Examining the Landscape of Prognostic Factors and Clinical Outcomes for Cancer Control.

Prognostic factors have important utility in various aspects of cancer surveillance, including research, patient care, and cancer control programmes. Nevertheless, there is heterogeneity in the collection of prognostic factors and outcomes data globally. This study aimed to investigate perspectives on the utility and application of prognostic factors and clinical outcomes in cancer control programmes. A qualitative phenomenology approach using expert interviews was taken to derive a rich description of the current state and future outlook of cancer prognostic factors and clinical outcomes. Individuals with expertise in this work and from various regions and institutions were invited to take part in one-on-one semi-structured interviews. Four areas related to infrastructure and funding challenges were identified by participants, including (1) data collection and access; (2) variability in data reporting, coding, and definitions; (3) limited coordination among databases; and (4) conceptualization and prioritization of meaningful prognostic factors and outcomes. Two areas were identified regarding important future priorities for cancer control: (1) global investment and intention in cancer surveillance and (2) data governance and exchange globally. Participants emphasized the need for better global collection of prognostic factors and clinical outcomes data and support for standardized data collection and data exchange practices by cancer registries.

Motivations for and Challenges in the Development of Global Medical Curricula: A Scoping Review.

PURPOSE: The aim of this scoping review is to understand the motivations for the creation of global medical curricula, summarize methods that have been used to create these curricula, and understand the perceived premises for the creation of these curricula. METHOD: In 2018, the authors used a comprehensive search strategy to identify papers on existing efforts to create global medical curricula published from 1998 to March 29, 2018, in the following databases: MEDLINE; MEDLINE Epub Ahead of Print, In-Process, and Other Non-Indexed Citations; Embase; Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic Reviews; PsycINFO; CINAHL; ERIC; Scopus; African Index Medicus; and LILACS. There were no language restrictions. Two independent researchers applied the inclusion and exclusion criteria. Demographic data were abstracted from publications and summarized. The stated purposes, methods used for the development, stated motivations, and reported challenges of curricula were coded. RESULTS: Of the 18,684 publications initially identified, 137 met inclusion criteria. The most common stated purposes for creating curricula were to define speciality-specific standards (50, 30%), to harmonize training standards (38, 23%), and to improve the quality or safety of training (31, 19%). The most common challenges were intercountry variation (including differences in health care systems, the operationalization of medical training, and sociocultural differences; 27, 20%), curricular implementation (20, 15%), and the need for a multistakeholder approach (6, 4%). Most curricula were developed by a social group (e.g., committee; 30, 45%) or Delphi or modified Delphi process (22, 33%). CONCLUSIONS: The challenges of intercountry variation, the need for a multistakeholder approach, and curricular implementation need to be considered if concerns about curricular relevance are to be addressed. These challenges undoubtedly impact the uptake of global medical curricula and can only be addressed by explicit efforts to make curricula applicable to the realities of diverse health care settings.

A critical review of representation in the development of global oncology curricula and the influence of neocolonialism.

BACKGROUND: Global curricular homogenization is purported to have a multitude of benefits. However, homogenization, as typically practiced has been found to promote largely Western ideals. The purpose of this study was to explore the issue of representation in the development of global oncology curricula. METHODS: This systematic review of global oncology curricula involved a comprehensive search strategy of eight databases from inception to December 2018. Where available, both controlled vocabulary terms and text words were used. Two investigators independently reviewed the publications for eligibility. Full global/core oncology curricular documents were included. Data analysis included exploration of representation across a number of axes of power including sex and geographic sector, consistent with a neocolonial approach. RESULTS: 32,835 documents were identified in the search and 17 remained following application of the inclusion/exclusion criteria. Eleven of 17 papers were published from 2010 to 2018 and 13 curricula originated from Europe. The 17 curricula had 300 authors; 207 were male and most were from Europe (n = 190; 64%) or North America (n = 73; 24%). The most common curricular purposes were promoting quality patient care (n = 11), harmonization of training standards (n = 10), and facilitating physician mobility (n = 3). The methods for creation of these curricula were most commonly a committee or task force (n = 10). Over time there was an increase in the proportion of female authors and the number of countries represented in the authorship. CONCLUSION: Existing global oncology curricula are heavily influenced by Western male authors and as a result may not incorporate relevant socio-cultural perspectives impacting care in diverse geographic settings.

The prevalence and determinants of return to work in head and neck cancer survivors.

PURPOSE: To determine the prevalence of and factors associated with the reduction or complete cessation of employment following treatment in head and neck cancer survivors. METHODS: This cross-sectional study was conducted among head and neck cancer survivors visiting outpatient clinics at the Princess Margaret Cancer Centre over a period of 18 months. Participants at any point along their survivorship course completed a survey that included demographic information, the Radiation Therapy Oncology Group (RTOG) Work Status Questionnaire, the Functional Assessment of Cancer Therapy-Head and Neck (FACT-HN), the M.D. Anderson Symptom Inventory-Head and Neck (MDASI-HN), the Cancer Survivors' Unmet Needs Measure (CaSUN), and the EuroQol EQ-5D-5L utility scale. RESULTS: Among 130 participants, 64 were employed at diagnosis. At the time of study, 31 (48%) had reduced their work, among whom, 21 (32.8%) had not returned to work at all following treatment. Pre-treatment employment status, cancer-related symptoms, quality of life, and health utility were associated with employment outcomes. CONCLUSION: A high proportion of head and neck cancer survivors reduced their work capacity and many did not return following cancer treatment. Further research is needed to understand the barriers to work return in these survivors and to explore strategies to encourage resumption of employment and employment satisfaction.