Follow-Up Care for Breast and Colorectal Cancer Across the Globe: Survey Findings From 27 Countries.

PURPOSE: The purpose of this study was to describe follow-up care for breast and colorectal cancer survivors in countries with varying levels of resources and highlight challenges regarding posttreatment survivorship care. METHODS: We surveyed one key stakeholder from each of 27 countries with expertise in survivorship care on questions including the components/structure of follow-up care, delivery of treatment summaries and survivorship care plans, and involvement of primary care in survivorship. Descriptive analyses were performed to characterize results across countries and variations between the WHO income categories (low, middle, high). We also performed a qualitative content analysis of narratives related to survivorship care challenges to identify major themes. RESULTS: Seven low- or /lower-middle-income countries (LIC/LMIC), seven upper-middle-income countries (UMIC), and 13 high-income countries (HICs) were included in this study. Results indicate that 44.4% of countries with a National Cancer Control Plan currently address survivorship care. Additional findings indicate that HICs use guidelines more often than those in LICs/LMICs and UMICs. There was great variation among countries regardless of income level. Common challenges include issues with workforce, communication and care coordination, distance/transportation issues, psychosocial support, and lack of focus on follow-up care. CONCLUSION: This information can guide researchers, providers, and policy makers in efforts to improve the quality of survivorship care on a national and global basis. As the number of cancer survivors increases globally, countries will need to prioritize their long-term needs. Future efforts should focus on efforts to bridge oncology and primary care, building international partnerships, and implementation of guidelines.

Perspectives on Strengthening Cancer Research and Control in Latin America Through Partnerships and Diplomacy: Experience of the National Cancer Institute's Center for Global Health.

According to the Pan American Health Organization, noncommunicable diseases, including cancer, are the leading causes of preventable and premature death in the Americas. Governments and health care systems in Latin America face numerous challenges as a result of increasing morbidity and mortality from cancer. Multiple international organizations have recognized the need for collaborative action on and technical support for cancer research and control in Latin America. The Center for Global Health at the US National Cancer Institute (NCI-CGH) is one entity among many that are working in the region and has sought to develop a strategy for working in Latin America that draws on and expands the collaborative potential of engaged, skilled, and diverse partners. NCI-CGH has worked toward developing and implementing initiatives in collaboration with global partners that share the common objectives of building a global cancer research community and translating research results into evidence-informed policy and practice. Both objectives are complementary and synergistic and are additionally supported by an overarching strategic framework that is focused on partnerships and science diplomacy. This work highlights the overall strategy for NCI-CGH engagement in Latin America through partnerships and diplomacy, and highlights selected collaborative efforts that are aimed at improving cancer outcomes in the region.

Making the invisible visible: Oncology nursing efforts of NCI-designated cancer centers in LMICs.

An increasing majority of new cancer cases and mortality occur in low- and middle-income countries (LMICs). Nurses provide most cancer care in LMICs, yet receive limited, if any, oncology education and training. To better understand the efforts taking place to address this need, the Center for Global Health (CGH) at the US National Cancer Institute (NCI) undertook a study of global oncology nursing projects at NCI-designated cancer centers. The 62 comprehensive and clinical NCI-designated cancer centers were surveyed about the nature and scope of their efforts in strengthening oncology nursing internationally. We received responses from 43 of the 62 cancer centers, with 21centers reporting a total of 29 projects. Twenty-three of 29 projects had involvement in an LMIC. The most common types of projects were research studies and short-term intensive trainings, most of which were for discrete tasks. Unsurprisingly, of the projects that had specific foci, most focused on breast or cervical cancer, and palliative care. Of the 22 projects that reported project costs, almost 90% were under $200,000 USD, suggesting that strengthening the global cancer workforce can be done with limited expense. While this study is limited to efforts of NCI-designated cancer centers, the findings reveal limited engagements in education and training of oncology nurses, who provide most of the cancer care in LMICs, but also provide tangible areas for strengthening this workforce and improving oncology care delivery.