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BACKGROUND: Cancer is a leading cause of disease burden globally, with more than 19·3 million cases and 10 million deaths recorded in 2020. Research is crucial to understanding the determinants of cancer and the effects of interventions, and to improving outcomes. We aimed to analyse global patterns of public and philanthropic investment in cancer research. METHODS: In this content analysis, we searched the UberResearch Dimensions database and Cancer Research UK data for human cancer research funding awards from public and philanthropic funders between Jan 1, 2016, and Dec 31, 2020. Included award types were project and programme grants, fellowships, pump priming, and pilot projects. Awards focused on operational delivery of cancer care were excluded. Awards were categorised by cancer type, cross-cutting research theme, and research phase. Funding amount was compared with global burden of specific cancers, measured by disability-adjusted life-years, years lived with disability, and mortality using data from the Global Burden of Disease study. FINDINGS: We identified 66â388 awards with total investment of about US$24·5 billion in 2016-20. Investment decreased year-on-year, with the largest drop observed between 2019 and 2020. Pre-clinical research received 73·5% of the funding across the 5 years ($18 billion), phase 1-4 clinical trials received 7·4% ($1·8 billion), public health research received 9·4% ($2·3 billion), and cross-disciplinary research received 5·0% ($1·2 billion). General cancer research received the largest investment ($7·1 billion, 29·2% of the total funding). The most highly funded cancer types were breast cancer ($2·7 billion [11·2%]), haematological cancer ($2·3 billion [9·4%]), and brain cancer ($1·3 billion [5·5%]). Analysis by cross-cutting theme revealed that 41·2% of investment ($9·6 billion) went to cancer biology research, 19·6% ($4·6 billion) to drug treatment research, and 12·1% ($2·8 billion) to immuno-oncology. 1·4% of the total funding ($0·3 billion) was spent on surgery research, 2·8% ($0·7 billion) was spent on radiotherapy research, and 0·5% ($0·1 billion) was spent on global health studies. INTERPRETATION: Cancer research funding must be aligned with the global burden of cancer with more equitable funding for cancer research in low-income and middle-income countries (which account for 80% of cancer burden), both to support research relevant to these settings, and build research capacity within these countries. There is an urgent need to prioritise investment in surgery and radiotherapy research given their primacy in the treatment of many solid tumours. FUNDING: None.
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Investigación Biomédica , Neoplasias Encefálicas , Obtención de Fondos , Humanos , Organización de la Financiación , Inversiones en Salud , Salud GlobalRESUMEN
INTRODUCTION: Stage III unresectable locally advanced non-small cell lung cancer (NSCLC) is a complex disease group with poor long-term survival. Clinical data suggests curative intent concurrent chemoradiotherapy (CCRT) is superior to a sequential (SCRT) approach but comes with additional toxicities. We report real world data regarding overall survival and toxicity to aid clinical decision making in balancing optimal management and treatment tolerability. METHODS: Retrospective analysis of survival data, treatment toxicities, and rates of treatment completion were performed for 241 patients who underwent chemoradiotherapy for unresectable stage III NSCLC within Leeds Cancer Centre from January 2011 to December 2014. RESULTS: Median survival was 18.8 months following SCRT compared to 22.7 months following CCRT HR 0.90 (95% CI 0.67-1.20, P = 0.46). Median follow up was 21 months. The clinical benefit rate for CCRT compared to SCRT was 22.7% versus 24%. In the CCRT group 63.8% patients completed treatment compared to 46% in the SCRT arm (P < 0.01). 90-day mortality rates were low in CCRT and SCRT cohorts at 4.3% and 1% respectively. There was greater pulmonary toxicity following CCRT versus SCRT (13.5% versus 1.0%, P < 0.01). CONCLUSION: This study provides real world data regarding the radical treatment of unresectable stage III NSCLC. Increased hospital admissions and pneumonitis toxicities did not adversely affect treatment completion for those undergoing CCRT; this was likely due to careful patient selection based on performance status. SCRT still remains an important treatment modality for patients who cannot tolerate the upfront CCRT approach but could still be treated with curative intent.
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Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Neoplasias Pulmonares/tratamiento farmacológico , Neoplasias Pulmonares/radioterapia , Adulto , Anciano , Instituciones Oncológicas , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/patología , Femenino , Humanos , Neoplasias Pulmonares/mortalidad , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios Retrospectivos , Análisis de Supervivencia , Reino UnidoAsunto(s)
COVID-19/epidemiología , Pandemias , Oncología por Radiación/organización & administración , Telerradiología/organización & administración , Técnicos Medios en Salud/educación , Técnicos Medios en Salud/organización & administración , Medicina Basada en la Evidencia , Humanos , Oncología por Radiación/educación , Radiología/educación , SARS-CoV-2 , Flujo de TrabajoRESUMEN
OBJECTIVE: Replying to germ cell tumour patients' needs, we implemented "Shared Community Follow-up"-a collaborative initiative, enabling remote delivery of specialist cancer care across large geographical areas. Blood, radiological investigations and patient-reported outcome measures (PROMs) are completed remotely and integrated within the electronic patient records for specialist review without patients requiring appointments. We describe the service evaluation estimating the feasibility, safety and acceptability of this initiative versus traditional Standard Follow-up. METHODS: This cross-sectional evaluation estimated feasibility (uptake, adherence) and safety (via missed appointments, timeliness, cancellations) using routinely collected service process data. An acceptability questionnaire, evaluating patient satisfaction, was administered to 91 patients. RESULTS: The new service is feasible. Across 2 years (2014-2016), uptake increased 54% (N = 123 to N = 270) and only 4.8% (N = 13) of patients were non-adherent. Fewer missed/cancelled investigations (N = 39, 5.9% vs. N = 566, 85.5%), timelier investigations (seven vs. 14 timely investigations) and equal relapse detection suggest its safety. PROMs replaced 3 appointments/patient. Patients were as satisfied with both services (3.4/4 vs. 3.6/4). CONCLUSION: New follow-up services, with investigations completed remotely and shared between community providers and cancer centres, offer an alternative to traditional appointments with advantages for patients and the National Health Service.
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Neoplasias de Células Germinales y Embrionarias , Medicina Estatal , Estudios Transversales , Estudios de Seguimiento , Humanos , Neoplasias de Células Germinales y Embrionarias/terapia , Medición de Resultados Informados por el PacienteAsunto(s)
Betacoronavirus , Infecciones por Coronavirus , Pandemias , Neumonía Viral , COVID-19 , Humanos , SARS-CoV-2Asunto(s)
Interpretación de Imagen Asistida por Computador/métodos , Imagen Multimodal/métodos , Oncología por Radiación/métodos , Estudios de Evaluación como Asunto , Predicción , Humanos , Imagen por Resonancia Magnética/métodos , Imagen Multimodal/tendencias , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Oncología por Radiación/tendencias , Reino UnidoRESUMEN
The fields of radiotherapy and clinical oncology have been rapidly changed by the advances of technology. Improvement in computer processing power and imaging quality heralded precision radiotherapy allowing radiotherapy to be delivered efficiently, safely and effectively for patient benefit. Artificial intelligence (AI) is an emerging field of computer science which uses computer models and algorithms to replicate human-like intelligence and perform specific tasks which offers a huge potential to healthcare. We reviewed and presented the history, evolution and advancement in the fields of radiotherapy, clinical oncology and machine learning. Radiotherapy target delineation is a complex task of outlining tumour and organ at risks volumes to allow accurate delivery of radiotherapy. We discussed the radiotherapy planning, treatment delivery and reviewed how technology can help with this challenging process. We explored the evidence and clinical application of machine learning to radiotherapy. We concluded on the challenges, possible future directions and potential collaborations to achieve better outcome for cancer patients.
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A previously well 25-year-old man presented with agitation, double incontinence and left-sided incoordination. His symptoms started after smoking a synthetic cannabinoid (black mamba) 5 days earlier. Over 48 hours, he developed aphasia, generalised hypertonia, hyper-reflexia and dense left hemiparesis. This progressed to profuse diaphoresis, fever, tachycardia, hypertension and a possible seizure necessitating admission to the intensive care unit. CT head and cerebrospinal fluid analysis were unremarkable. MRI brain demonstrated asymmetric multifocal hyperintense lesions in white and grey matter, which raised suspicions of acute disseminated encephalomyelitis (ADEM). An electroencephalogram showed widespread brain wave slowing, indicating diffuse cerebral dysfunction. Cerebral angiogram was normal. Toxicology analysis of the substance confirmed a potent synthetic cannabinoid NM2201, technically legal at the time. The patient made a slow but significant recovery after a course of intravenous methylprednisolone, intravenous immunoglobulins and oral steroids, and was later transferred to a rehabilitation bed.
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Cannabinoides/toxicidad , Encefalomielitis Aguda Diseminada/diagnóstico por imagen , Sustancia Gris/diagnóstico por imagen , Sustancia Blanca/diagnóstico por imagen , Adulto , Encefalomielitis Aguda Diseminada/inducido químicamente , Encefalomielitis Aguda Diseminada/tratamiento farmacológico , Humanos , Inmunoglobulinas Intravenosas/administración & dosificación , Inmunoglobulinas Intravenosas/uso terapéutico , Imagen por Resonancia Magnética , Masculino , Metilprednisolona/administración & dosificación , Metilprednisolona/uso terapéutico , Esteroides/administración & dosificación , Esteroides/uso terapéutico , Resultado del TratamientoAsunto(s)
Carcinoma Adenoide Quístico/diagnóstico por imagen , Carcinoma Adenoide Quístico/terapia , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/terapia , Terapia Combinada , Humanos , Masculino , Persona de Mediana Edad , Nasofaringe/diagnóstico por imagen , Tomografía de Emisión de PositronesAsunto(s)
Anemia Ferropénica/complicaciones , Cefalea/etiología , Rasgo Drepanocítico/complicaciones , Trombosis de los Senos Intracraneales/diagnóstico por imagen , Adolescente , Anemia Ferropénica/tratamiento farmacológico , Heparina de Bajo-Peso-Molecular/administración & dosificación , Heparina de Bajo-Peso-Molecular/uso terapéutico , Humanos , Hierro/administración & dosificación , Hierro/uso terapéutico , Masculino , Rasgo Drepanocítico/tratamiento farmacológico , Trombosis de los Senos Intracraneales/tratamiento farmacológico , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
A 70-year-old man newly diagnosed with metastatic gastric adenocarcinoma was started on standard first-line palliative chemotherapy with anthracycline (epirubicin), platinum (oxaliplatin) and fluoropyrimidine (capecitabine); EOX combination chemotherapy. 5â days after the first cycle of chemotherapy, he presented with tachycardia with associated severe abdominal and lumbar pains. Initial investigations confirmed life-threatening metabolic acidosis with serum lactate of 9.7â mmol/L (normal range 0.5-2.2â mmol/L). CT angiogram identified acute arterial thrombosis within the abdominal aorta, lumbar and right common iliac artery, which was absent on staging contrast CT scan 6â weeks prior. The patient was immediately anticoagulated and chemotherapy discontinued. Urgent oncology and surgical opinions advised conservative management. The patient responded well to early treatment and survived this acute episode. He was subsequently started on life-long treatment dose enoxaparin and second-line single agent chemotherapy with docetaxel (taxotere), with no reported complications.