Pub Date : 2026-03-01Epub Date: 2026-01-18DOI: 10.1016/j.jcpo.2026.100708
Mark Lawler , Csaba L. Degi , Lauren Diamond , Katie Thurston-Smith
<div><h3>Introduction</h3><div>As the global burden of cancer increases, international and national policymakers have made notable progress with the development of national cancer control plans (NCCPs). An increasing number of countries have published and updated their NCCPs; their design and implementation vary widely.</div></div><div><h3>Methods</h3><div>A literature scoping review was conducted to understand common challenges and progress in NCCPs across 20 representative countries based on a framework drafted to reflect the European Beating Cancer Plan and World Health Organisation’s guidance on NCCPs. In total, 103 sources were used for the analysis. These comprised of 42 official NCCPs, five accompanying documents, whilst the remainder (56) included other government official reports, academic, and grey literature. The research followed a standardised framework used to evaluate policies across five pillars: prevention, early detection, care, treatment, and quality-of-life.</div></div><div><h3>Results</h3><div>Across the 20 NCCPs, 65% assigned implementation of objectives to key stakeholders. A total of 25% of NCCPs did not include details on the allocated budget for implementation. Overall, there was variation in the definition of clear objectives and actionable targets across pillars. In the ‘Prevention’ pillar, most plans addressed reducing risk factors (80%), but less than half focus on increasing people’s awareness (40%). For ‘Early Detection’, 50% of NCCP included targets for cancer screening programmes, while 25% included targets for advanced diagnostics. NCCPs included well-defined objectives across ‘Care’ mechanisms, including centres of excellence (35%), multi-stakeholder engagement (50%), informed providers (40%), and cancer registries (55%). The pillar focused on ‘Treatment’ generally lacked actionable objectives, with low proportion of NCCPs having objectives related to early access (10%), access and reimbursement (15%), and none for regulatory approval or evidence requirements. Finally, plans demonstrated a relatively strong focus on ‘Quality-of-Life’ policy mechanisms, with clear goals and targets for palliative care (60%), support programmes (60%). ‘Research and Innovation’ and objectives related to these domains were highlighted across the cancer care continuum (65%). From a country perspective, NCCP Governance Scores (a measure of the inclusion of targeted, actionable objectives, allocated budgets, clearly assigned responsibilities, and monitoring reports) were highest in France, Ireland and Japan and lowest in Austria, Brazil, Norway, Saudi Arabia, Sweden and Turkiye, whereas NCCP Policy Indices (a measure of the inclusion of targeted, actionable objectives in each policy pillar) were higher in Belgium and Ireland and lower in Germany, Mexico, Switzerland The Netherlands and the US.</div></div><div><h3>Conclusion</h3><div>We propose the following recommendations to further enhance NCCPs: 1) Strengthen measurable and actiona
{"title":"Analysis and recommendations to improve national cancer control plans and policies informed by a 20 country analysis","authors":"Mark Lawler , Csaba L. Degi , Lauren Diamond , Katie Thurston-Smith","doi":"10.1016/j.jcpo.2026.100708","DOIUrl":"10.1016/j.jcpo.2026.100708","url":null,"abstract":"<div><h3>Introduction</h3><div>As the global burden of cancer increases, international and national policymakers have made notable progress with the development of national cancer control plans (NCCPs). An increasing number of countries have published and updated their NCCPs; their design and implementation vary widely.</div></div><div><h3>Methods</h3><div>A literature scoping review was conducted to understand common challenges and progress in NCCPs across 20 representative countries based on a framework drafted to reflect the European Beating Cancer Plan and World Health Organisation’s guidance on NCCPs. In total, 103 sources were used for the analysis. These comprised of 42 official NCCPs, five accompanying documents, whilst the remainder (56) included other government official reports, academic, and grey literature. The research followed a standardised framework used to evaluate policies across five pillars: prevention, early detection, care, treatment, and quality-of-life.</div></div><div><h3>Results</h3><div>Across the 20 NCCPs, 65% assigned implementation of objectives to key stakeholders. A total of 25% of NCCPs did not include details on the allocated budget for implementation. Overall, there was variation in the definition of clear objectives and actionable targets across pillars. In the ‘Prevention’ pillar, most plans addressed reducing risk factors (80%), but less than half focus on increasing people’s awareness (40%). For ‘Early Detection’, 50% of NCCP included targets for cancer screening programmes, while 25% included targets for advanced diagnostics. NCCPs included well-defined objectives across ‘Care’ mechanisms, including centres of excellence (35%), multi-stakeholder engagement (50%), informed providers (40%), and cancer registries (55%). The pillar focused on ‘Treatment’ generally lacked actionable objectives, with low proportion of NCCPs having objectives related to early access (10%), access and reimbursement (15%), and none for regulatory approval or evidence requirements. Finally, plans demonstrated a relatively strong focus on ‘Quality-of-Life’ policy mechanisms, with clear goals and targets for palliative care (60%), support programmes (60%). ‘Research and Innovation’ and objectives related to these domains were highlighted across the cancer care continuum (65%). From a country perspective, NCCP Governance Scores (a measure of the inclusion of targeted, actionable objectives, allocated budgets, clearly assigned responsibilities, and monitoring reports) were highest in France, Ireland and Japan and lowest in Austria, Brazil, Norway, Saudi Arabia, Sweden and Turkiye, whereas NCCP Policy Indices (a measure of the inclusion of targeted, actionable objectives in each policy pillar) were higher in Belgium and Ireland and lower in Germany, Mexico, Switzerland The Netherlands and the US.</div></div><div><h3>Conclusion</h3><div>We propose the following recommendations to further enhance NCCPs: 1) Strengthen measurable and actiona","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"47 ","pages":"Article 100708"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146012776","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 : 2026-03-01Epub Date: 2026-01-30DOI: 10.1016/j.jcpo.2026.100710
Ernest Adankwah , Adwoa Bemah Boamah Mensah , Thomas Konney , Madalyn Nones , Rita Ziem Ekekpi , Joshua Okyere , Laud Anthony Basing , Kwame Ofori Boadu , Felicia Maame Efua Eduah , Beth Virnig , Shalini Kulasingam
Background
Self-sampled HPV testing followed by timely treatment has shown promise in increasing screening uptake and improving cervical cancer outcomes. However, in low-resource countries like Ghana, its adoption and sustainability face significant challenges.
Methods
This cross-sectional pilot study comprised a convenience sample of women presenting at two healthcare facilities in Ghana: Kumasi South Hospital and South Suntreso Hospital. Following consent, a pre-and post-collection survey was administered by a trained study nurse to examine women's preferences and experiences with self-sampling. Participants were then asked to self-collect an HPV sample followed by a clinician-conducted exam using visual inspection with acetic acid (VIA). Samples were tested for HPV genotypes using the Seegene Anyplex HPV28 Test.
Results
Sixty women were enrolled. After performing HPV self-collection, 91.7 % (n = 55) stated that they would prefer self-sampling instead of a clinician-collected Pap smear. Prior to the self-collection process, 40.0 % (24 women) gave high ratings for the overall acceptability of HPV self-collection. This increased to 86.7 % (52 women) after the self-collection process. Of the 60 women, 25 % (15/60) tested positive for HPV and 6.7 % (4/60) were confirmed positive by VIA examination. Overall agreement between the two procedures was fair (κ=0.24).
Conclusions
This pilot study supports the feasibility of HPV self-sampling and its potential to increase access to cervical screening in Ghana.
{"title":"A pilot study on the acceptability and feasibility of HPV self-sampling for cervical cancer screening among women attending urban hospitals in Kumasi, Ghana","authors":"Ernest Adankwah , Adwoa Bemah Boamah Mensah , Thomas Konney , Madalyn Nones , Rita Ziem Ekekpi , Joshua Okyere , Laud Anthony Basing , Kwame Ofori Boadu , Felicia Maame Efua Eduah , Beth Virnig , Shalini Kulasingam","doi":"10.1016/j.jcpo.2026.100710","DOIUrl":"10.1016/j.jcpo.2026.100710","url":null,"abstract":"<div><h3>Background</h3><div>Self-sampled HPV testing followed by timely treatment has shown promise in increasing screening uptake and improving cervical cancer outcomes. However, in low-resource countries like Ghana, its adoption and sustainability face significant challenges.</div></div><div><h3>Methods</h3><div>This cross-sectional pilot study comprised a convenience sample of women presenting at two healthcare facilities in Ghana: Kumasi South Hospital and South Suntreso Hospital. Following consent, a pre-and post-collection survey was administered by a trained study nurse to examine women's preferences and experiences with self-sampling. Participants were then asked to self-collect an HPV sample followed by a clinician-conducted exam using visual inspection with acetic acid (VIA). Samples were tested for HPV genotypes using the Seegene Anyplex HPV28 Test.</div></div><div><h3>Results</h3><div>Sixty women were enrolled. After performing HPV self-collection, 91.7 % (n = 55) stated that they would prefer self-sampling instead of a clinician-collected Pap smear. Prior to the self-collection process, 40.0 % (24 women) gave high ratings for the overall acceptability of HPV self-collection. This increased to 86.7 % (52 women) after the self-collection process. Of the 60 women, 25 % (15/60) tested positive for HPV and 6.7 % (4/60) were confirmed positive by VIA examination. Overall agreement between the two procedures was fair (κ=0.24).</div></div><div><h3>Conclusions</h3><div>This pilot study supports the feasibility of HPV self-sampling and its potential to increase access to cervical screening in Ghana.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"47 ","pages":"Article 100710"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146100891","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 : 2026-03-01Epub Date: 2025-12-18DOI: 10.1016/j.jcpo.2025.100695
Claire Poole , Michelle Leech , Laure Marignol
{"title":"Barriers to radiation therapy Access: A Multi-stakeholder exploration across Europe","authors":"Claire Poole , Michelle Leech , Laure Marignol","doi":"10.1016/j.jcpo.2025.100695","DOIUrl":"10.1016/j.jcpo.2025.100695","url":null,"abstract":"","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"47 ","pages":"Article 100695"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147394339","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 : 2026-03-01Epub Date: 2026-02-16DOI: 10.1016/j.jcpo.2026.100718
Rashidul Alam Mahumud , Yifu Chen , Padam Kanta Dahal , Nasrin Akter , Md Shahjalal , Khorshed Alam
<div><h3>Background</h3><div>Adjuvant immunotherapies have transformed lung cancer management by improving survival and patient-reported quality of life. However, their high acquisition costs and uncertainty around real-world economic value raise concerns regarding health system affordability and long-term sustainability. This study assessed the cost-effectiveness of adjuvant immunotherapies and evaluated their projected budget impact under plausible real-world adoption scenarios.</div></div><div><h3>Methods</h3><div>We systematically reviewed published economic evaluations of adjuvant immunotherapies in lung cancer from 2010 to 2024. Eligible studies included cost-effectiveness and cost-utility analyses comparing immune checkpoint inhibitors with standard chemotherapy or best supportive care. Data on costs, quality-adjusted life years (QALYs), incremental cost-effectiveness ratios (ICERs), and willingness-to-pay (WTP) thresholds were extracted and narratively synthesised. For therapies judged cost-effective, we conducted a five-year (2025–2029) budget impact analysis using ISPOR-consistent methods, with costs standardised to 2024 US dollars. Three adoption scenarios were modelled: a base-case phased adoption (10 %–50 %), an accelerated uptake scenario (30 %–50 %), and a restricted uptake scenario (10 %–30 %), to examine the sensitivity of affordability to alternative implementation pathways.</div></div><div><h3>Results</h3><div>Thirty-five economic evaluations of adjuvant immunotherapies for lung cancer were included (33 NSCLC and 2 SCLC studies). Frequently evaluated agents were pembrolizumab (n = 11), nivolumab (n = 8), atezolizumab (n = 6), and durvalumab (n = 5), alongside emerging agents including icotinib, sintilimab, sugemalimab and camrelizumab. Overall, adjuvant immunotherapies were associated with improved health outcomes compared with standard chemotherapy, with incremental gains of ∼0.3–0.5 QALYs in several US/European models and gains of ≥ 1.0 QALY in selected biomarker-defined population or Chinese cohorts. However, per-patient costs were substantially higher, ranging from modest increases (∼US$4000 with icotinib) to totals >US$230,000–390,000 for PD-1/PD-L1 based regimens and > 10-fold higher than standard care in some middle-income settings. ICERs ranged from highly favourable estimates (e.g. icotinib ∼US$3440/QALY; selected pembrolizumab, sintilimab, sugemalimab, squamous-specific nivolumab and CAD strategies within local WTP thresholds) to clearly non-cost-effective values (>US$300,000–600,000/QALY) for broad, unselected use, combination regimens, and several SCLC indications.</div><div>Fo interventions judged cost-effective, five-year dudget impact estimates for cost-effective options indicated substantial 5-year incremental spending (from low millions up to >US$400 million), while a small subset of regimens were cost-saving or near budget-neutral, underscoring the need for targeted adoption and price negotiation i
{"title":"Economic value, affordability, and scale-up of adjuvant immunotherapies in lung cancer treatment: From cost-effectiveness decision to budget impact analysis","authors":"Rashidul Alam Mahumud , Yifu Chen , Padam Kanta Dahal , Nasrin Akter , Md Shahjalal , Khorshed Alam","doi":"10.1016/j.jcpo.2026.100718","DOIUrl":"10.1016/j.jcpo.2026.100718","url":null,"abstract":"<div><h3>Background</h3><div>Adjuvant immunotherapies have transformed lung cancer management by improving survival and patient-reported quality of life. However, their high acquisition costs and uncertainty around real-world economic value raise concerns regarding health system affordability and long-term sustainability. This study assessed the cost-effectiveness of adjuvant immunotherapies and evaluated their projected budget impact under plausible real-world adoption scenarios.</div></div><div><h3>Methods</h3><div>We systematically reviewed published economic evaluations of adjuvant immunotherapies in lung cancer from 2010 to 2024. Eligible studies included cost-effectiveness and cost-utility analyses comparing immune checkpoint inhibitors with standard chemotherapy or best supportive care. Data on costs, quality-adjusted life years (QALYs), incremental cost-effectiveness ratios (ICERs), and willingness-to-pay (WTP) thresholds were extracted and narratively synthesised. For therapies judged cost-effective, we conducted a five-year (2025–2029) budget impact analysis using ISPOR-consistent methods, with costs standardised to 2024 US dollars. Three adoption scenarios were modelled: a base-case phased adoption (10 %–50 %), an accelerated uptake scenario (30 %–50 %), and a restricted uptake scenario (10 %–30 %), to examine the sensitivity of affordability to alternative implementation pathways.</div></div><div><h3>Results</h3><div>Thirty-five economic evaluations of adjuvant immunotherapies for lung cancer were included (33 NSCLC and 2 SCLC studies). Frequently evaluated agents were pembrolizumab (n = 11), nivolumab (n = 8), atezolizumab (n = 6), and durvalumab (n = 5), alongside emerging agents including icotinib, sintilimab, sugemalimab and camrelizumab. Overall, adjuvant immunotherapies were associated with improved health outcomes compared with standard chemotherapy, with incremental gains of ∼0.3–0.5 QALYs in several US/European models and gains of ≥ 1.0 QALY in selected biomarker-defined population or Chinese cohorts. However, per-patient costs were substantially higher, ranging from modest increases (∼US$4000 with icotinib) to totals >US$230,000–390,000 for PD-1/PD-L1 based regimens and > 10-fold higher than standard care in some middle-income settings. ICERs ranged from highly favourable estimates (e.g. icotinib ∼US$3440/QALY; selected pembrolizumab, sintilimab, sugemalimab, squamous-specific nivolumab and CAD strategies within local WTP thresholds) to clearly non-cost-effective values (>US$300,000–600,000/QALY) for broad, unselected use, combination regimens, and several SCLC indications.</div><div>Fo interventions judged cost-effective, five-year dudget impact estimates for cost-effective options indicated substantial 5-year incremental spending (from low millions up to >US$400 million), while a small subset of regimens were cost-saving or near budget-neutral, underscoring the need for targeted adoption and price negotiation i","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"47 ","pages":"Article 100718"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146221374","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 : 2026-03-01Epub Date: 2026-02-26DOI: 10.1016/j.jcpo.2026.100722
Soumendu Sen , Sanjay K. Mohanty , Tabassum Wadasadawala , Suraj Maiti
Background
The study examines the extent of loans and debts for patients with breast cancer across different phases of their treatment in India.
Methods
This study used primary data of 500 breast cancer patients who sought treatment during 2019–2023 at Tata Memorial Hospital, Mumbai, India. This study is registered on the clinical trial registry of India (CTRI/2019/07/020142) on 10/07/2019. Data on economic burden was collected at three phases: baseline or at the time of registration to the hospital, endline or after completion of the treatment, and follow-up or after six months of post-treatment period. The outcome variables were the proportion of patients taken loan, loan sources, loan amount. Bivariate and two-part model were used to explore the determinants and estimate the amount of loan.
Findings
The proportion of patients taking loans increased from 37.8% at baseline to 64.6% at endline and 68.9% at follow-up. Mean loan amount rose from ₹20,399 (9.2% of annual income) at baseline to ₹115,340 (47.4% of annual income) at follow-up. Younger patients, those with lower education, lower income quintiles, and rural residence were more likely to take loans. Loan sources shifted from friends and relatives at baseline to moneylenders at endline and follow-up. Significant factors influencing loan amount included income quintile, distance to the treatment center, marital status, and stage of cancer.
Conclusion
As the treatment progresses, increase in loan amount and the shifts towards informal, high-interest lending sources are alarming concerns. These findings highlight the need for improved financial protection mechanisms and targeted support for vulnerable cancer patients to prevent medical impoverishment.
{"title":"The extent of indebtedness among breast cancer survivors in India: A prospective longitudinal study from a tertiary cancer hospital","authors":"Soumendu Sen , Sanjay K. Mohanty , Tabassum Wadasadawala , Suraj Maiti","doi":"10.1016/j.jcpo.2026.100722","DOIUrl":"10.1016/j.jcpo.2026.100722","url":null,"abstract":"<div><h3>Background</h3><div>The study examines the extent of loans and debts for patients with breast cancer across different phases of their treatment in India.</div></div><div><h3>Methods</h3><div>This study used primary data of 500 breast cancer patients who sought treatment during 2019–2023 at Tata Memorial Hospital, Mumbai, India. This study is registered on the clinical trial registry of India (CTRI/2019/07/020142) on 10/07/2019. Data on economic burden was collected at three phases: baseline or at the time of registration to the hospital, endline or after completion of the treatment, and follow-up or after six months of post-treatment period. The outcome variables were the proportion of patients taken loan, loan sources, loan amount. Bivariate and two-part model were used to explore the determinants and estimate the amount of loan.</div></div><div><h3>Findings</h3><div>The proportion of patients taking loans increased from 37.8% at baseline to 64.6% at endline and 68.9% at follow-up. Mean loan amount rose from ₹20,399 (9.2% of annual income) at baseline to ₹115,340 (47.4% of annual income) at follow-up. Younger patients, those with lower education, lower income quintiles, and rural residence were more likely to take loans. Loan sources shifted from friends and relatives at baseline to moneylenders at endline and follow-up. Significant factors influencing loan amount included income quintile, distance to the treatment center, marital status, and stage of cancer.</div></div><div><h3>Conclusion</h3><div>As the treatment progresses, increase in loan amount and the shifts towards informal, high-interest lending sources are alarming concerns. These findings highlight the need for improved financial protection mechanisms and targeted support for vulnerable cancer patients to prevent medical impoverishment.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"47 ","pages":"Article 100722"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147318481","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 : 2026-03-01Epub Date: 2026-02-26DOI: 10.1016/j.jcpo.2026.100719
Johanna Swenne , Christoffer Johansen , Lars Henrik Jensen
Global advocacy for early and integrated palliative care (PC) in oncology has intensified over the past two decades, frequently positioning PC as both a clinical imperative and a human right. However, the empirical foundation supporting these claims remains surprisingly fragile relative to the strength of the associated policy rhetoric. This analytic paper critically examines the disjunction between expanding normative expectations and the limited, context-bound evidence base underpinning early PC integration in contemporary cancer care. We argue that prevailing narratives risk overstating the robustness and generalizability of existing trial evidence while underestimating the structural, organizational, and clinical realities facing oncology services. Much of the evidence derives from a small number of randomized trials conducted in high-income settings, with methodological limitations that constrain transferability and policy relevance, particularly in tax-funded European health care systems. Despite this, these findings have been widely extrapolated to justify system-wide integration mandates. Against this backdrop, we situate PC within three intersecting transformations: the transformation of many cancers into prolonged, chronic illness trajectories, the growing policy–practice gap in PC provision across Europe, and the normalization of person-centered care as a foundational principle of modern healthcare. We propose a reorientation of PC away from a distinct, predominantly specialist service model, toward a shared clinical responsibility embedded across oncology and general healthcare. In this model, specialist PC expertise is repositioned toward consultation, education, and system-level leadership rather than parallel service provision.
{"title":"Palliative care: Seduced by wishful thinking or on safe ground?","authors":"Johanna Swenne , Christoffer Johansen , Lars Henrik Jensen","doi":"10.1016/j.jcpo.2026.100719","DOIUrl":"10.1016/j.jcpo.2026.100719","url":null,"abstract":"<div><div>Global advocacy for early and integrated palliative care (PC) in oncology has intensified over the past two decades, frequently positioning PC as both a clinical imperative and a human right. However, the empirical foundation supporting these claims remains surprisingly fragile relative to the strength of the associated policy rhetoric. This analytic paper critically examines the disjunction between expanding normative expectations and the limited, context-bound evidence base underpinning early PC integration in contemporary cancer care. We argue that prevailing narratives risk overstating the robustness and generalizability of existing trial evidence while underestimating the structural, organizational, and clinical realities facing oncology services. Much of the evidence derives from a small number of randomized trials conducted in high-income settings, with methodological limitations that constrain transferability and policy relevance, particularly in tax-funded European health care systems. Despite this, these findings have been widely extrapolated to justify system-wide integration mandates. Against this backdrop, we situate PC within three intersecting transformations: the transformation of many cancers into prolonged, chronic illness trajectories, the growing policy–practice gap in PC provision across Europe, and the normalization of person-centered care as a foundational principle of modern healthcare. We propose a reorientation of PC away from a distinct, predominantly specialist service model, toward a shared clinical responsibility embedded across oncology and general healthcare. In this model, specialist PC expertise is repositioned toward consultation, education, and system-level leadership rather than parallel service provision.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"47 ","pages":"Article 100719"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147318474","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 : 2026-03-01Epub Date: 2025-12-20DOI: 10.1016/j.jcpo.2025.100699
Alexander M. Gorzewski , Rebecca Z. Steuer , Charmi Trivedi , Kaavya Mandi , Christina A. Raker , Charles J. Milrod , Ari R. Pelcovits
Introduction
In clinical trials for diffuse large B-cell lymphoma (DLBCL), progression-free survival (PFS) has been used as a validated surrogate endpoint to help expedite drug development and regulatory approval. The advent of chimeric antigen receptor (CAR) T-cell therapies has radically changed the treatment landscape, potentially prolonging post-progression survival and weakening the correlation between PFS and overall survival (OS). This study evaluates the utility of PFS as a surrogate endpoint for OS in relapsed/refractory (R/R) DLBCL in the CAR T-cell era.
Materials and methods
A systematic review of Phase 3 randomized clinical trials for R/R DLBCL initiated after 2015 was conducted. A weighted linear regression analysis was performed to assess the correlation between PFS and OS.
Results
Six trials, comprising 1577 patients, met the inclusion criteria. Weighted linear regression demonstrated a coefficient of determination (R²) of 0.88 (p = 0.0054), indicating a strong association between PFS and OS in R/R DLBCL trials conducted since the introduction of CAR T-cell therapy.
Discussion
These findings provide evidence that PFS remains a valid and strong surrogate endpoint for OS in the contemporary R/R DLBCL treatment landscape. This supports the continued use of PFS as a primary endpoint in regulatory studies for new therapies for R/R DLBCL and provides important information for health policy discussions on drug approval, insurance coverage, and reimbursement decisions for aggressive lymphomas.
{"title":"Progression-free survival is strongly associated with overall survival in relapsed/refractory diffuse large B-cell lymphoma in the CAR T-cell era","authors":"Alexander M. Gorzewski , Rebecca Z. Steuer , Charmi Trivedi , Kaavya Mandi , Christina A. Raker , Charles J. Milrod , Ari R. Pelcovits","doi":"10.1016/j.jcpo.2025.100699","DOIUrl":"10.1016/j.jcpo.2025.100699","url":null,"abstract":"<div><h3>Introduction</h3><div>In clinical trials for diffuse large B-cell lymphoma (DLBCL), progression-free survival (PFS) has been used as a validated surrogate endpoint to help expedite drug development and regulatory approval. The advent of chimeric antigen receptor (CAR) T-cell therapies has radically changed the treatment landscape, potentially prolonging post-progression survival and weakening the correlation between PFS and overall survival (OS). This study evaluates the utility of PFS as a surrogate endpoint for OS in relapsed/refractory (R/R) DLBCL in the CAR T-cell era.</div></div><div><h3>Materials and methods</h3><div>A systematic review of Phase 3 randomized clinical trials for R/R DLBCL initiated after 2015 was conducted. A weighted linear regression analysis was performed to assess the correlation between PFS and OS.</div></div><div><h3>Results</h3><div>Six trials, comprising 1577 patients, met the inclusion criteria. Weighted linear regression demonstrated a coefficient of determination (R²) of 0.88 (p = 0.0054), indicating a strong association between PFS and OS in R/R DLBCL trials conducted since the introduction of CAR T-cell therapy.</div></div><div><h3>Discussion</h3><div>These findings provide evidence that PFS remains a valid and strong surrogate endpoint for OS in the contemporary R/R DLBCL treatment landscape. This supports the continued use of PFS as a primary endpoint in regulatory studies for new therapies for R/R DLBCL and provides important information for health policy discussions on drug approval, insurance coverage, and reimbursement decisions for aggressive lymphomas.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"47 ","pages":"Article 100699"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145811053","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 : 2025-12-01Epub Date: 2025-09-16DOI: 10.1016/j.jcpo.2025.100640
J. Deodhar , P. Nayak , C.S. Pramesh , A. Purushotham
Psychosocial care is essential for high-quality cancer care. Psycho-oncology is a developing discipline globally. A narrative review was conducted of studies published in India from 2000 to 2024 on psychosocial care in patients with cancer. Of 233 papers identified, 85 were included. Distress rates ranged from 22 % to 62 % with the highest being in head and neck and breast cancer. Seven tools for measuring distress have been validated in a few Indian languages. Cancer-related communication revealed high rates of collusion and use of euphemisms. There is a paucity of intervention studies. Few studies described psychosocial issues in children and adolescents and older adults.Therefore, future high-quality intervention and outcome studies are required. There is an urgent need for the inclusion of psycho-oncology in national cancer control policy globally.
{"title":"Psycho-oncology in India","authors":"J. Deodhar , P. Nayak , C.S. Pramesh , A. Purushotham","doi":"10.1016/j.jcpo.2025.100640","DOIUrl":"10.1016/j.jcpo.2025.100640","url":null,"abstract":"<div><div>Psychosocial care is essential for high-quality cancer care. Psycho-oncology is a developing discipline globally. A narrative review was conducted of studies published in India from 2000 to 2024 on psychosocial care in patients with cancer. Of 233 papers identified, 85 were included. Distress rates ranged from 22 % to 62 % with the highest being in head and neck and breast cancer. Seven tools for measuring distress have been validated in a few Indian languages. Cancer-related communication revealed high rates of collusion and use of euphemisms. There is a paucity of intervention studies. Few studies described psychosocial issues in children and adolescents and older adults.Therefore, future high-quality intervention and outcome studies are required. There is an urgent need for the inclusion of psycho-oncology in national cancer control policy globally.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"46 ","pages":"Article 100640"},"PeriodicalIF":2.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087645","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}
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