Why location matters: associations between county-level characteristics and availability of National Cancer Oncology Research Program and National Cancer Institute sites.

BACKGROUND: The majority of patients with cancer seek care at community oncology sites; however, most clinical trials are available at National Cancer Institute (NCI)-designated sites. Although the NCI National Cancer Oncology Research Program (NCORP) was designed to address this problem, little is known about the county-level characteristics of NCORP site locations. METHODS: This cross-sectional analysis determined the association between availability of NCORP or NCI sites and county-level characteristic theme percentile scores from the Center for Disease Control and Prevention's Social Vulnerability Index themes. Health Resources and Services Administration's Area Health Resource Files were used to determine contiguous counties. We estimated risk ratios and 95% confidence intervals (CIs) using modified Poisson regression models to evaluate the association between county-level characteristics and site availability within singular and singular and contiguous counties. RESULTS: Of 3141 included counties, 14% had an NCORP, 2% had an NCI, and 1% had both sites. Among singular counties, for a standard deviation increase in the racial and ethnic theme score, there was a 22% higher likelihood of NCORP site availability (95% CI = 1.10 to 1.36); for a standard deviation increase in the socioeconomic status theme score, there was a 24% lower likelihood of NCORP site availability (95% CI = 0.67 to 0.87). Associations were of smaller magnitude when including contiguous counties. NCI sites were located in more vulnerable counties. CONCLUSIONS: NCORP sites were more often in racially diverse counties and less often in socioeconomically vulnerable counties. Research is needed to understand how clinical trial representation will increase if NCORP sites strategically increase their locations in more vulnerable counties.

Racial Disparities in Access to Prostate Cancer Clinical Trials: A County-Level Analysis.

Background: African American men have a higher burden of prostate cancer compared with other populations. We sought to determine if they experience disparities in access to prostate cancer clinical trials. Methods: We created a database of all US counties by linking prostate cancer clinical trial data with county-level socioeconomic, demographic, and health-care facility data derived from several external data sources. Using this data linkage, we examined 2 potential access barriers. We investigated the relationship between the proportion of African Americans and access to cancer facilities, adjusting for county population size and other characteristics. Additionally, among counties with cancer facilities, we investigated the relationship between the proportion of African Americans and number of available prostate cancer trials per capita per year. We addressed these questions using logistic and negative binomial regression, respectively. Results: Between 2008 and 2015, 613 prostate cancer trial sites were found among 3145 US counties. Counties with a higher proportion of African Americans were less likely to have cancer facilities (adjusted odds ratio = 0.85, 95% confidence interval = 0.78 to 0.92). Among counties with cancer facilities, those with a higher proportion of African Americans had statistically significantly fewer prostate cancer trials per capita per year (rate ratio per 10% increase in African Americans = 0.90, 95% confidence interval = 0.83 to 0.96). Conclusions: Counties with higher proportions of African Americans seem less likely to have access to cancer facilities. Among counties with cancer facilities, those with higher proportions of African Americans appear to have fewer prostate cancer trials available per capita per year. Clinical trials in prostate cancer therapy should ensure adequate availability of enrollment sites in regions with high concentrations of African Americans.

Impactos da COVID-19 nos pacientes oncológicos: uma revisão sistemática / Impacts of COVID-19 on cancer patients: a systematic review

Introdução: Com a pandemia de coronavírus os pacientes oncológicos, que estão em tratamentos, nos quais a maioria são imunossupressores, se tornaram um grupo muito suscetível a formas graves da infecção. Logo, como forma de proteção e prevenção, a realização de exames de rastreio no ambiente hospitalar foi restringida, atrasando diversos diagnósticos e comprometendo a eficácia de tratamentos. Objetivos: Analisar a produção científica acerca do tema câncer e COVID-19, a fim de contribuir com informações sobre o assunto. Métodos: Revisão sistemática da literatura nas bases de dados SciELO, LILACS e PubMed. Os descritores utilizados foram "câncer" AND "COVID-19" de acordo com o Medical Subject Headings (MeSH) e seus equivalentes para a língua portuguesa, conforme os descritores de Ciências da Saúde (DeCS). Foram incluídos artigos originais em inglês e português, sem delimitação temporal. Resultados: Foram encontrados 1.606 artigos e, após utilizar os critérios de inclusão e exclusão, nove foram incluídos para análise na revisão. Dentre os temas centrais abordados pelos estudos selecionados estão o impacto da pandemia em algumas áreas de acompanhamento do paciente oncológico, como: tratamento, telemedicina, diminuição de funcionários no atendimento ao paciente com câncer, diminuição dos ensaios clínicos, redução dos recursos financeiros e apoio psicológico a essa população. Conclusão: A pandemia afetou diretamente o modo de vida desse grupo, que sofreu com uma redução no atendimento médico e nos recursos dispostos a eles. Portanto, nota-se a necessidade de prestar um cuidado mais específico a esses pacientes em situação tão delicada durante a pandemia.

Introduction: During the coronavirus pandemic, oncological patients, who are undergoing treatments in which the majority are immunosuppressant, have become a group very susceptible to severe forms of the infection. Therefore, as a form of protection, their going to hospital environments were restricted, delaying diagnosis and compromising the effectiveness of treatments. Objectives: This study aims to analyze the scientific about the production of the theme cancer and COVID-19 in order to contribute with informations on the subject. Methods: Systematic review of literature using the SciELO, LILACS and PubMed. The following keywords were used: "cancer" AND "COVID-19" according to the Medical Subject Headings (MeSH) and their translation to the Portuguese. Studies in English and Portuguese from inception were included. Results: 1,606 studies were screened and 9 were included in the systematic review after using the inclusion and exclusion criterias. Among the central themes addressed by the selected studies are the pandemic impacts in areas of monitoring oncological patients, such as: treatment, telemedicine, reduction of employees in the care of cancer patients, reduction of clinical trials, reduction of financial resources, and psychological support to that population. Conclusion: The pandemic directly affected the way of life of this group, which suffered from a reduction in medical care and the resources available to them. Therefore, there is a need to provide more specific care to these patients in such a delicate situation during the pandemic.

Management of sarcomas in children, adolescents and adults: Interactions in two different age groups under the umbrellas of GSF-GETO and SFCE, with the support of the NETSARC+ network.

Sarcomas are a rare heterogeneous group of malignant neoplasms that can arise in almost any anatomic site and any age. Close collaboration among adult and pediatric cancer specialists in the management of these tumors is of foremost importance. In this review, we present the current multidisciplinary organization in care of patients with sarcoma in France and we review the main advances made in the last decades in systemic and radiotherapy treatment in the main sarcoma types diagnosed in children, adolescents and young adults (AYA), thanks to the international collaboration.

A survey on the current status of clinical resources for diagnosis and treatment of breast cancer in rural hospitals of the Tohoku region in Japan.

BACKGROUND: We administered a questionnaire survey to assess the available clinical resources for the diagnosis and treatment of breast cancer and identify the issues faced by rural hospitals in the Tohoku region in Japan. METHODS: The term rural hospital was defined by the following three criteria: the facility is a certified regional cancer center and hospital, no breast specialist is on staff, and ≥ 10 breast surgeries per year have been performed. Thirty-eight rural hospitals were eligible, and each was sent a self-administered questionnaire consisting of 26 questions by mail. RESULTS: Responses were received from 29 of the 38 hospitals. Most of the hospitals had adequate facilities for diagnosis and treatment, but they needed specialists' support for ≥ 2 days per month. Approximately half of the hospitals indicated that applying resources for diagnosis and treatment of breast cancer, especially during planning of treatment and management of advanced breast cancer patients, was a burden. Interestingly, the hospitals felt that being able to provide treatment to their patients was more ideal rather than referring them to urban hospital like the prefectural cancer center and hospital providing specialized cancer treatment. CONCLUSIONS: The surveyed rural hospitals needed practical and knowledge-based support from specialists. Unfortunately, the number of specialists is currently insufficient in Tohoku. Increased number of certified physicians, clinical pathways for sharing patient's information and updated knowledge, and information and communication technology for treatment with specialists' intervention in rural hospitals may solve issues in Tohoku.

Establishing a Multidisciplinary Liver Tumour Clinic in a Limited Resource Scenario: Core Concepts and Our Experience.

Multidisciplinary tumour clinics represent the modern state-of-the-art cancer care. However, liver tumour clinics are resource exhaustive and establishing them in resource restricted scenarios is a challenge. We present core concepts in establishing a multidisciplinary tumour clinic, followed by our 5-year experience of multidisciplinary liver tumour clinic from Tata Memorial Hospital Mumbai, India, which represents one of the largest hepatobiliary oncology units in the country. This study provides a roadmap for setting up a multidisciplinary liver tumour clinic and explains the stepwise real-time working of the clinic. The account will act as a blueprint for the establishment of such clinics in the country and abroad.

[Regional cancers networks, collaborative work in adults and pediatricians]. / Réseaux régionaux en cancérologie, collaboration équipes adulte et pédiatrique.

Regional cancer networks missions have been defined by successive "Plan Cancer" and are focused on coordination and the safety and quality of care. Regional pediatric oncology networks, considering the specific care pathways, have these same coordination missions. The examples of partnership of the oncoped-PL (Pays de Loire) and oncomip (Occitanie) networks are successful collaboration models.

[Nomadism of patients treated by radiotherapy in Île-de-France: Does our health system have as much money to waste?] / Nomadisme des patients traités par radiothérapie en Île-de-France : notre système de santé a-t-il autant d'argent à gaspiller ?

PURPOSE: Human, material, and financial resources being limited, the organization of the care system must allow an efficient allocation of resources. The management of cancers leads to specific and repetitive care for which the reimbursement of transport costs represents a high cost. We carried out an analysis of the additional transport costs, linked to the care of patients in Île-de-France, in a center other than the radiotherapy center closest to their home. MATERIALS AND METHODS: Using data from the Île-de-France Regional Health Agency, we have created a model evaluating the additional cost linked to transport generated by the care of a radiotherapy patient far from his home. In order to take into account the uncertainties linked to the hypotheses made in the development of the model, we carried out deterministic and probabilistic sensitivity analyzes. RESULTS: In the base case, the additional annual cost related to transport was 841,176 euros in Île-de-France. The probabilistic sensitivity analysis reports a total annual additional cost of 2,817,481 euros. CONCLUSION: Our results are similar to a report from the General Inspectorate of Social Affairs published in July 2011, which then pointed to an additional cost of between 4 and 6 million euros annually. The long-term care of cancer patients from their homes contributes to a deterioration in the quality of life linked to travel times, a delay in the care of potential treatment complications, and the spread of infectious diseases, such as COVID-19, and bacteria resistant to antibiotics.

The 20th Gray lecture 2019: health and heavy ions.

OBJECTIVE: Particle radiobiology has contributed new understanding of radiation safety and underlying mechanisms of action to radiation oncology for the treatment of cancer, and to planning of radiation protection for space travel. This manuscript will highlight the significance of precise physical and biologically effective dosimetry to this translational research for the benefit of human health.This review provides a brief snapshot of the evolving scientific basis for, and the complex current global status, and remaining challenges of hadron therapy for the treatment of cancer. The need for particle radiobiology for risk planning in return missions to the Moon, and exploratory deep-space missions to Mars and beyond are also discussed. METHODS: Key lessons learned are summarized from an impressive collective literature published by an international cadre of multidisciplinary experts in particle physics, radiation chemistry, medical physics of imaging and treatment planning, molecular, cellular, tissue radiobiology, biology of microgravity and other stressors, theoretical modeling of biophysical data, and clinical results with accelerator-produced particle beams. RESULTS: Research pioneers, many of whom were Nobel laureates, led the world in the discovery of ionizing radiations originating from the Earth and the Cosmos. Six radiation pioneers led the way to hadron therapy and the study of charged particles encountered in outer space travel. Worldwide about 250,000 patients have been treated for cancer, or other lesions such as arteriovenous malformations in the brain between 1954 and 2019 with charged particle radiotherapy, also known as hadron therapy. The majority of these patients (213,000) were treated with proton beams, but approximately 32,000 were treated with carbon ion radiotherapy. There are 3500 patients who have been treated with helium, pions, neon or other ions. There are currently 82 facilities operating to provide ion beam clinical treatments. Of these, only 13 facilities located in Asia and Europe are providing carbon ion beams for preclinical, clinical, and space research. There are also numerous particle physics accelerators worldwide capable of producing ion beams for research, but not currently focused on treating patients with ion beam therapy but are potentially available for preclinical and space research. Approximately, more than 550 individuals have traveled into Lower Earth Orbit (LEO) and beyond and returned to Earth. CONCLUSION: Charged particle therapy with controlled beams of protons and carbon ions have significantly impacted targeted cancer therapy, eradicated tumors while sparing normal tissue toxicities, and reduced human suffering. These modalities still require further optimization and technical refinements to reduce cost but should be made available to everyone in need worldwide. The exploration of our Universe in space travel poses the potential risk of exposure to uncontrolled charged particles. However, approaches to shield and provide countermeasures to these potential radiation hazards in LEO have allowed an amazing number of discoveries currently without significant life-threatening medical consequences. More basic research with components of the Galactic Cosmic Radiation field are still required to assure safety involving space radiations and combined stressors with microgravity for exploratory deep space travel. ADVANCES IN KNOWLEDGE: The collective knowledge garnered from the wealth of available published evidence obtained prior to particle radiation therapy, or to space flight, and the additional data gleaned from implementing both endeavors has provided many opportunities for heavy ions to promote human health.

Retrospective analysis of reduced energy switching and room switching times on throughput efficiency of a multi-room proton therapy center.

OBJECTIVE: To quantify how a control software upgrade changed beam delivery times and impacted efficiency and capacity of a multiroom proton therapy center. METHODS: A four-room center treating approximately 90 patients/day, treating for approximately 7 years with optimized operations, underwent a software upgrade which reduced room and energy switching times from approximately 30 to 20 s and approximately 4 s to ~0.5 s, respectively. The center uses radio-frequency identification data to track patient treatments and has software which links this to beam delivery data extracted from the treatment log server. Two 4-month periods, with comparable patient volume, representing periods before and after the software change, were retrospectively analyzed. RESULTS: A total of 16,168 and 17,102 fields were analyzed. For bilateral head and neck and prostate patients, the beam waiting time was reduced by nearly a factor of 3 and the beam delivery times were reduced by nearly a factor of 2.5. Room switching times were reduced more modestly. Gantry capacity has increased from approximately 30 patients to 40-45 patients in a 16-h daily operation. CONCLUSIONS: Many proton centers are striving for increased efficiencies. We demonstrated that reductions in energy and room switching time can significantly increase center capacity. Greater potential for further gains would come from improvements in setup and imaging efficiency. ADVANCES IN KNOWLEDGE: This paper provides detailed measured data on the effect on treatment times resulting from reducing energy and room switching times under controlled conditions. It helps validate the models of previous investigations to establish treatment capacity of a proton therapy center.

Proton beam therapy: perspectives on the National Health Service England clinical service and research programme.

The UK has an important role in the evaluation of proton beam therapy (PBT) and takes its place on the world stage with the opening of the first National Health Service (NHS) PBT centre in Manchester in 2018, and the second in London coming in 2020. Systematic evaluation of the role of PBT is a key objective. By September 2019, 108 patients had started treatment, 60 paediatric, 19 teenagers and young adults and 29 adults. Obtaining robust outcome data is vital, if we are to understand the strengths and weaknesses of current treatment approaches. This is important in demonstrating when PBT will provide an advantage and when it will not, and in quantifying the magnitude of benefit.The UK also has an important part to play in translational PBT research, and building a research capability has always been the vision. We are perfectly placed to perform translational pre-clinical biological and physical experiments in the dedicated research room in Manchester. The nature of DNA damage from proton irradiation is considerably different from X-rays and this needs to be more fully explored. A better understanding is needed of the relative biological effectiveness (RBE) of protons, especially at the end of the Bragg peak, and of the effects on tumour and normal tissue of PBT combined with conventional chemotherapy, targeted drugs and immunomodulatory agents. These experiments can be enhanced by deterministic mathematical models of the molecular and cellular processes of DNA damage response. The fashion of ultra-high dose rate FLASH irradiation also needs to be explored.

[Proton therapy in France in 2019]. / État des lieux de la protonthérapie en France en 2019.

Among over 100 proton therapy centres worldwide in operation or under construction, French proton therapy is coming to full maturity with the recent opening of the Nice (1991, upgrade in 2016) and Caen (2018) facilities next to the Orsay (1991, upgrade in 2010) centre. Proton therapy is a national priority for children and young adults in all three centres. The patient-related activity of the three French centres is coordinated via the Protonshare portal to optimise referral by type of indication and available expertise in coordination with the French society of radiation oncology SFRO and French radiotherapy centres. The centres are recognised by the French Health Care excellence initiative, promoted by the ministry of Foreign Affairs. The three centres collaborate structurally in terms of clinical research and are engaged at the international level in the participation to European databases and research initiatives. Concerted actions are now also promoted in preclinical research via the Radiotransnet network. Ongoing French developments in proton therapy are well presented in international hadron therapy meetings, including European Proton Therapy Network and Particle Therapy Cooperative Oncology Group. Proton therapy teaching in France is offered at several levels and is open to colleagues from all radiation oncology centres, so that they are fully informed, involved and trained to facility recognition of possible indications and thereby to contribute to appropriate patient referral. This close collaboration between all actors in French radiation oncology facilitates the work to demonstrate the required level of medical and scientific evidence for current and emerging indications for particle therapy. Based on that, the future might entail a possible creation of more proton therapy facilities in France.

Challenges and Opportunities to Realize "The 2030 Agenda for Sustainable Development" by the United Nations: Implications for Radiation Therapy Infrastructure in Low- and Middle-Income Countries.

PURPOSE: In 2015, the United Nations proposed "The 2030 Agenda for Sustainable Development" goals, which envision reducing premature mortality from noncommunicable diseases by one third by 2030. Because >50% of patients with cancer require radiation therapy (RT), the existing gaps in RT infrastructure in low- and middle-income countries (LMICs) and additional requirements by 2030 were examined. Cost-effective strategies to address this challenge were explored. METHODS AND MATERIALS: Public domain databases of the United Nation organizations were accessed. RT requirements for 2030 were estimated according to the International Atomic Energy Agency recommendations. To explore a feasible cost-effective solution, a teleradiotherapy network (TRTNet) was conceived with 4 to 8 primary RT centers (PRTCs) (each with 1 teletherapy unit, US$2.05 million) linked to a secondary RT center (SRTC; 2 teletherapy units and 1 brachytherapy unit, US$5.05 million). RESULTS: Of the 137 LMICs, 51 (37.3%) presently lack RT facilities. The remaining 86 LMICs have 5084 teletherapy units (gap: -7741) and thus a mean access to RT of 33%. By 2030, an additional 12,133 teletherapy units would be required for 14.2 million patients with cancer. A TRTNet linked 4 to 8 PRTCs with 1 SRTC could yield a return of investment (ROI) between -181.1% and 757.6% depending on the TRTNet configuration, 2-year survival, gross national income per capita, and employment-population ratio of the individual LMICs. Sixty-five (47.4%) of these could be expected to attain a positive ROI (7.1% to 757.6%) with a 2-year survival of 50% and a TRTNet configuration of 1 SRTC and 8 PRTCs. CONCLUSION: Optimized TRTNets through resource sharing could be a cost-effective and financially viable option to create RT infrastructure and facilitate capacity building toward realizing the 2030 Agenda for Sustainable Development goals in most LMICs. Low-income countries and some LMICs not expected to gain positive ROI should be considered for external financial assistance.

Brachytherapy boost for prostate cancer: A national survey from Groupe curiethérapie - Société française de radiothérapie oncologique.

PURPOSE: Brachytherapy can be used for the treatment of every localized prostate cancer, notably as boost for intermediate- and high-risk prostate cancer. With the incidence of prostate cancer increasing significantly during the next decades and brachytherapy developing, we conducted a descriptive survey to analyse the current status of prostate brachytherapy in France to see if the future demands could be met. MATERIAL AND METHODS: All radiotherapy centres that declared providing brachytherapy were found from the French national institute of cancer registry and they were asked to reply to an online form in April 2018. RESULTS: Fifty-two of the 54-brachytherapy centres (96%) replied the form and 34 centres did prostate brachytherapy. Among those centres, 32 performed iodine 125 low-dose rate brachytherapy as monotherapy, 19 provided brachytherapy boost (eight centres low-dose rate 125I; seven centres high-dose rate; four centres both). Among the centres not performing brachytherapy boost, 18 wanted to do, eight did not want and nine did not reply. The main reasons for reluctance towards brachytherapy boost were: organization constraints (three centres), refer patients to a nearby brachytherapy centre (one centre), technical issues (two centres) and lack of strong scientific evidences (two centres). In terms of human resources, the mean number of trained physicians and physicists were two (range: 1-6) and three (range: 1-5) respectively. CONCLUSION: In France, the future needs for prostate brachytherapy cannot be met by the current health supply. Health authorities should firstly reimburse brachytherapy boost and redefine an optimal training and organization of centres such that every patient with prostate cancer can receive optimal treatment.

Melanoma prognosis in the United States: Identifying barriers for improved care.

BACKGROUND: Despite improvements in melanoma mortality, disparities in melanoma survival persist. We evaluated possible sociodemographic and health care-based predictors of differences in melanoma survival in the United States by using the melanoma mortality-to-incidence ratio (MIR). METHODS: State-based MIRs were calculated by using US cancer statistics data from 1999 to 2014. Pearson correlations and linear regressions were used to determine associations between MIR and dermatologist density, primary care provider density, number of physicians by state, number of National Cancer Institute-designated cancer centers, health care spending per capita, average household income, racial/ethnic makeup of the population, percentage of uninsured individuals, and percentage with a bachelor's degree. RESULTS: The mean overall MIR was 0.15 ± 0.04; only Alaska was an outlier (0.24). No state MIRs increased significantly over time; MIR decreased for most states. Multivariable analysis revealed that states with more active physicians (P = .02) and a higher percentage non-Hispanic whites (P = .004) had higher MIRs (poorer survival). Significant Pearson correlations were seen between MIR and melanoma incidence (r = -0.72, P < .001), melanoma mortality (r = 0.38, P < .001), dermatologist density (r = 0.32, P < .001), and National Cancer Institute-designated cancer center count (r = -0.12, P = .001). CONCLUSIONS: Melanoma survival is improved in higher-incidence areas and areas with higher dermatologist density. These findings highlight areas of poorer melanoma survival and the need for local studies evaluating disparities in melanoma survival.