Synthesis of Existent Oncology Curricula for Primary Care Providers: A Scoping Review With a Global Equity Lens.

PURPOSE: Global increases in cancer, coupled with a shortage of cancer specialists, has led to an increasing role for primary care providers (PCP) in cancer care. This review aimed to examine all extant cancer curricula for PCPs and to analyze the motivations for curriculum development. METHODS: A comprehensive literature search was conducted from inception to October 13, 2021, with no language restrictions. The initial search yielded 11,162 articles and 10,902 articles underwent title and abstract review. After full-text review, 139 articles were included. Numeric and thematic analyses were conducted and education programs were evaluated using Bloom's taxonomy. RESULTS: Most curricula were developed in high-income countries (HICs), with 58% in the United States. Cancer-specific curricula focused on HIC priority cancers, such as skin/melanoma, and did not represent the global cancer burden. Most (80%) curricula were developed for staff physicians and 73% focused on cancer screening. More than half (57%) of programs were delivered in person, with a shift toward online delivery over time. Less than half (46%) of programs were codeveloped with PCPs and 34% did not involve PCPs in the program design and development. Curricula were primarily developed to improve cancer knowledge, and 72 studies assessed multiple outcome measures. No studies included the top two levels of Bloom's taxonomy of learning (evaluating; creating). CONCLUSION: To our knowledge, this is the first review to assess the current state of cancer curricula for PCPs with a global focus. This review shows that extant curricula are primarily developed in HICs, do not represent the global cancer burden, and focus on cancer screening. This review lays a foundation to advance the cocreation of curricula that are aligned to the global cancer burden.

PTHrP-related Hypercalcaemia in Infancy and Congenital Anomalies of the Kidney and Urinary Tract (CAKUT).

BACKGROUND: Severe hypercalcaemia is a rare but clinically significant condition in infancy and childhood. Parathyroid hormone-related peptide (PTHrP)-mediated hypercalcaemia resulting from a malignancy is rare and only a handful of case reports have outlined its incidence alongside a benign condition. OBJECTIVES: To describe the diagnostic workup and management of an infant with hypercalcaemia, renal dysplasia, and elevated PTHrP levels. DESIGN: Case report. SETTING: The Victoria Hospital campus of the London Health Sciences Centre in London, Ontario, Canada. PATIENTS: A child with congenital anomalies of the kidneys and urinary tract (CAKUT), stage 2 chronic kidney disease (CKD), and renal dysplasia who presented with severe hypercalcaemia. MEASUREMENTS: Weight, renal ultrasound, creatinine, cystatin C, eGFR, calcium, urea, bicarbonate, serum sodium, fractional sodium excretion, urine calcium to creatinine ratio, PTH, TSH, Free T4, AM cortisol, HMA, VMA, 25-vitamin D, 1,25 dihydroxy-vitamin D, calcitriol, vitamin A, ACE levels, skull and chest x-rays, alkaline phosphatase, CBC, tumour lysis profile, catecholamine breakdown, whole-body MRI, PTHrP. METHODS: Full diagnostic workup and patient management. Patient treated with intravenous hydration, furosemide, calcitonin and CalciLo. RESULTS: PTHrP was elevated and no evidence of a malignancy was found. Treatment consisting of a low-calcium CalciLo diet (in place of breast milk) adequately controlled the patient's hypercalcaemia. Hypercalcaemia associated with CAKUT in infancy is not all that uncommon and was reported in 15/99 infants in another study, most of whom had a suppressed PTH similar to that of our patient. PTHrP was not measured in these cases and may have also been elevated. LIMITATIONS: The study is limited in that it is a description of a single patient case. Future measurement of PTHrP in similar patients is necessary to confirm our results. CONCLUSIONS: The possibility of elevated PTHrP levels must be considered in patients with known renal dysplasia who are differentially diagnosed with hypercalcaemia.

CONTEXTE: L'hypercalcémie aigue est rare, bien qu'elle constitue un trouble important de la petite enfance et de l'enfance du point de vue clinique. Rares sont les hypercalcémies à médiation de peptide lié à l'hormone parathyroïdienne (PTHrP) qui résultent d'une malignité, et seules quelques observations cliniques témoignent de leur incidence dans les cas de troubles bénins. OBJECTIFS: Décrire le bilan diagnostic et la prise en charge d'un petit enfant atteint d'hypercalcémie, de dysplasie rénale, et présentant des taux élevés de PTHrP. TYPE D'ÉTUDE: Observation clinique. CONTEXTE: Le campus de l'Hôpital Victoria du Centre de services de santé de London (London Health Sciences Centre), à London, en Ontario, au Canada. PARTICIPANTS: Un enfant atteint d'anomalies congénitales du rein et des voies urinaires (CAKUT), d'insuffisance rénale chronique (IRC) de stade 2 et de dysplasie rénale, qui présentait une hypercalcémie aigue. MESURES: Le poids, l'échographie rénale, la créatinine, la cystatine C, le R-EGF, le calcium, l'urée, le bicarbonate, le sodium sérique, la fraction d'excrétion du sodium, le ratio calcium/créatine dans l'urine, la PTH, la TSH, le T4 libre, le taux de cortisol le matin, l'acide homomandelique, l'acide vanillylmandelique , le 25-vitamine D, le 1,25 dihydroxy-vitamine D, le calcitriol, la vitamineA, les taux d'enzyme de conversion de l'angiotensine, les radiographies thoraciques et crâniennes, la phosphatase alcaline, la formule sanguine complète, le profil de lyse tumorale, les taux de catécholamine, la résonnance magnétique du corps entier, le taux de PTHrP. MÉTHODES: Bilan diagnostic et prise en charge du patient. Le patient a reçu une hydratation intraveineuse, du furosémide, de la calcitonine et du Calcilo. RÉSULTATS: Le taux de PTHrP était élevé et on n'a découvert aucune trace d'une malignité. Le traitement, qui consistait en un régime faible en calcium de Calcilo (en remplacement du lait maternel), a permis de limiter adéquatement l'hypercalcémie du patient. L'hypercalcémie associée à des anomalies congénitales du rein et des voies urinaires dans la petite enfance n'est pas si rare. Une autre étude a fait état de 15/99 petits enfants, dont la plupart présentait un faible taux de PTH semblable à celui de notre patient. Le PTHrP, qui n'a pas été mesuré dans ces cas, pourrait également avoir été élevé. LIMITES DE L'ÉTUDE: L'étude est limitée en ceci qu'elle consiste en la description d'un seul cas. Des mesures du taux de PTHrP chez des patients similaires seront nécessaires pour confirmer nos résultats. CONCLUSIONS: L'éventualité de taux élevés de PTHrP doit être envisagée chez les patients atteints de dysplasie rénale et chez lesquels on a autrement diagnostiqué une hypercalcémie.