Journal of Cancer Policy最新文献

Background

Cancer incidence and mortality are rapidly rising in Africa. National Cancer Control Plans (NCCPs have contributed to a reduction in the burden of some preventable cancers, availing early diagnosis and adequate treatment modalities and palliative care, while sustaining them with sufficient monitoring systems. knowledge we undertook a cross-sectional survey across continental Africa to understand the presence of NCCPs, availability of early detection and screening policies and the status of health financing pertaining to cancer.

Methods

Through an online survey, we approached key cancer care staff in 54 countries. Questions were themed in 3 main areas - Cancer registries and national cancer control plans (NCCPs) availability in countries, Cancer screening, diagnosis and management capacity, Financing in cancer care.

Results

On 54 approached respondents, we received 32 responses. 88 % of responding countries have active national cancer registries, 75 % with NCCPs and 47 % with cancer screening policies and practices. Universal Health Coverage is available in 40 % of countries.

Conclusion

Our study shows that there is a scarcity of NCCPs in Africa. Deliberate investment in cancer registry and clinical services is key to improving access to care and ultimately reduce cancer mortality in Africa.

Introduction

Multiple myeloma (MM) is more common in Black persons when compared to non-Hispanic White persons. The International Myeloma Working Group (IMWG) provides consensus for diagnosis and treatment of MM. Our study aimed to assess the racial composition of supporting studies used by IMWG to publish their guidelines

Methods

We performed a cross sectional study that included all IMWG publications up to July 2022. References cited in each publication were reviewed. Review articles, comments, editorials, case reports, and animal-based studies were excluded.

Results

A total of 59 IMWG publications with 3956 references were reviewed. Final analysis included 2047 references of which 39 % (n = 804) were clinical trials, 35 % (n = 712) were observational studies, 20 % (n = 401) were diagnostic and or genetic testing-based studies, 3 % (n = 65) were population-based analysis and 3 % (n = 65) classified as others. Only 10.4 % of included references (n = 213/2047) reported race/ethnicity of studied patients. The total number of patients in all referenced studies were 5,747,920, only 2.6 % (n = 150,790) black patients. Of the trials referenced and done exclusively in the US, 41 out of 282 (14.5 %) reported race/ethnicity with a total number of patients of 38,050 of which 2493 (6.5 %) were black patients.

Conclusion

IMWG guidelines were based mainly on studies that did not include enough Black patients. Guidelines should consider inclusion of observational, diagnostic and population-based studies with more black patients to allow for better reflection of disease prevalence, clinical characteristics and/or outcomes.

Background

In oncology, quality of life (QoL) questionnaires were historically designed to be used in the advanced or metastatic setting. We sought to determine the effects of contemporary treatments on QoL in the adjuvant setting and to determine if the QoL instruments used in these studies provide a relevant assessment.

Methods

We conducted a systematic identification of all anti-cancer drugs used in the adjuvant setting and approved by the US Food and Drug Administration from January 2018 to March 2022. We conducted a quality evaluation and a meta-analysis of reported QoL results. We used the global QoL results when multiple QoL outcomes were reported.

Results

There were 224 FDA approvals reviewed, of which 12 met the inclusion criteria. The placebo was the control arm in 10 out of 12 trials. Of those, 11 trials (92 %) assessed QoL, and ten (83 %) reported results. In reports with QoL results, a moderate-risk of bias was found in 3 out of 10 (30 %) and a high-risk of bias in 6 out of 10 (60 %) of reports, respectively. No trial reported a meaningful difference between arms. The meta-analysis found an overall detrimental effect on QoL in the experimental arm, though it was not statistically different.

Conclusion

This study identified 12 FDA registration trials in the adjuvant setting between 2018 and 2022. We found a moderate- to high-risk of bias in 90 % of the ten trials reporting QoL data. Our meta-analysis suggested a detrimental effect on QoL in the experimental arm, questioning the relevancy, in the adjuvant setting, of thresholds that were mostly developed in the advanced or metastatic setting.

Policy summary

Future works should focus on specificities of the adjuvant setting when considering QoL evaluation.

Background

Prostate cancer (PCa) screening is a cost-effective strategy to promote early detection and treatment. Understanding the determinants of PCa screening uptake would help policy makers to identify high-risk populations and ensure the cost-effectiveness of health promotion interventions. This study aims to estimate the prevalence of PCa screening uptake and assess its associated factors among Kenyan men.

Methods

The study relied on data from the 2014 Kenya Demographic and Health Survey. Both descriptive and inferential analyses were performed. Firth logistic regression was employed using the “firthlogit” command in STATA. The adjusted odds ratio and 95% confidence interval were presented.

Results

Overall, the prevalence of PCa screening uptake was 4.4%. The odds of PCa screening uptake were high among men aged 50–54 [aOR= 2.08; CI= 1.23, 3.52], those who had health insurance coverage [aOR= 1.69; CI= 1.28, 2.23], those who read at least once in a week [aOR= 1.52; CI= 1.10, 2.10], and among those who watched TV at least once in a week [aOR= 1.73; CI= 1.18, 2.52]. Men who resided in the Eastern [aOR= 2.23; CI= 1.39, 3.60], Nyanza [aOR= 2.13; CI= 1.29, 3.53], and Nairobi [aOR= 1.97; CI= 1.01, 3.86] had a higher likelihood of getting screened for PCa.

Conclusion

In conclusion, the uptake of PCa screening in Kenya is low. To ensure the cost-effectiveness of health-promoting interventions that aim to improve PCa screening uptake in Kenya, men without health insurance coverage should be targeted and prioritized. Increasing literacy rate, sensitization via television, and increasing the insurance coverage in the country would significantly contribute to a higher uptake of PCa screening.

Policy summary

To improve the uptake of PCa screening, there would be a need to implement a national advocacy campaign that will sensitize Kenyan men about the need to undergo PCa screening. This national advocacy campaign to increase the uptake of PCa screening in Kenya must leverage mass media platforms.

Background

Choosing Wisely (CW) Canada is a national campaign to identify unnecessary or harmful services that are frequently used in Canada. The original CW Oncology Canada Cancer list was developed in 2014. A CW Oncology Canada working group was established to review new evidence and guidelines and to update the current CW Oncology Canada Cancer List.

Methods

Between January and March 2022, we conducted a survey of members of the Canadian Association of Medical Oncology (CAMO), Canadian Association of Radiation Oncology (CARO) and the Canadian Society of Surgical Oncology (CSSO). We took the feedback from the survey, including potential new recommendations as well as those that were thought to be no longer relevant and up to date, and conducted a literature review with the assistance of the Canadian Agency for Drugs and Technology in Health (CADTH). The final updated list of recommendations was made by the CW Oncology Canada working group based on a consensus process.

Results

We reviewed two potential recommendations to add and two potential recommendations to remove from the existing CW Oncology Canada Cancer List. The recommendation “Do not prescribe whole brain radiation over stereotactic radiosurgery for patient with limited brain metastases (≤4 lesions)” was supported by several evidence-based guidelines with the strength of recommendations ranging from strong to moderate and the quality of evidence ranging from level 1 to level 3. After reviewing the evidence, the working group felt that the other potential recommendation to add and the two potential recommendations to remove did not have sufficient strength and quality of evidence at this time to be added or removed from the list.

Conclusion

The updated Choosing Wisely Oncology Canada Cancer List consists of 11 items that oncologists should question in the treatment of patients with cancer. This list can be used to design specific interventions to reduce low value care.

Clinical trials are a fundamental part of cancer research as they establish the efficacy and safety of new cancer treatments for everyone. The lack of sociodemographic diversity among cancer clinical trial participants leaves a vacuum in scientific knowledge, which can distort credible evidence from being accessible and represents a major barrier to advancing cancer care for the entire patient population. It can also cause avoidable harm to the public, undermine patients trust and result in wasteful allocation of healthcare resources. It is therefore imperative that there is representation of all population groups who may use these new cancer treatments in clinical trial settings. Europeans are disproportionately affected by cancer with cancer mortality rates being substantially affected by inequities in socioeconomic education status. General and political recognition of cancer injustices in the EU have further increased given the contemptuously unequal impacts of the legal and policy responses to it. While innovative advances in cancer research have bridged much of these critical gaps particularly in the last few decades more work needs to be done to circumvent implications of cancer health disparities. To reduce cancer health disparities, systemic and individual-level barriers to cancer clinical trial participation must be addressed through effective and ethically rigorous EU health laws and policies.

Introduction

Lung cancer is the most common cancer in men and the second most common cancer in women. It is associated with substantial economic impact in terms of direct and indirect costs. The main objective of this study is to estimate the direct medical cost of lung cancer management in Morocco

Materials and methods

A cost-of-illness study was conducted among patients treated at the Mohammed VI Center of Cancer (Casablanca) in 2019. The costs were estimated from the societal perspective using a bottom-up approach. The materials and procedures used were identified and quantified retrospectively from the information system and files. Their monetary value was calculated according to official prices published by the national health insurance agency. The horizon time adopted was 12 months.

Results

The study included 271 patients, with an average age of 62.5 ± 9.5 years. Of these, 93.4 % were men and 92.1 % were former smokers. In terms of cancer staging, 68.3 % of patients were in stage IV while 28.8 % were in stage III. Adenocarcinoma was present in 43.5 % of cases. Patients underwent an average of 10.6 ± 5.1 radiological investigations, 56.1 ± 30.9 biological tests, and 24.1 ± 11.7 consultations.

The average direct medical cost was 4455.3 USD (95 % CI: 4037.4–4873.2). Chemotherapy accounted for 19.9 % of the total cost, while radiological investigations and drugs accounted for 18.7 % and 17.6 %, respectively. Diagnostic tests and radiotherapy each accounted for 7.6 % of the total cost, while biological tests accounted for 7.5 % and hospitalizations accounted for 7.1 %.

The cost was statistically higher in young patients (p = 0.017), in patients with adenocarcinoma (p < 0.0001), in patients with stage II tumor (< 0.00001), in patients who have undergone surgery (p = 0.002), chemotherapy (p < 0.0001), radiotherapy (p < 0.001) and in those without metastases (p < 0.0001).

Conclusion

These results provide evidence to support the ratification of the Framework Convention on Tobacco Control and the full adherence of the Kingdom of Morocco to the MPOWER measures.

Background

Cancer is a public health issue in Brazil. To mitigate exposure to risk factors, change habits and ensure access to cancer care, an increasing number of bills are presented every year. This article analyzes the changes proposed in these bills, portraying how the representatives perceive and respond to the challenges imposed by cancer on the healthcare system and society.

Methods

Through a systematic search on the Brazilian House of Representatives website, this exploratory study examines cancer-related bills presented up to 2022.

Results

Of 1311 bills identified, 310 met the inclusion criteria and were categorized based on their content. The increasing annual number of cancer bills reflects the interest of representatives on the topic. The cancer types addressed correspond to the most prevalent ones, except for the colorectal. The most common strategy is primary prevention (n: 129), proposing the reduction of risk factors exposure or the promotion of protective ones, followed by tertiary (n: 106) and secondary (n: 36) strategies, targeting, respectively, cancer treatment/management and its early diagnosis/detection. On the nature of proposed changes, most seek to implement increased healthcare access (n: 125), production/sale (dis)incentives for goods containing carcinogens (n: 60), and fiscal/financial (dis)incentives (n: 53).

Conclusion

The identified gaps - such as the limited use of data and evidence to support what is proposed, overlapping but fragmented efforts with previous bills, scarce efforts directly addressing the determinants of health, and the low rate of conversion to law - entails opportunities to advance the Legislative propositions.

Policy summary

To effectively respond to cancer-related challenges, is essential that the Legislative branch takes into account what is already being proposed or being left out, inputs from society, real-world data, and the results produced by the multisectoral policies in place.

Introduction

Cancer is the second leading cause of death worldwide, causing about 10 million deaths per year, 70 % of which occur in low- and middle-income countries. In the DRC, the absence of a national cancer registry is a handicap to the definition of a strategy to combat this disease. The purpose of this study is to establish an epidemiological profile of cancer in this laboratory in order to overcome this deficit in this part of the country.

Methodology

We conducted a descriptive study of 1636 histopathological analysis reports from 2015 to 2021 at the Anatomy and Pathological Cytology Laboratory of Anualite Hospital in Mungbere.

Results

A total of 502 cases of cancer have been identified; female accounted for 51.4 % of cases; all age groups are affected; The most common cancers in both sexes are Kaposi's sarcoma (17.9 %), breast cancer (15.3 %), lymphoma (13.7 %), cervical cancer (9.6 %) and squamous cell carcinoma of the skin (9 %). In women, breast cancer (27.1 %), cervical cancer (18.6 %), Kaposi's sarcoma (10.1 %), lymphoma (7.4 %) and squamous cell carcinoma of the skin (5.8 %) and in men Kaposi's sarcoma (26.2 %), lymphoma (20.5 %), liver cancer (13.1 %)) and squamous cell carcinoma of the skin (12.3 %).

Conclusion

Cancer affects all age groups with a slight female predominance. The most common in both sexes are Kaposi's sarcoma, breast cancer, lymphoma, cervical cancer and squamous cell carcinoma of the skin. For an effective fight against cancer, the creation of a national cancer registry is an emergency in our country