs and/or drugs approved in combination.</p></div><div><h3>Design</h3><p>Cross-sectional analysis.</p></div><div><h3>Setting</h3><p>US FDA Oncology Drug Approvals (2013–2022)</p></div><div><h3>Participants</h3><p>US FDA Oncology Drug Approvals (2013–2022)</p></div><div><h3>Exposures</h3><p>Trial-level characteristics (tumor types, basis of approval, randomized or not, phase) and associations between overall survival (OS), progression-free survival (PFS), or overall response rate (ORR) and whether NME drugs were approved as monotherapy or in combination .</p></div><div><h3>Results</h3><p>Drugs approved for use as a monotherapy are less likely to be approved using a randomized study (p < 0.001) and more likely to be approved via the accelerated pathway (p = 0.012) and be open-label (p < 0.001). Drugs approved for use as a combination or monotherapy significantly differed on their approval basis (p = 0.002), phase of trial at the time of approval (p = 0.02), and ESMO scores (p = 0.02). There was low correlation between response rate and either PFS or OS metrics. However, nearly all of the drugs with large improvements in OS (> 5months) were drugs with robust ORR.</p></div><div><h3>Conclusions and relevance</h3><p>Drugs approved as monotherapy with a low response rate are likely to have marginal benefit in OS and PFS.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138614153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In India the cancer burden for 2021 was 26.7 million disability-adjusted life years (DALYs), and this is expected to increase to 29.8 million in 2025 (Kulothungan et al., 2022). According to the World Health Organisation (WHO), cancer is a leading cause of death worldwide, accounting for one in six deaths. As per WHO, palliative care is a strategy that assists both adults and children along with their families in dealing with life-threatening illnesses. Currently, only 14% of those in need of pain and palliative (P&P) care receive it globally (WHO, 2020). Financial toxicity (FT) is the term used to describe the negative effects that an excessive financial burden resulting from cancer have on patients, their families, and society (Desai and Gyawali, 2020). Addressing this gap will require significant adjustments to both demand- and supply-side policies to ensure accessible and equitable cancer care in India (Caduff et al., 2019). Measuring FT along with health-related quality of life (HRQoL) represents a clinically relevant and patient-centred approach (de Souza et al., 2017).
Aim and objective
To estimate FT and its association with quality of life (QoL).
Materials and methods
This was an observational descriptive study conducted among cancer patients recommended for P&P care. Scores were estimated from September 2022 to February 2023 using official tools: the Functional Assessment for Chronic illness Treatment Compressive Score for Financial Toxicity (FACIT-COST) and the European Organisation for Research and Treatment of Cancer (EORTC) Quality of life Questionnaires for Cancer (QLQ30).
Results
From 150 patients (70 males and 80 females, mean age 54.96 ± 13.5 years), 92.6% suffered from FT. Eleven patients (7.3%) were under FT grade 0, 41 (27.3%) were FT grade 1, 98 (65.3%) were FT grade 2, and no patients were under FT grade 3. At criterial alpha 0.05 (95%CI), FT and the global score for HRQoL showed an association. Among inpatient department (IPD) expenses, medication bills contributed the greatest expense at 33%, and among outpatient department (OPD) expenses treatment expenses contributed 50% of the total. Breast cancer (30 cases, 20%) and oral cancer (26 cases, 17.3%) were the most frequent cancers.
Conclusion
FT measured using the COST tool showed an association with HRQoL.
Policy summary
This paper refers to the insurance policies available for cancer patients irrespective of P&P care treatment.
{"title":"Financial toxicity and its implication on quality of life in patients attending the palliative care department in a regional cancer centre: An observational study","authors":"Vaishnavi Nikte , Savita Patil , Hemakshi Chaudhari , Chaitanya Patil , Reshma Pawar , Prasad Patil , Harshvardhan More , Ujjwal Katolkar","doi":"10.1016/j.jcpo.2023.100460","DOIUrl":"10.1016/j.jcpo.2023.100460","url":null,"abstract":"<div><p><span>In India the cancer burden for 2021 was 26.7 million disability-adjusted life years (DALYs), and this is expected to increase to 29.8 million in 2025 (Kulothungan et al., 2022). According to the World Health Organisation (WHO), cancer is a leading cause of death worldwide, accounting for one in six deaths. As per WHO, palliative care is a strategy that assists both adults and children along with their families in dealing with life-threatening illnesses. Currently, only 14% of those in need of pain and palliative (P&P) care receive it globally (WHO, 2020). Financial toxicity (FT) is the term used to describe the negative effects that an excessive financial burden resulting from cancer have on patients, their families, and society (Desai and Gyawali, 2020). Addressing this gap will require significant adjustments to both demand- and supply-side policies to ensure accessible and equitable cancer care in India (Caduff et al., 2019). Measuring FT along with health-related </span>quality of life (HRQoL) represents a clinically relevant and patient-centred approach (de Souza et al., 2017).</p></div><div><h3>Aim and objective</h3><p>To estimate FT and its association with quality of life (QoL).</p></div><div><h3>Materials and methods</h3><p>This was an observational descriptive study conducted among cancer patients recommended for P&P care. Scores were estimated from September 2022 to February 2023 using official tools: the Functional Assessment for Chronic illness Treatment Compressive Score for Financial Toxicity (FACIT-COST) and the European Organisation for Research and Treatment of Cancer (EORTC) Quality of life Questionnaires for Cancer (QLQ30).</p></div><div><h3>Results</h3><p>From 150 patients (70 males and 80 females, mean age 54.96 ± 13.5 years), 92.6% suffered from FT. Eleven patients (7.3%) were under FT grade 0, 41 (27.3%) were FT grade 1, 98 (65.3%) were FT grade 2, and no patients were under FT grade 3. At criterial alpha 0.05 (95%CI), FT and the global score for HRQoL showed an association. Among inpatient department (IPD) expenses, medication bills contributed the greatest expense at 33%, and among outpatient department (OPD) expenses treatment expenses contributed 50% of the total. Breast cancer (30 cases, 20%) and oral cancer (26 cases, 17.3%) were the most frequent cancers.</p></div><div><h3>Conclusion</h3><p>FT measured using the COST tool showed an association with HRQoL.</p></div><div><h3>Policy summary</h3><p>This paper refers to the insurance policies available for cancer patients irrespective of P&P care treatment.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138616690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-28DOI: 10.1016/j.jcpo.2023.100459
Andre G. Gouveia , Gustavo A. Viani , Vanessa F. Bratti , Gustavo N. Marta , Samir A. Hanna , Alexandre A. Jacinto , Mauricio S. Silva , Ana C. Hamamura , Arthur A. Rosa , Marcus S. Castilho , Laura Carson , Wilma M. Hopman , Richard Sullivan , Christopher M. Booth , Ajay Aggarwal , Timothy P. Hanna , Fabio Y. Moraes
Background
In 2012, the Brazilian government launched a radiotherapy (RT) expansion plan (PER-SUS) to install 100 linear accelerators. This study assesses the development of this program after eight years.
Methods
Official reports from the Ministry of Health (MoH) were reviewed. RT centres projects status, timeframes, and cost data (all converted to US dollars) were extracted. The time analysis was divided into seven phases, and for cost evaluation, there were five stages. The initial predicted project time (IPPT) and costs (estimated by the MoH) for each phase were compared between the 18 operational RT centres (able to treat patients) and 30 non-operational RT centres using t-tests, ANOVA, and the Mann-Whitney U. A p-value < 0.05 indicates statistical significance.
Results
A significant delay was observed when comparing the IPPT with the overall time to conclude each 48 RT centres project (p < 0.001), with considerable delays in the first five phases (p < 0.001 for all). Moreover, the median time to conclude the first 18 operational RT centres (77.4 months) was shorter compared with the 30 non-operational RT centres (94.0 months), p < 0.001. The total cost of 48 RT services was USD 82,84 millions (mi) with a significant difference in the per project median total cost between 18 operational RT centres, USD1,34 mi and 30 non-operational RT centres USD2,11 mi, p < 0.001. All phases had a higher cost when comparing 30 non-operational RT centres to 18 operational RT centres, p < 0.001. The median total cost for expanding existing RT centres was USD1,30 mi versus USD2,18 mi for new RT services, p < 0.0001.
Conclusion
After eight years, the PER-SUS programs showed a substantial delay in most projects and their phases, with increased costs over time.
Policy summary
Our findings indicate a need to act to increase the success of this plan. This study may provide a benchmark for other developing countries trying to expand RT capacity.
背景:2012年，巴西政府启动了一项放疗(RT)扩展计划(PER-SUS)，计划安装100台直线加速器。本研究评估了该项目八年后的发展情况。方法:查阅卫生部官方报告。提取RT中心、项目状态、时间框架和成本数据(全部转换为美元)。时间分析分为7个阶段，成本评估分为5个阶段。每个阶段的初始预测项目时间(IPPT)和成本(由卫生部估计)在18个手术RT中心(能够治疗患者)和30个非手术RT中心之间进行比较，使用t检验，方差分析和Mann-Whitney U. A p值结果:当比较IPPT与完成每48个RT中心项目的总时间时，观察到显着延迟(pConclusion:8年后，PER-SUS项目显示出大多数项目及其阶段的实质性延迟，成本随着时间的推移而增加。政策摘要:我们的研究结果表明，需要采取行动以提高该计划的成功率。这项研究可能为其他发展中国家扩大RT能力提供一个基准。
{"title":"Challenges in building radiotherapy capacity: A longitudinal study evaluating eight years of the Brazilian radiotherapy expansion plan","authors":"Andre G. Gouveia , Gustavo A. Viani , Vanessa F. Bratti , Gustavo N. Marta , Samir A. Hanna , Alexandre A. Jacinto , Mauricio S. Silva , Ana C. Hamamura , Arthur A. Rosa , Marcus S. Castilho , Laura Carson , Wilma M. Hopman , Richard Sullivan , Christopher M. Booth , Ajay Aggarwal , Timothy P. Hanna , Fabio Y. Moraes","doi":"10.1016/j.jcpo.2023.100459","DOIUrl":"10.1016/j.jcpo.2023.100459","url":null,"abstract":"<div><h3>Background</h3><p>In 2012, the Brazilian government launched a radiotherapy (RT) expansion plan (PER-SUS) to install 100 linear accelerators. This study assesses the development of this program after eight years.</p></div><div><h3>Methods</h3><p>Official reports from the Ministry of Health (MoH) were reviewed. RT centres projects status, timeframes, and cost data (all converted to US dollars) were extracted. The time analysis was divided into seven phases, and for cost evaluation, there were five stages. The initial predicted project time (IPPT) and costs (estimated by the MoH) for each phase were compared between the 18 operational RT centres (able to treat patients) and 30 non-operational RT centres using t-tests, ANOVA, and the Mann-Whitney U. A p-value < 0.05 indicates statistical significance.</p></div><div><h3>Results</h3><p>A significant delay was observed when comparing the IPPT with the overall time to conclude each 48 RT centres project (p < 0.001), with considerable delays in the first five phases (p < 0.001 for all). Moreover, the median time to conclude the first 18 operational RT centres (77.4 months) was shorter compared with the 30 non-operational RT centres (94.0 months), p < 0.001. The total cost of 48 RT services was USD 82,84 millions (mi) with a significant difference in the per project median total cost between 18 operational RT centres, USD1,34 mi and 30 non-operational RT centres USD2,11 mi, p < 0.001. All phases had a higher cost when comparing 30 non-operational RT centres to 18 operational RT centres, p < 0.001. The median total cost for expanding existing RT centres was USD1,30 mi versus USD2,18 mi for new RT services, p < 0.0001.</p></div><div><h3>Conclusion</h3><p>After eight years, the PER-SUS programs showed a substantial delay in most projects and their phases, with increased costs over time.</p></div><div><h3>Policy summary</h3><p>Our findings indicate a need to act to increase the success of this plan. This study may provide a benchmark for other developing countries trying to expand RT capacity.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138463188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-25DOI: 10.1016/j.jcpo.2023.100457
Iman Hesso , Reem Kayyali , Lithin Zacharias , Andreas Charalambous , Maria Lavdaniti , Evangelia Stalika , Tarek Ajami , Wanda Acampa , Jasmina Boban , Shereen Nabhani Gebara
Background
Cancer poses significant challenges for healthcare professionals across the disease pathway including cancer imaging. This study constitutes part of the user requirement definition of INCISIVE EU project. The project has been designed to explore the full potential of artificial intelligence (AI)-based technologies in cancer imaging to streamline diagnosis and management. The study aimed to map cancer care pathways (breast, prostate, colorectal and lung cancers) across INCISIVE partner countries, and identify bottle necks within these pathways.
Methods
Email interviews were conducted with ten oncology specialised healthcare professionals representing INCISIVE partner countries: Greece, Cyprus, Spain, Italy, Finland, the United Kingdom (UK) and Serbia. A purposive sampling strategy was employed for recruitment and data was collected between December 2020 and April 2021. Data was entered into Microsoft Excel spreadsheet to allow content examination and comparative analysis.
Results
The analysed pathways all shared a common characteristic: inequalities in relation to delays in cancer diagnosis and treatment. All the studied countries, except the UK, lacked official national data about diagnostic and therapeutic delays. Furthermore, a considerable variation was noted regarding the availability of imaging and diagnostic services across the seven countries. Several concerns were also noted for inefficiencies/inequalities with regards to national screening for the four investigated cancer types.
Conclusions
Delays in cancer diagnosis and treatment are an ongoing challenge and a source for inequalities. It is important to have systematic reporting of diagnostic and therapeutic delays in all countries to allow the proper estimation of its magnitude and support needed to address it. Our findings also support the orientation of the current policies towards early detection and wide scale adoption and implementation of cancer screening, through research, innovation, and technology. Technologies involving AI can have a great potential to revolutionise cancer care delivery.
Policy summary
This study highlights the widespread delay in cancer diagnosis across Europe and supports the need for, systematic reporting of delays, improved availability of imaging services, and optimised national screening programs. The goal is to enhance cancer care delivery, encourage early detection, and implement research, innovation, and AI-based technologies for improved cancer imaging.
{"title":"Cancer care pathways across seven countries in Europe: What are the current obstacles? And how can artificial intelligence help?","authors":"Iman Hesso , Reem Kayyali , Lithin Zacharias , Andreas Charalambous , Maria Lavdaniti , Evangelia Stalika , Tarek Ajami , Wanda Acampa , Jasmina Boban , Shereen Nabhani Gebara","doi":"10.1016/j.jcpo.2023.100457","DOIUrl":"10.1016/j.jcpo.2023.100457","url":null,"abstract":"<div><h3>Background</h3><p>Cancer poses significant challenges for healthcare professionals across the disease pathway including cancer imaging. This study constitutes part of the user requirement definition of INCISIVE EU project. The project has been designed to explore the full potential of artificial intelligence (AI)-based technologies in cancer imaging to streamline diagnosis and management. The study aimed to map cancer care pathways (breast, prostate, colorectal and lung cancers) across INCISIVE partner countries, and identify bottle necks within these pathways.</p></div><div><h3>Methods</h3><p>Email interviews were conducted with ten oncology specialised healthcare professionals representing INCISIVE partner countries: Greece, Cyprus, Spain, Italy, Finland, the United Kingdom (UK) and Serbia. A purposive sampling strategy was employed for recruitment and data was collected between December 2020 and April 2021. Data was entered into Microsoft Excel spreadsheet to allow content examination and comparative analysis.</p></div><div><h3>Results</h3><p>The analysed pathways all shared a common characteristic: inequalities in relation to delays in cancer diagnosis and treatment. All the studied countries, except the UK, lacked official national data about diagnostic and therapeutic delays. Furthermore, a considerable variation was noted regarding the availability of imaging and diagnostic services across the seven countries. Several concerns were also noted for inefficiencies/inequalities with regards to national screening for the four investigated cancer types.</p></div><div><h3>Conclusions</h3><p>Delays in cancer diagnosis and treatment are an ongoing challenge and a source for inequalities. It is important to have systematic reporting of diagnostic and therapeutic delays in all countries to allow the proper estimation of its magnitude and support needed to address it. Our findings also support the orientation of the current policies towards early detection and wide scale adoption and implementation of cancer screening, through research, innovation, and technology. Technologies involving AI can have a great potential to revolutionise cancer care delivery.</p></div><div><h3>Policy summary</h3><p>This study highlights the widespread delay in cancer diagnosis across Europe and supports the need for, systematic reporting of delays, improved availability of imaging services, and optimised national screening programs. The goal is to enhance cancer care delivery, encourage early detection, and implement research, innovation, and AI-based technologies for improved cancer imaging.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213538323000747/pdfft?md5=afd536d2a53d02f52f743a571937652a&pid=1-s2.0-S2213538323000747-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138441348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-25DOI: 10.1016/j.jcpo.2023.100458
Benjamin Pickwell-Smith , Sarah Greenley , Michael Lind , Una Macleod
Introduction
Patients diagnosed with ovarian cancer from more deprived areas may face barriers to accessing timely, quality healthcare. We evaluated the literature for any association between socioeconomic group, treatments received and hospital delay among patients diagnosed with ovarian cancer in the United Kingdom, a country with universal healthcare.
Methods
We searched MEDLINE, EMBASE, CINAHL, CENTRAL, SCIE, AMED, PsycINFO and HMIC from inception to January 2023. Forward and backward citation searches were conducted. Two reviewers independently reviewed titles, abstracts, and full-text articles. UK-based studies were included if they reported socioeconomic measures and an association with either treatments received or hospital delay. The inclusion of studies from one country ensured greater comparability. Risk of bias was assessed using the QUIPS tool, and a narrative synthesis was conducted. The review is reported to PRISMA 2020 and registered with PROSPERO [CRD42022332071].
Results
Out of 2876 references screened, ten were included. Eight studies evaluated treatments received, and two evaluated hospital delays. We consistently observed socioeconomic inequalities in the likelihood of surgery (range of odds ratios 0.24–0.99) and chemotherapy (range of odds ratios 0.70–0.99) among patients from the most, compared with the least, deprived areas. There were no associations between socioeconomic groups and hospital delay.
Policy summary
Ovarian cancer treatments differed between socioeconomic groups despite the availability of universal healthcare. Further research is needed to understand why, though suggested reasons include patient choice, health literacy, and financial and employment factors. Qualitative research would provide a rich understanding of the complex factors that drive these inequalities.
{"title":"Where are the inequalities in ovarian cancer care in a country with universal healthcare? A systematic review and narrative synthesis","authors":"Benjamin Pickwell-Smith , Sarah Greenley , Michael Lind , Una Macleod","doi":"10.1016/j.jcpo.2023.100458","DOIUrl":"10.1016/j.jcpo.2023.100458","url":null,"abstract":"<div><h3>Introduction</h3><p>Patients diagnosed with ovarian cancer from more deprived areas may face barriers to accessing timely, quality healthcare. We evaluated the literature for any association between socioeconomic group, treatments received and hospital delay among patients diagnosed with ovarian cancer in the United Kingdom, a country with universal healthcare.</p></div><div><h3>Methods</h3><p>We searched MEDLINE, EMBASE, CINAHL, CENTRAL, SCIE, AMED, PsycINFO and HMIC from inception to January 2023. Forward and backward citation searches were conducted. Two reviewers independently reviewed titles, abstracts, and full-text articles. UK-based studies were included if they reported socioeconomic measures and an association with either treatments received or hospital delay. The inclusion of studies from one country ensured greater comparability. Risk of bias was assessed using the QUIPS tool, and a narrative synthesis was conducted. The review is reported to PRISMA 2020 and registered with PROSPERO [CRD42022332071].</p></div><div><h3>Results</h3><p>Out of 2876 references screened, ten were included. Eight studies evaluated treatments received, and two evaluated hospital delays. We consistently observed socioeconomic inequalities in the likelihood of surgery (range of odds ratios 0.24–0.99) and chemotherapy (range of odds ratios 0.70–0.99) among patients from the most, compared with the least, deprived areas. There were no associations between socioeconomic groups and hospital delay.</p></div><div><h3>Policy summary</h3><p>Ovarian cancer treatments differed between socioeconomic groups despite the availability of universal healthcare. Further research is needed to understand why, though suggested reasons include patient choice, health literacy, and financial and employment factors. Qualitative research would provide a rich understanding of the complex factors that drive these inequalities.</p></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2023-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2213538323000759/pdfft?md5=db512190bee39b2c2fd83ff809fcfb31&pid=1-s2.0-S2213538323000759-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138446549","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号