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1.
Lancet Oncol ; 24(12): e472-e518, 2023 Dec.
Article in English | MEDLINE | ID: mdl-37924819

ABSTRACT

The first Lancet Oncology Commission on Global Cancer Surgery was published in 2015 and serves as a landmark paper in the field of cancer surgery. The Commission highlighted the burden of cancer and the importance of cancer surgery, while documenting the many inadequacies in the ability to deliver safe, timely, and affordable cancer surgical care. This Commission builds on the first Commission by focusing on solutions and actions to improve access to cancer surgery globally, developed by drawing upon the expertise from cancer surgery leaders across the world. We present solution frameworks in nine domains that can improve access to cancer surgery. These nine domains were refined to identify solutions specific to the six WHO regions. On the basis of these solutions, we developed eight actions to propel essential improvements in the global capacity for cancer surgery. Our initiatives are broad in scope, pragmatic, affordable, and contextually applicable, and aimed at cancer surgeons as well as leaders, administrators, elected officials, and health policy advocates. We envision that the solutions and actions contained within the Commission will address inequities and promote safe, timely, and affordable cancer surgery for every patient, regardless of their socioeconomic status or geographic location.


Subject(s)
Neoplasms , Surgeons , Humans , Neoplasms/surgery , Global Health , Health Policy
2.
J Surg Oncol ; 128(6): 1032-1037, 2023 Nov.
Article in English | MEDLINE | ID: mdl-37818914

ABSTRACT

Among patients undergoing surgical oncologic operations, patients in low- and middle-income countries are at particularly high risk for inadequate perioperative analgesia. This article reviews some of the guiding pillars of pain management for cancer surgery, including use of regional analgesia and acute pain service consultation, multimodal adjunctive analgesia, and judicious opioid use while presenting data on international disparities for each pillar and proposing strategies to address these inequities.


Subject(s)
Analgesia , Neoplasms , Humans , Pain Management , Analgesics, Opioid/therapeutic use , Pain, Postoperative , Neoplasms/surgery
3.
J Natl Compr Canc Netw ; 17(8): 977-1007, 2019 08 01.
Article in English | MEDLINE | ID: mdl-31390582

ABSTRACT

In recent years, the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Adult Cancer Pain have undergone substantial revisions focusing on the appropriate and safe prescription of opioid analgesics, optimization of nonopioid analgesics and adjuvant medications, and integration of nonpharmacologic methods of cancer pain management. This selection highlights some of these changes, covering topics on management of adult cancer pain including pharmacologic interventions, nonpharmacologic interventions, and treatment of specific cancer pain syndromes. The complete version of the NCCN Guidelines for Adult Cancer Pain addresses additional aspects of this topic, including pathophysiologic classification of cancer pain syndromes, comprehensive pain assessment, management of pain crisis, ongoing care for cancer pain, pain in cancer survivors, and specialty consultations.


Subject(s)
Cancer Pain/diagnosis , Cancer Pain/therapy , Neoplasms/complications , Pain Management , Adult , Age Factors , Cancer Pain/etiology , Combined Modality Therapy/adverse effects , Combined Modality Therapy/methods , Humans
4.
J Surg Oncol ; 115(5): 637-641, 2017 Apr.
Article in English | MEDLINE | ID: mdl-28230243

ABSTRACT

Palliative care and pain management constitute an integral part of the multi-disciplinary approach to treating patients with cancer. There are major disparities in the global presence of sustainable palliative care models and universal availability of effective pain medications, especially in low and middle income countries with the highest predicted future burden of cancer. Active intervention is needed to improve the availability of palliative care and effective pain control worldwide.


Subject(s)
Cancer Pain/therapy , Global Health , Palliative Care , Analgesics, Opioid/supply & distribution , Analgesics, Opioid/therapeutic use , Clinical Competence , Developed Countries , Developing Countries , Health Services Accessibility , Humans
5.
J Natl Compr Canc Netw ; 14(6): 715-24, 2016 06.
Article in English | MEDLINE | ID: mdl-27283164

ABSTRACT

The NCCN Guidelines for Survivorship provide screening, evaluation, and treatment recommendations for common consequences of cancer and cancer treatment. They are intended to aid health care professionals who work with survivors of adult-onset cancer in the posttreatment period, including those in general oncology, specialty cancer survivor clinics, and primary care practices. Guidance is also provided to help promote physical activity, weight management, and proper immunizations in survivors. This article summarizes the NCCN Survivorship panel's discussions for the 2016 update of the guidelines regarding the management of anxiety, depression, posttraumatic stress disorder-related symptoms, and emotional distress in survivors.


Subject(s)
Neoplasms/mortality , Humans , Neoplasms/therapy , Survival Rate
6.
J Natl Compr Canc Netw ; 12(1): 34-45, 2014 Jan.
Article in English | MEDLINE | ID: mdl-24453291

ABSTRACT

Many cancer survivors experience physical and/or psychosocial side effects, which can be severe, debilitating, and sometimes permanent. These NCCN Guidelines for Survivorship provide screening, evaluation, and treatment recommendations for common consequences of cancer and cancer treatment for health care professionals who work with survivors of adult-onset cancer in the posttreatment period. These introductory sections of the guidelines include the panel's definition of cancer survivors, a discussion of the effects of cancer and its treatment, general principles and standards for survivorship care, and guidance regarding screening for problems that require further assessment.


Subject(s)
Neoplasms/epidemiology , Survival Rate , Adult , Guidelines as Topic , Humans , Neoplasms/pathology , Neoplasms/psychology , Neoplasms/therapy , Survivors/psychology
7.
J Natl Compr Canc Netw ; 12(8): 1098-111, 2014 Aug.
Article in English | MEDLINE | ID: mdl-25099442

ABSTRACT

Cancer survivors are at an elevated risk for infection because of immune suppression associated with prior cancer treatments, and they are at increased risk of complications from vaccine-preventable diseases. This section of the NCCN Guidelines for Survivorship provides recommendations for the prevention of infections in survivors through education, antimicrobial prophylaxis, and the judicious use of vaccines. These guidelines provide information about travel and gardening precautions and safe pet care/avoidance of zoonosis, and include detailed recommendations regarding vaccinations that should be considered and encouraged in cancer and transplant survivors.


Subject(s)
Communicable Diseases/therapy , Immunization , Neoplasms/complications , Vaccination , Communicable Diseases/chemically induced , Communicable Diseases/immunology , Communicable Diseases/pathology , Guidelines as Topic , Humans , Neoplasms/drug therapy , Neoplasms/immunology , Neoplasms/pathology , Risk Assessment , Survival Rate , Survivors
8.
J Natl Compr Canc Netw ; 12(6): 876-87, 2014 Jun.
Article in English | MEDLINE | ID: mdl-24925198

ABSTRACT

Many cancer survivors report that fatigue is a disruptive symptom even after treatment ends. Persistent cancer-related fatigue affects quality of life, because individuals become too tired to fully participate in the roles and activities that make life meaningful. Identification and management of fatigue remains an unmet need for many cancer survivors. This section of the NCCN Guidelines for Survivorship provides screening, evaluation, and management recommendations for fatigue in survivors. Management includes education and counseling, physical activity, psychosocial interventions, and pharmacologic treatments.


Subject(s)
Fatigue/rehabilitation , Motor Activity , Survival Rate , Fatigue/complications , Fatigue/pathology , Humans , Neoplasms/complications , Neoplasms/rehabilitation , Patient Education as Topic
9.
J Natl Compr Canc Netw ; 12(7): 976-86, 2014 Jul.
Article in English | MEDLINE | ID: mdl-24994918

ABSTRACT

Cognitive impairment is a common complaint among cancer survivors and may be a consequence of the tumors themselves or direct effects of cancer-related treatment (eg, chemotherapy, endocrine therapy, radiation). For some survivors, symptoms persist over the long term and, when more severe, can impact quality of life and function. This section of the NCCN Guidelines for Survivorship provides assessment, evaluation, and management recommendations for cognitive dysfunction in survivors. Nonpharmacologic interventions (eg, instruction in coping strategies; management of distress, pain, sleep disturbances, and fatigue; occupational therapy) are recommended, with pharmacologic interventions as a last line of therapy in survivors for whom other interventions have been insufficient.


Subject(s)
Adaptation, Psychological , Brain Neoplasms/pathology , Cognition Disorders/therapy , Pain Management , Quality of Life , Benzhydryl Compounds/therapeutic use , Brain Neoplasms/mortality , Central Nervous System Stimulants/therapeutic use , Cognition Disorders/drug therapy , Fatigue/therapy , Humans , Methylphenidate/therapeutic use , Modafinil , Occupational Therapy , Sleep Wake Disorders/therapy , Survival Rate , Treatment Outcome , Wakefulness-Promoting Agents/therapeutic use
10.
J Natl Compr Canc Netw ; 12(5): 630-42, 2014 May.
Article in English | MEDLINE | ID: mdl-24812132

ABSTRACT

Sleep disorders, including insomnia and excessive sleepiness, affect a significant proportion of patients with cancer and survivors, often in combination with fatigue, anxiety, and depression. Improvements in sleep lead to improvements in fatigue, mood, and quality of life. This section of the NCCN Guidelines for Survivorship provides screening, diagnosis, and management recommendations for sleep disorders in survivors. Management includes combinations of sleep hygiene education, physical activity, psychosocial interventions, and pharmacologic treatments.


Subject(s)
Neoplasms/complications , Sleep Wake Disorders/diagnosis , Sleep Wake Disorders/etiology , Sleep Wake Disorders/therapy , Survivors , Humans
11.
J Natl Compr Canc Netw ; 12(4): 488-500, 2014 Apr.
Article in English | MEDLINE | ID: mdl-24717568

ABSTRACT

Many posttreatment cancer survivors experience chronic pain, often leading to psychological distress; decreased activity, motivation, and personal interactions; and an overall poor quality of life. This section of the NCCN Guidelines for Survivorship provides screening and management recommendations for pain in survivors. A multidisciplinary approach is recommended, with a combination of pharmacologic treatments, psychosocial and behavioral interventions, physical therapy and exercise, and interventional procedures.


Subject(s)
Chronic Pain , Neoplasms , Survivors/psychology , Chronic Pain/etiology , Chronic Pain/psychology , Chronic Pain/therapy , Humans
12.
J Natl Compr Canc Netw ; 12(3): 356-63, 2014 Mar 01.
Article in English | MEDLINE | ID: mdl-24616541

ABSTRACT

Various anticancer treatments, especially those directed toward the pelvis, can damage blood vessels and reduce circulation of blood to the penis and/or damage the autonomic nervous system, resulting in higher rates of erectile dysfunction in survivors than in the general population. In addition, hormonal therapy can contribute to sexual problems, as can depression and anxiety, which are common in cancer survivors. This section of the NCCN Guidelines for Survivorship provides screening, evaluation, and treatment recommendations for male sexual problems, namely erectile dysfunction.


Subject(s)
Erectile Dysfunction/diagnosis , Erectile Dysfunction/therapy , Survivors , Erectile Dysfunction/etiology , Humans , Male , Neoplasms/complications , Neoplasms/therapy
13.
J Natl Compr Canc Netw ; 12(2): 184-92, 2014 Feb.
Article in English | MEDLINE | ID: mdl-24586080

ABSTRACT

Cancer treatment, especially hormonal therapy and therapy directed toward the pelvis, can contribute to sexual problems, as can depression and anxiety, which are common in cancer survivors. Thus, sexual dysfunction is common in survivors and can cause increased distress and have a significant negative impact on quality of life. This section of the NCCN Guidelines for Survivorship provides screening, evaluation, and treatment recommendations for female sexual problems, including those related to sexual desire, arousal, orgasm, and pain.


Subject(s)
Neoplasms/complications , Sexual Dysfunction, Physiological/diagnosis , Sexual Dysfunction, Physiological/therapy , Survivors , Female , Humans , Neoplasms/therapy , Sexual Dysfunction, Physiological/etiology , Survivors/psychology
14.
J Natl Compr Canc Netw ; 12(11): 1526-31, 2014 Nov.
Article in English | MEDLINE | ID: mdl-25361799

ABSTRACT

The NCCN Guidelines for Survivorship provide screening, evaluation, and treatment recommendations for common physical and psychosocial consequences of cancer and cancer treatment. This portion of the guidelines describes recommendations regarding screening for the effects of cancer and its treatment. The panel created a sample screening tool, specifically for use in combination with the NCCN Guidelines for Survivorship, to guide providers to topics that require more in-depth assessment. Effective screening and assessment can help providers deliver necessary and comprehensive survivorship care.


Subject(s)
Neoplasms/diagnosis , Neoplasms/mortality , Early Detection of Cancer/methods , Humans , Neoplasms/therapy , Survival Rate , Survivors
15.
J Natl Compr Canc Netw ; 12(10): 1396-406, 2014 Oct.
Article in English | MEDLINE | ID: mdl-25313179

ABSTRACT

Healthy lifestyle habits have been associated with improved health outcomes and quality of life and, for some cancers, a reduced risk of recurrence and death. The NCCN Guidelines for Survivorship therefore recommend that cancer survivors be encouraged to achieve and maintain a healthy lifestyle, including attention to weight management, physical activity, and dietary habits. This section of the NCCN Guidelines focuses on recommendations regarding nutrition, weight management, and supplement use in survivors. Weight management recommendations are based on the survivor's body mass index and include discussions of nutritional, weight management, and physical activity principles, with referral to community resources, dietitians, and/or weight management programs as needed.


Subject(s)
Neoplasm Recurrence, Local/prevention & control , Diet , Humans , Survivors , Weight Reduction Programs
16.
J Natl Compr Canc Netw ; 12(9): 1222-37, 2014 Sep.
Article in English | MEDLINE | ID: mdl-25190692

ABSTRACT

Healthy lifestyle habits have been associated with improved health outcomes and quality of life and, for some cancers, a reduced risk of recurrence and death. The NCCN Guidelines for Survivorship therefore recommend that cancer survivors be encouraged to achieve and maintain a healthy lifestyle, with attention to weight management, physical activity, and dietary habits. This section of the NCCN Guidelines focuses on recommendations regarding physical activity in survivors, including assessment for the risk of exercise-induced adverse events, exercise prescriptions, guidance for resistance training, and considerations for specific populations (eg, survivors with lymphedema, ostomies, peripheral neuropathy). In addition, strategies to encourage health behavioral change in survivors are discussed.


Subject(s)
Life Style , Survivors , Behavior , Exercise , Humans
17.
J Surg Oncol ; 107(2): 221-6, 2013 Feb.
Article in English | MEDLINE | ID: mdl-22926725

ABSTRACT

Cancer is one of the leading causes of death worldwide. The global cancer burden (GCB) is expected to rise significantly and will disproportionately affect the less developed world (LDW). The aim of this review is to analyze the trends in GCB and describe the types, estimates, and causes of new cancer cases. The challenges and strategies associated with tackling this rising GCB are described in which surgeons can play a vital role.


Subject(s)
Cost of Illness , Global Health , Medical Oncology , Neoplasms , Physician's Role , Specialties, Surgical , Developing Countries , Global Health/statistics & numerical data , Global Health/trends , Health Promotion , Health Services Accessibility , Healthcare Disparities , Humans , Neoplasms/epidemiology , Neoplasms/etiology , Neoplasms/surgery
18.
World J Surg Oncol ; 10: 18, 2012 Jan 23.
Article in English | MEDLINE | ID: mdl-22269090

ABSTRACT

BACKGROUND: The current educational environment may need enhancement to tackle the rising cancer burden in India. The aim of this study was to conduct a survey of Surgical Oncologists to identify their perceptions of the current state of Oncology education in India. METHODS: An Institutional Review Board approved questionnaire was developed to target the audience of the 2009 annual meeting of the Indian Association of Surgical Oncology in India. The survey collected demographic information and asked respondents to provide their opinions about Oncology education in India. RESULTS: A total of 205 out of 408 attendee's participated in the survey with a 42.7% response rate. The majority of respondents felt that Oncology education was poor to fair during medical school (75%), residency (56%) and for practicing physicians (71%). The majority of participants also felt that the quality of continuing medical education was poor and that minimal emphasis was placed on evidence based medicine. CONCLUSIONS: The results of our survey demonstrate that the majority of respondents feel that the current educational environment for Oncology in India should be enhanced. The study identified perceptions of several gaps and needs, which can be the targets for implementing measures to enhance the training of Oncology professionals.


Subject(s)
Attitude of Health Personnel , Clinical Competence , Medical Oncology/education , Physicians/psychology , Practice Patterns, Physicians' , Adult , Data Collection , Female , Follow-Up Studies , Humans , Male , Middle Aged , Perception , Prognosis , Prospective Studies , Surveys and Questionnaires
19.
Pain Pract ; 5(1): 43-53; quiz 53-4, 2005 Mar.
Article in English | MEDLINE | ID: mdl-17156116

ABSTRACT

Opioids remain an important cornerstone in the treatment of cancer pain. Effective analgesia is obtained in the majority of cancer pain patients with the application of fairly straightforward algorithms using opioids as the main therapy. Many rational treatment algorithms exist. In this tutorial we will describe the role of opioids in the treatment of cancer pain, including a brief overview of cancer pain syndromes, essential aspects of opioid therapy, opioid pharmacology, opioid rotation, properties of the individual opioids, and management of common side effects of opioids.

20.
Am J Surg ; 202(6): 720-6; discussion 726, 2011 Dec.
Article in English | MEDLINE | ID: mdl-22018766

ABSTRACT

BACKGROUND: The aim of this study was to analyze national trends in minimally invasive and open cases of all graduating residents in general surgery. METHODS: A retrospective analysis was performed on data obtained from Accreditation Council for Graduate Medical Education logs (1999-2008) of graduating residents from all US general surgery residency programs. Data were analyzed using Mantel-Haenszel χ(2) tests and the Bonferroni adjustment to detect trends in the number of minimally invasive and open cases. RESULTS: Minimally invasive procedures accounted for an increasing proportion of cases performed (3.7% to 11.1%, P < .0001), with a proportional decrease in open cases. An increase in minimally invasive procedures with a proportional decrease in open procedures was noted in subcategories such as alimentary tract, abdominal, vascular, thoracic, and pediatric surgery (P < .0001). CONCLUSIONS: The results of this study demonstrate that general surgery residents in the United States are performing a greater number of minimally invasive and fewer open procedures for common surgical conditions.


Subject(s)
Clinical Competence , Curriculum/standards , Education, Medical, Graduate/trends , General Surgery/education , Internship and Residency/standards , Minimally Invasive Surgical Procedures/trends , Surgical Procedures, Operative/trends , Career Choice , Educational Measurement , General Surgery/trends , Health Care Surveys , Humans , Minimally Invasive Surgical Procedures/education , Retrospective Studies , Surgical Procedures, Operative/education , United States
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