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1.
Lancet Oncol ; 22(10): 1367-1377, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34560006

RESUMO

BACKGROUND: The WHO Essential Medicines List (EML) identifies priority medicines that are most important to public health. Over time, the EML has included an increasing number of cancer medicines. We aimed to investigate whether the cancer medicines in the EML are aligned with the priority medicines of frontline oncologists worldwide, and the extent to which these medicines are accessible in routine clinical practice. METHODS: This international, cross-sectional survey was developed by investigators from a range of clinical practice settings across low-income to high-income countries, including members of the WHO Essential Medicines Cancer Working Group. A 28-question electronic survey was developed and disseminated to a global network of oncologists in 89 countries and regions by use of a hierarchical snowball method; each primary contact distributed the survey through their national and regional oncology associations or personal networks. The survey was open from Oct 15 to Dec 7, 2020. Fully qualified physicians who prescribe systemic anticancer therapy to adults were eligible to participate in the survey. The primary question asked respondents to select the ten cancer medicines that would provide the greatest public health benefit to their country; subsequent questions explored availability and cost of cancer medicines. Descriptive statistics were used to compare access to medicines between low-income and lower-middle-income countries, upper-middle-income countries, and high-income countries. FINDINGS: 87 country-level contacts and two regional networks were invited to participate in the survey; 46 (52%) accepted the invitation and distributed the survey. 1697 respondents opened the survey link; 423 were excluded as they did not answer the primary study question and 326 were excluded because of ineligibility. 948 eligible oncologists from 82 countries completed the survey (165 [17%] in low-income and lower-middle-income countries, 165 [17%] in upper-middle-income countries, and 618 [65%] in high-income countries). The most commonly selected medicines were doxorubicin (by 499 [53%] of 948 respondents), cisplatin (by 470 [50%]), paclitaxel (by 423 [45%]), pembrolizumab (by 414 [44%]), trastuzumab (by 402 [42%]), carboplatin (by 390 [41%]), and 5-fluorouracil (by 386 [41%]). Of the 20 most frequently selected high-priority cancer medicines, 19 (95%) are currently on the WHO EML; 12 (60%) were cytotoxic agents and 13 (65%) were granted US Food and Drug Administration regulatory approval before 2000. The proportion of respondents indicating universal availability of each top 20 medication was 9-54% in low-income and lower-middle-income countries, 13-90% in upper-middle-income countries, and 68-94% in high-income countries. The risk of catastrophic expenditure (spending >40% of total consumption net of spending on food) was more common in low-income and lower-middle-income countries, with 13-68% of respondents indicating a substantial risk of catastrophic expenditures for each of the top 20 medications in lower-middle-income countries versus 2-41% of respondents in upper-middle-income countries and 0-9% in high-income countries. INTERPRETATION: These data demonstrate major barriers in access to core cancer medicines worldwide. These findings challenge the feasibility of adding additional expensive cancer medicines to the EML. There is an urgent need for global and country-level policy action to ensure patients with cancer globally have access to high priority medicines. FUNDING: None.


Assuntos
Antineoplásicos/provisão & distribuição , Medicamentos Essenciais/provisão & distribuição , Saúde Global , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde , Oncologistas , Adulto , Antineoplásicos/economia , Estudos Transversais , Custos de Medicamentos , Medicamentos Essenciais/economia , Feminino , Saúde Global/economia , Pesquisas sobre Serviços de Saúde , Acesso aos Serviços de Saúde/economia , Disparidades em Assistência à Saúde/economia , Humanos , Masculino , Pessoa de Meia-Idade
2.
JCO Glob Oncol ; 7: 342-352, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33656910

RESUMO

PURPOSE: Delays and disruptions in health systems because of the COVID-19 pandemic were identified by a previous systematic review from our group. For improving the knowledge about the pandemic consequences for cancer care, this article aims to identify the effects of mitigation strategies developed to reduce the impact of such delays and disruptions. METHODS: Systematic review with a comprehensive search including formal databases, cancer and COVID-19 data sources, gray literature, and manual search. We considered clinical trials, observational longitudinal studies, cross-sectional studies, before-and-after studies, case series, and case studies. The selection, data extraction, and methodological assessment were performed by two independent reviewers. The methodological quality of the included studies was assessed by specific tools. The mitigation strategies identified were described in detail and their effects were summarized narratively. RESULTS: Of 6,692 references reviewed, 28 were deemed eligible, and 9 studies with low to moderate methodological quality were included. Five multiple strategies and four single strategies were reported, and the possible effects of mitigating delays and disruptions in cancer care because of COVID-19 are inconsistent. The only comparative study reported a 48.7% reduction observed in the number of outpatient visits to the hospital accompanied by a small reduction in imaging and an improvement in radiation treatments after the implementation of a multiple organizational strategy. CONCLUSION: The findings emphasize the infrequency of measuring and reporting mitigation strategies that specifically address patients' outcomes and thus a scarcity of high-quality evidence to inform program development. This review reinforces the need of adopting standardized measurement methods to monitor the impact of the mitigation strategies proposed to reduce the effects of delays and disruptions in cancer health care because of COVID-19.


Assuntos
COVID-19/epidemiologia , Institutos de Câncer , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Oncologia/tendências , Neoplasias/terapia , Estudos Transversais , Tomada de Decisões , Humanos , Oncologia/organização & administração , Modelos Organizacionais , Avaliação de Resultados em Cuidados de Saúde , Pandemias , Tempo para o Tratamento
3.
JCO Glob Oncol ; 7: 311-323, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33617304

RESUMO

PURPOSE: There has been noteworthy concern about the impact of COVID-19 pandemic on health services including the management of cancer. In addition to being considered at higher risk for worse outcomes from COVID-19, people with cancer may also experience disruptions or delays in health services. This systematic review aimed to identify the delays and disruptions to cancer services globally. METHODS: This is a systematic review with a comprehensive search including specific and general databases. We considered any observational longitudinal and cross-sectional study design. The selection, data extraction, and methodological assessment were performed by two independent reviewers. The methodological quality of the studies was assessed by specific tools. The delays and disruptions identified were categorized, and their frequency was presented. RESULTS: Among the 62 studies identified, none exhibited high methodological quality. The most frequent determinants for disruptions were provider- or system-related, mainly because of the reduction in service availability. The studies identified 38 different categories of delays and disruptions with impact on treatment, diagnosis, or general health service. Delays or disruptions most investigated included reduction in routine activity of cancer services and number of cancer surgeries; delay in radiotherapy; and delay, reschedule, or cancellation of outpatient visits. Interruptions and disruptions largely affected facilities (up to 77.5%), supply chain (up to 79%), and personnel availability (up to 60%). CONCLUSION: The remarkable frequency of delays and disruptions in health care mostly related to the reduction of the COVID-19 burden unintentionally posed a major risk on cancer care worldwide. Strategies can be proposed not only to mitigate the main delays and disruptions but also to standardize their measurement and reporting. As a high number of publications continuously are being published, it is critical to harmonize the upcoming reports and constantly update this review.


Assuntos
COVID-19 , Atenção à Saúde/métodos , Neoplasias/terapia , Assistência Ambulatorial , Estudos Transversais , Atenção à Saúde/organização & administração , Atenção à Saúde/estatística & dados numéricos , Humanos , Neoplasias/radioterapia , Neoplasias/cirurgia
6.
Med Decis Making ; 40(3): 364-378, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32160823

RESUMO

Background. Low-and-middle-income countries (LMICs) have higher mortality-to-incidence ratio for breast cancer compared to high-income countries (HICs) because of late-stage diagnosis. Mammography screening is recommended for early diagnosis, however, the infrastructure capacity in LMICs are far below that needed for adopting current screening guidelines. Current guidelines are extrapolations from HICs, as limited data had restricted model development specific to LMICs, and thus, economic analysis of screening schedules specific to infrastructure capacities are unavailable. Methods. We applied a new Markov process method for developing cancer progression models and a Markov decision process model to identify optimal screening schedules under a varying number of lifetime screenings per person, a proxy for infrastructure capacity. We modeled Peru, a middle-income country, as a case study and the United States, an HIC, for validation. Results. Implementing 2, 5, 10, and 15 lifetime screens would require about 55, 135, 280, and 405 mammography machines, respectively, and would save 31, 62, 95, and 112 life-years per 1000 women, respectively. Current guidelines recommend 15 lifetime screens, but Peru has only 55 mammography machines nationally. With this capacity, the best strategy is 2 lifetime screenings at age 50 and 56 years. As infrastructure is scaled up to accommodate 5 and 10 lifetime screens, screening between the ages of 44-61 and 41-64 years, respectively, would have the best impact. Our results for the United States are consistent with other models and current guidelines. Limitations. The scope of our model is limited to analysis of national-level guidelines. We did not model heterogeneity across the country. Conclusions. Country-specific optimal screening schedules under varying infrastructure capacities can systematically guide development of cancer control programs and planning of health investments.


Assuntos
Neoplasias da Mama/diagnóstico , Detecção Precoce de Câncer/métodos , Mamografia/métodos , Neoplasias da Mama/epidemiologia , Países em Desenvolvimento/estatística & dados numéricos , Humanos , Incidência , Mamografia/estatística & dados numéricos , Peru/epidemiologia
7.
Lancet Oncol ; 20(11): e645-e652, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31674323

RESUMO

When developed and implemented effectively, national cancer control plans (NCCPs) improve cancer outcomes at the population level. However, many countries do not have a high-quality, operational NCCP, contributing to disparate cancer outcomes globally. Until now, a standard reference of NCCP core elements has not been available to guide development and evaluation across diverse countries and contexts. In this Policy Review, we describe the methods, process, and outcome of an initiative to develop an itemised and evidence-based comprehensive checklist of core elements for NCCP formulation. The final list provides a ready-to-use guide to support NCCP development and to facilitate internal and external critical appraisal of existing NCCPs for countries of all income levels and settings. Governments, policy makers, and stakeholders can utilise this checklist, while considering their own unique contexts and priorities, from the drafting through to the implementation of NCCPs.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Saúde Global , Planejamento em Saúde/organização & administração , Política de Saúde , Oncologia/organização & administração , Neoplasias/terapia , Lista de Checagem , Prestação Integrada de Cuidados de Saúde/legislação & jurisprudência , Saúde Global/legislação & jurisprudência , Planejamento em Saúde/legislação & jurisprudência , Política de Saúde/legislação & jurisprudência , Humanos , Oncologia/legislação & jurisprudência , Modelos Organizacionais , Neoplasias/diagnóstico , Neoplasias/mortalidade , Formulação de Políticas
8.
J Glob Oncol ; 5: 1-8, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30668270

RESUMO

PURPOSE: The WHO framework for early cancer diagnosis highlights the need to improve health care capacity among primary care providers. In Rwanda, general practitioners (GPs) at district hospitals (DHs) play key roles in diagnosing, initiating management, and referring suspected patients with cancer. We sought to ascertain educational and resource needs of GPs to provide a blueprint that can inform future early cancer diagnosis capacity-building efforts. METHODS: We administered a cross-sectional survey study to GPs practicing in 42 Rwandan DHs to assess gaps in cancer-focused knowledge, skills, and resources, as well as delays in the referral process. Responses were aggregated and descriptive analysis was performed to identify trends. RESULTS: Survey response rate was 76% (73 of 96 GPs). Most responders were 25 to 29 years of age (n = 64 [88%]) and 100% had been practicing between 3 and 12 months. Significant gaps in cancer knowledge and physical exam skills were identified-88% of respondents were comfortable performing breast exams, but less than 10 (15%) GPs reported confidence in performing pelvic exams. The main educational resource requested by responders (n = 59 [81%]) was algorithms to guide clinical decision-making. Gaps in resource availability were identified, with only 39% of responders reporting breast ultrasound availability and 5.8% reporting core needle biopsy availability in DHs. Radiology and pathology resources were limited, with 52 (71%) reporting no availability of pathology services at the DH level. CONCLUSION: The current study reveals significant basic oncologic educational and resource gaps in Rwanda, such as physical examination skills and diagnostic tools. Capacity building for GPs in low- and middle-income countries should be a core component of national cancer control plans to improve accurate and timely diagnosis of cancer. Continuing professional development activities should address and focus on context-specific educational gaps, resource availability, and referral practice guidelines.


Assuntos
Atenção à Saúde/métodos , Clínicos Gerais/educação , Hospitais de Distrito/organização & administração , Determinação de Necessidades de Cuidados de Saúde/estatística & dados numéricos , Neoplasias/prevenção & controle , Adulto , África ao Sul do Saara , Estudos Transversais , Feminino , Clínicos Gerais/estatística & dados numéricos , Recursos em Saúde , Humanos , Masculino , Oncologia , Neoplasias/diagnóstico , Encaminhamento e Consulta/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
9.
JAMA Netw Open ; 2(1): e186875, 2019 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-30644967

RESUMO

Importance: High costs and risks of research and development (R&D) have been used to justify the high prices of cancer drugs. However, what the return on R&D investment is, and by extension what a justifiable price might be, is unclear. Objective: To compare incomes from the sales of cancer drugs with the estimated R&D costs. Design, Setting, and Participants: This observational study used global pharmaceutical industry sales data to quantify the cumulative incomes generated from the sales of cancer drugs for companies that have held patents or marketing rights (originator companies). All cancer drugs approved by the US Food and Drug Administration from 1989 to 2017 were identified from the United States Food and Drug Administration's website and literature. Itemized product sales data were extracted from the originator companies' consolidated financial reports. For drugs with data missing in specific years, additional data was sought from other public sources, or where necessary, estimated values from known reported values. Drugs were excluded if there were missing data for half or more of the years since approval. Data analysis was conducted from May 2018 to October 2018. Main Outcomes and Measures: Sales data were expressed in 2017 US dollars with adjustments for inflation. Cumulative incomes from the sales of these drugs were compared against the R&D costs estimated in the literature, which had been adjusted for the costs of capital and trial failure (risk adjusted). Results: Of the 156 US Food and Drug Administration-approved cancer drugs identified, 99 drugs (63.5%) had data for more than half of the years since approval and were included in the analysis. There was a median of 10 years (range, 1-28 years) of sales data with 1040 data points, 79 (7.6%) of which were estimated. Compared with the total risk-adjusted R&D cost of $794 million (range, $2827-$219 million) per medicine estimated in the literature, by the end of 2017, the median cumulative sales income was $14.50 (range, $3.30-$55.10) per dollar invested for R&D. Median time to fully recover the maximum possible risk-adjusted cost of R&D ($2827 million) was 5 years (range, 2-10 years; n = 56). Cancer drugs continued to generate billion-dollar returns for the originator companies after the end-of-market exclusivity, particularly for biologics. Conclusions and Relevance: Cancer drugs, through high prices, have generated returns for the originator companies far in excess of possible R&D costs. Lowering prices of cancer drugs and facilitating greater competition are essential for improving patient access, health system's financial sustainability, and future innovation.


Assuntos
Antineoplásicos/economia , Custos de Medicamentos/estatística & dados numéricos , Indústria Farmacêutica , Marketing , Pesquisa/economia , Aprovação de Drogas , Indústria Farmacêutica/economia , Indústria Farmacêutica/métodos , Indústria Farmacêutica/estatística & dados numéricos , Saúde Global , Humanos , Renda/estatística & dados numéricos , Marketing/métodos , Marketing/estatística & dados numéricos
10.
Lancet Oncol ; 19(12): e709-e719, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30507437

RESUMO

Medical devices are indispensable for cancer management across the entire cancer care continuum, yet many existing medical interventions are not equally accessible to the global population, contributing to disparate mortality rates between countries with different income levels. Improved access to priority medical technologies is required to implement universal health coverage and deliver high-quality cancer care. However, the selection of appropriate medical devices at all income and hospital levels has been difficult because of the extremely large number of devices needed for the full spectrum of cancer care; the wide variety of options within the medical device sector, ranging from small inexpensive disposable devices to sophisticated diagnostic imaging and treatment units; and insufficient in-country expertise, in many countries, to prioritise cancer interventions and to determine associated technologies. In this Policy Review, we describe the methods, process, and outcome of a WHO initiative to define a list of priority medical devices for cancer management. The methods, approved by the WHO Guidelines Review Committee, can be used as a model approach for future endeavours to define and select medical devices for disease management. The resulting list provides ready-to-use guidance for the selection of devices to establish, maintain, and operate necessary clinical units within the continuum of care for six cancer types, with the goal of promoting efficient resource allocation and increasing access to priority medical devices, particularly in low-income and middle-income countries.


Assuntos
Política de Saúde/legislação & jurisprudência , Legislação de Dispositivos Médicos , Oncologia/instrumentação , Oncologia/legislação & jurisprudência , Neoplasias/diagnóstico , Neoplasias/terapia , Formulação de Políticas , Organização Mundial da Saúde , Tomada de Decisão Clínica , Regulamentação Governamental , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Humanos , Determinação de Necessidades de Cuidados de Saúde/legislação & jurisprudência , Segurança do Paciente/legislação & jurisprudência
11.
Cost Eff Resour Alloc ; 16: 38, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30450014

RESUMO

Background: Following the adoption of the Global Action Plan for the Prevention and Control of NCDs 2013-2020, an update to the Appendix 3 of the action plan was requested by Member States in 2016, endorsed by the Seventieth World Health Assembly in May 2017 and provides a list of recommended NCD interventions. The main contribution of this paper is to present results of analyses identifying how decision makers can achieve maximum health gain using the cancer interventions listed in the Appendix 3. We also present methods used to calculate new WHO-CHOICE cost-effectiveness results for breast cancer, cervical cancer, and colorectal cancer in Southeast Asia and eastern sub-Saharan Africa. Methods: We used "Generalized Cost-Effectiveness Analysis" for our analysis which uses a hypothetical null reference case, where the impacts of all current interventions are removed, in order to identify the optimal package of interventions. All health system costs, regardless of payer, were included. Health outcomes are reported as the gain in healthy life years due to a specific intervention scenario and were estimated using a deterministic state-transition cohort simulation (Markov model). Results: Vaccination against human papillomavirus (two doses) for 9-13-year-old girls (in eastern sub-Saharan Africa) and HPV vaccination combined with prevention of cervical cancer by screening of women aged 30-49 years through visual inspection with acetic acid linked with timely treatment of pre-cancerous lesions (in Southeast Asia) were found to be the most cost effective interventions. For breast cancer, in both regions the treatment of breast cancer, stages I and II, with surgery ± systemic therapy, at 95% coverage, was found to be the most cost-effective intervention. For colorectal cancer, treatment of colorectal cancer, stages I and II, with surgery ± chemotherapy and radiotherapy, at 95% coverage, was found to be the most cost-effective intervention. Conclusion: The results demonstrate that cancer prevention and control interventions are cost-effective and can be implemented through a step-wise approach to achieve maximum health benefits. As the global community moves toward universal health coverage, this analysis can support decision makers in identifying a core package of cancer services, ensuring treatment and palliative care for all.

12.
Lancet Glob Health ; 6(12): e1288-e1296, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30420032

RESUMO

BACKGROUND: To curb the rising global burden of non-communicable diseases (NCDs), the UN Sustainable Development Goals (SDGs) include a target to reduce premature mortality from NCDs by a third by 2030. A quantitative assessment of the effect on longevity of meeting this target is one of the many important measures needed to advocate and inform national disease control policies. We did a global analysis to estimate improvements in average expected years lived between 30 and 70 years of age that would result from meeting the SDG target. METHODS: We estimated age-specific mortality in 183 countries in 2015, for the four major NCDs (cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes) and all NCDs combined, using data from WHO Global Health Estimates. We then estimated the potential gains in average expected years lived between 30 and 70 years of age (LE[30-70)) by eliminating all or a third of premature mortality from specific causes of death in countries grouped by World Bank income groups. The feasibility of reducing mortality to the targeted level over 15 years was also assessed on the basis of historical mortality trends from 2000 to 2015. FINDINGS: Reducing a third of premature mortality from NCDs over 15 years is feasible in high-income and upper-middle-income countries, but remains challenging in countries with lower income levels. National longevity will improve if this target is met, corresponding to an average gain in LE[30-70) of 0·64 years worldwide from reduced premature mortality for the four major NCDs and 0·80 years for all NCDs. According to major NCD type, the largest gains attributable to cardiovascular diseases would be in lower-middle-income countries (a gain of 0·45 years), whereas gains attributable to cancer would be in low-income countries (0·33 years). INTERPRETATION: A one-third reduction in premature mortality from the major NCDs in 2015-30 would have substantial effects on longevity. High-level political commitments to effective and equitable national surveillance and prioritised prevention, early detection, and treatment programmes tailored to the major NCD types are needed urgently in lower-resourced settings if this SDG target is to be met by 2030. FUNDING: None.


Assuntos
Saúde Global/estatística & dados numéricos , Longevidade , Mortalidade Prematura/tendências , Doenças não Transmissíveis/mortalidade , Adulto , Idoso , Objetivos , Humanos , Pessoa de Meia-Idade , Desenvolvimento Sustentável
13.
Lancet Oncol ; 19(10): e546-e555, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30268693

RESUMO

There is increasing global recognition that national cancer plans are crucial to effectively address the cancer burden and to prioritise and coordinate programmes. We did a global analysis of available national cancer-related health plans using a standardised assessment questionnaire to assess their inclusion of elements that characterise an effective cancer plan and, thereby, improve understanding of the strengths and limitations of existing plans. The results show progress in the development of cancer plans, as well as in the inclusion of stakeholders in plan development, but little evidence of their implementation. Areas of continued unmet need include setting of realistic priorities, specification of programmes for cancer management, allocation of appropriate budgets, monitoring and evaluation of plan implementation, promotion of research, and strengthening of information systems. We found that countries with a non-communicable disease (NCD) plan but no national cancer control plan (NCCP) were less likely than countries with an NCCP and NCP plan or an NCCP only to have comprehensive, coherent, or consistent plans. As countries move towards universal health coverage, greater emphasis is needed on developing NCCPs that are evidence based, financed, and implemented to ensure translation into action.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Saúde Global , Planejamento em Saúde/organização & administração , Política de Saúde , Oncologia/organização & administração , Neoplasias/terapia , Orçamentos/organização & administração , Prestação Integrada de Cuidados de Saúde/economia , Prestação Integrada de Cuidados de Saúde/legislação & jurisprudência , Saúde Global/economia , Saúde Global/legislação & jurisprudência , Regulamentação Governamental , Custos de Cuidados de Saúde , Planejamento em Saúde/economia , Planejamento em Saúde/legislação & jurisprudência , Política de Saúde/economia , Política de Saúde/legislação & jurisprudência , Humanos , Oncologia/economia , Oncologia/legislação & jurisprudência , Modelos Organizacionais , Neoplasias/diagnóstico , Neoplasias/economia , Neoplasias/mortalidade , Formulação de Políticas
14.
Med Decis Making ; 38(4): 520-530, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29577814

RESUMO

Implementation of organized cancer screening and prevention programs in high-income countries (HICs) has considerably decreased cancer-related incidence and mortality. In low- and middle-income countries (LMICs), screening and early diagnosis programs are generally unavailable, and most cancers are diagnosed in late stages when survival is very low. Analyzing the cost-effectiveness of alternative cancer control programs and estimating resource needs will help prioritize interventions in LMICs. However, mathematical models of natural cancer onset and progression needed to conduct the economic analyses are predominantly based on populations in HICs because the longitudinal data on screening and diagnoses required for parameterization are unavailable in LMICs. Models currently used for LMICs mostly concentrate on directly calculating the shift in distribution of cancer diagnosis as an evaluative measure of screening. We present a mathematical methodology for the parameterization of natural cancer onset and progression, specifically for LMICs that do not have longitudinal data. This full onset and progression model can help conduct comprehensive analyses of cancer control programs, including cancer screening, by considering both the positive impact of screening as well as any adverse consequences, such as over-diagnosis and false-positive results. The methodology has been applied to breast, cervical, and colorectal cancers for 2 regions, under the World Health Organization categorization: Eastern Sub-Saharan Africa (AFRE) and Southeast Asia (SEARB). The cancer models have been incorporated into the Spectrum software and interfaced with country-specific demographic data through the demographic projections (DemProj) module and costing data through the OneHealth tool. These software are open-access and can be used by stakeholders to analyze screening strategies specific to their country of interest.


Assuntos
Países em Desenvolvimento , Detecção Precoce de Câncer/economia , Cadeias de Markov , Modelos Teóricos , Neoplasias/diagnóstico , Neoplasias da Mama , Neoplasias Colorretais , Análise Custo-Benefício , Feminino , Humanos , Neoplasias/economia , Neoplasias/prevenção & controle , Neoplasias do Colo do Útero
15.
Clin Lab Med ; 38(1): 151-160, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29412879

RESUMO

Universal coverage of basic laboratory services is fundamental to achieving sustainable development goals and attaining health for all. Yet, comprehensive laboratory services are unavailable to large percentages of the global population. To help policymakers identify a basic package of services for cancer, the World Health Organization (WHO) published Priority Medical Devices for Cancer Management. The package of services includes key interventions, associated devices and technologies, and the requirements for health workforce and infrastructure. These services must be linked to national strategic policies and plans and regulatory and quality assurance processes.


Assuntos
Equipamentos e Provisões , Neoplasias/terapia , Cobertura Universal do Seguro de Saúde , Serviços de Laboratório Clínico , Acesso aos Serviços de Saúde , Humanos , Patologia Clínica , Organização Mundial da Saúde
16.
ESMO Open ; 3(2): e000285, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29464109

RESUMO

The cancer burden is rising globally, exerting significant strain on populations and health systems at all income levels. In May 2017, world governments made a commitment to further invest in cancer control as a public health priority, passing the World Health Assembly Resolution 70.12 on cancer prevention and control within an integrated approach. In this manuscript, the 2016 European Society for Medical Oncology Leadership Generation Programme participants propose a strategic framework that is in line with the 2017 WHO Cancer Resolution and consistent with the principle of universal health coverage, which ensures access to optimal cancer care for all people because health is a basic human right. The time for action is now to reduce barriers and provide the highest possible quality cancer care to everyone regardless of circumstance, precondition or geographic location. The national actions and the policy recommendations in this paper set forth the vision of its authors for the future of global cancer control at the national level, where the WHO Cancer Resolution must be implemented if we are to reduce the cancer burden, avoid unnecessary suffering and save as many lives as possible.

19.
Lancet Oncol ; 16(11): 1193-224, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26427363

RESUMO

Surgery is essential for global cancer care in all resource settings. Of the 15.2 million new cases of cancer in 2015, over 80% of cases will need surgery, some several times. By 2030, we estimate that annually 45 million surgical procedures will be needed worldwide. Yet, less than 25% of patients with cancer worldwide actually get safe, affordable, or timely surgery. This Commission on global cancer surgery, building on Global Surgery 2030, has examined the state of global cancer surgery through an analysis of the burden of surgical disease and breadth of cancer surgery, economics and financing, factors for strengthening surgical systems for cancer with multiple-country studies, the research agenda, and the political factors that frame policy making in this area. We found wide equity and economic gaps in global cancer surgery. Many patients throughout the world do not have access to cancer surgery, and the failure to train more cancer surgeons and strengthen systems could result in as much as US $6.2 trillion in lost cumulative gross domestic product by 2030. Many of the key adjunct treatment modalities for cancer surgery--e.g., pathology and imaging--are also inadequate. Our analysis identified substantial issues, but also highlights solutions and innovations. Issues of access, a paucity of investment in public surgical systems, low investment in research, and training and education gaps are remarkably widespread. Solutions include better regulated public systems, international partnerships, super-centralisation of surgical services, novel surgical clinical trials, and new approaches to improve quality and scale up cancer surgical systems through education and training. Our key messages are directed at many global stakeholders, but the central message is that to deliver safe, affordable, and timely cancer surgery to all, surgery must be at the heart of global and national cancer control planning.


Assuntos
Atenção à Saúde , Necessidades e Demandas de Serviços de Saúde , Neoplasias/cirurgia , Saúde Global , Humanos
20.
Ann Surg Oncol ; 22(3): 719-27, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25623597

RESUMO

PURPOSE AND DESIGN: The failure to translate cancer knowledge into action contributes to regional, national, and international health inequities. Disparities in cancer care are the most severe in low-resource settings, where delivery obstacles are compounded by health infrastructure deficits and inadequate basic services. Global cancer consortiums (GCCs) have developed to strengthen cancer care expertise, advance knowledge on best practices, and bridge the cancer gap worldwide. Within the complex matrix of public health priorities, consensus is emerging on cost-effective cancer care interventions in low- and medium-resource countries, which include the critical role of surgical services. Distinct from traditional health partnerships that collaborate to provide care at the local level, GCCs collaborate more broadly to establish consensus on best practice models for service delivery. To realize the benefit of programmatic interventions and achieve tangible improvements in patient outcomes, GCCs must construct and share evidence-based implementation strategies to be tested in real world settings. REVIEW AND CONCLUSIONS: Implementation research should inform consensus formation, program delivery, and outcome monitoring to achieve the goals articulated by GCCs. Fundamental steps to successful implementation are: (1) to adopt an integrated, multisectoral plan with local involvement; (2) to define shared implementation priorities by establishing care pathways that avoid prescriptive but suboptimal health care delivery; (3) to build capacity through education, technology transfer, and surveillance of outcomes; and (4) to promote equity and balanced collaboration. GCCs can bridge the gap between what is known and what is done, translating normative sharing of clinical expertise into tangible improvements in patient care.


Assuntos
Neoplasias da Mama/prevenção & controle , Consenso , Atenção à Saúde , Recursos em Saúde/organização & administração , Guias de Prática Clínica como Assunto , Feminino , Recursos em Saúde/normas , Humanos , Padrões de Prática Médica
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