Patients with cancer in low- and middle-income countries experience worse outcomes as a result of the limited capacity of health systems to deliver comprehensive cancer care. The health workforce is ...a key component of health systems; however, deep gaps exist in the availability and accessibility of cancer care providers.
We carried out a systematic review of the literature evaluating the strategies for capacity building of the cancer workforce. We studied how the policy strategies addressed the availability, accessibility, acceptability, and quality (AAAQ) of the workforce. We used a strategic planning framework (SWOT: strengths, weaknesses, opportunities, threats) to identify actionable areas of capacity building. We contextualized our findings based on the WHO 2030 Global Strategy on Human Resources for Health, evaluating how they can ultimately be framed in a labour market approach and inform strategies to improve the capacity of the workforce (PROSPERO: CRD42020109377).
The systematic review of the literature yielded 9617 records, and we selected 45 eligible papers for data extraction. The workforce interventions identified were delivered mostly in the African and American Regions, and in two-thirds of cases, in high-income countries. Many strategies have been shown to increase the number of competent oncology providers. Optimization of the existing workforce through role delegation and digital health interventions was reported as a short- to mid-term solution to optimize cancer care, through quality-oriented, efficiency-improving, and acceptability-enforcing workforce strategies. The increased workload alone was potentially detrimental. The literature on retaining the workforce and reducing brain drain or attrition in underserved areas was commonly limited.
Workforce capacity building is not only a quantitative problem but can also be addressed through quality-oriented, organizational, and managerial solutions of human resources. The delivery of comprehensive, acceptable, and impact-oriented cancer care requires an available, accessible, and competent workforce for comprehensive cancer care. Efficiency-improving strategies may be instrumental for capacity building in resource-constrained settings.
•Shortages of the oncology workforce are common in low- and middle-income countries (LMICs).•Strategies for capacity building of the cancer workforce must be evidence based and impact oriented.•Most common strategies to improve capacity are educational and aim at increasing the number of providers.•Organizational approaches, such as role delegation and digital health solutions, are key to improving the workforce capacity.•More efforts are needed toward accountability and monitoring, and to enhance the retention of the workforce in LMICs.
The coronavirus disease 2019 (COVID-19) pandemic has severely affected cancer care and research by disrupting the prevention and treatment paths as well as the preclinical, clinical, and ...translational research ecosystem. In Italy, this has been particularly significant given the severity of the pandemic’s impact and the intrinsic vulnerabilities of the national health system. However, whilst detrimental, disruption can also be constructive and may stimulate innovation and progress. The Italian Association of Medical Oncology (AIOM) has recognized the impact of COVID-19 on cancer care continuum and research and proposes the ‘2021 Matera statement’ which aims at providing pragmatic guidance for policymakers and health care institutions to mitigate the impact of the global health crisis on Italian oncology and design the recovery plan for the post-pandemic scenario. The interventions are addressed both to the pillars (prevention, diagnosis, treatment, follow-up, health care professionals) and foundations of cancer care (communication and care relationship, system organization, resources, research, networking). The priorities to be implemented can be summarized in the MATERA acronym: Multidisciplinarity; Access to cancer care; Telemedicine and Territoriality; Equity, ethics, education; Research and resources; Alliance between stakeholders and patients.
•The COVID-19 pandemic has severely affected cancer care and research in Italy.•Whilst detrimental, disruption can also be constructive and may stimulate innovation and progress.•The ‘2021 Matera statement’ gives guidance to design a recovery plan for cancer care in a post-pandemic scenario.•The proposed interventions are addressed both to cancer care (pillars and foundations) and research ecosystem.
Germline BRCA1 and BRCA2 mutations (gBRCAm) can inform pancreatic cancer (PC) risk and treatment but most of the available information is derived from white patients. The ethnic and geographic ...variability of gBRCAm prevalence and of germline BRCA (gBRCA) testing uptake in PC globally is largely unknown.
We carried out a systematic review and prevalence meta-analysis of gBRCA testing and gBRCAm prevalence in PC patients stratified by ethnicity. The main outcome was the distribution of gBRCA testing uptake across diverse populations worldwide. Secondary outcomes included: geographic distribution of gBRCA testing uptake, temporal analysis of gBRCA testing uptake in ethnic groups, and pooled proportion of gBRCAm stratified by ethnicity. The study is listed under PROSPERO registration number #CRD42022311769.
A total of 51 studies with 16 621 patients were included. Twelve of the studies (23.5%) enrolled white patients only, 10 Asians only (19.6%), and 29 (56.9%) included mixed populations. The pooled prevalence of white, Asian, African American, and Hispanic patients tested per study was 88.7%, 34.8%, 3.6%, and 5.2%, respectively. The majority of included studies were from high-income countries (HICs) (64; 91.2%). Temporal analysis showed a significant increase only in white and Asians patients tested from 2000 to present (P < 0.001). The pooled prevalence of gBRCAm was: 3.3% in white, 1.7% in Asian, and negligible (<0.3%) in African American and Hispanic patients.
Data on gBRCA testing and gBRCAm in PC derive mostly from white patients and from HICs. This limits the interpretation of gBRCAm for treating PC across diverse populations and implies substantial global and racial disparities in access to BRCA testing in PC.
•gBRCA testing is relevant for precision PC treatment and more broad cancer screening strategies.•Little is known about the ethnicity of PC patients tested for germline BRCA1/2 mutations.•We show that most PC patients tested for germline BRCA1/2 mutations in research context are white (74.7%) and from high-income countries (91.2%).•These findings implie major global and ethnic disparities in access to gBRCA testing for patients with PC.•Global efforts are urgently needed to promote accessibility of non-white patients to gBRCA testing and, in general, to clinical trials.
Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, leading to diagnosis and treatment delays, with an increased number of ...neoplasms at advanced stages worldwide. The aims of this study were to quantify the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic; and to evaluate whether delays in surgery led to an increased occurrence of aggressive tumours.
In this retrospective, international, cross-sectional study, centres were invited to participate in June 22, 2022; each centre joining the study was asked to provide data from medical records on all surgical thyroidectomies consecutively performed from Jan 1, 2019, to Dec 31, 2021. Patients with indeterminate thyroid nodules were divided into three groups according to when they underwent surgery: from Jan 1, 2019, to Feb 29, 2020 (global prepandemic phase), from March 1, 2020, to May 31, 2021 (pandemic escalation phase), and from June 1 to Dec 31, 2021 (pandemic decrease phase). The main outcomes were, for each phase, the number of surgeries for indeterminate thyroid nodules, and in patients with a postoperative diagnosis of thyroid cancers, the occurrence of tumours larger than 10 mm, extrathyroidal extension, lymph node metastases, vascular invasion, distant metastases, and tumours at high risk of structural disease recurrence. Univariate analysis was used to compare the probability of aggressive thyroid features between the first and third study phases. The study was registered on ClinicalTrials.gov, NCT05178186.
Data from 157 centres (n=49 countries) on 87 467 patients who underwent surgery for benign and malignant thyroid disease were collected, of whom 22 974 patients (18 052 78·6% female patients and 4922 21·4% male patients) received surgery for indeterminate thyroid nodules. We observed a significant reduction in surgery for indeterminate thyroid nodules during the pandemic escalation phase (median monthly surgeries per centre, 1·4 IQR 0·6-3·4) compared with the prepandemic phase (2·0 0·9-3·7; p<0·0001) and pandemic decrease phase (2·3 1·0-5·0; p<0·0001). Compared with the prepandemic phase, in the pandemic decrease phase we observed an increased occurrence of thyroid tumours larger than 10 mm (2554 69·0% of 3704 vs 1515 71·5% of 2119; OR 1·1 95% CI 1·0-1·3; p=0·042), lymph node metastases (343 9·3% vs 264 12·5%; OR 1·4 1·2-1·7; p=0·0001), and tumours at high risk of structural disease recurrence (203 5·7% of 3584 vs 155 7·7% of 2006; OR 1·4 1·1-1·7; p=0·0039).
Our study suggests that the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic period could have led to an increased occurrence of aggressive thyroid tumours. However, other compelling hypotheses, including increased selection of patients with aggressive malignancies during this period, should be considered. We suggest that surgery for indeterminate thyroid nodules should no longer be postponed even in future instances of pandemic escalation.
None.
The JEM-EUSO instrument Andreev, V.; Asano, K.; Barrillon, P. ...
Experimental astronomy,
11/2015, Letnik:
40, Številka:
1
Journal Article
Recenzirano
Odprti dostop
In this paper we describe the main characteristics of the JEM-EUSO instrument. The Extreme Universe Space Observatory on the Japanese Experiment Module (JEM-EUSO) of the International Space Station ...(ISS) will observe Ultra High-Energy Cosmic Rays (UHECR) from space. It will detect UV-light of Extensive Air Showers (EAS) produced by UHECRs traversing the Earth’s atmosphere. For each event, the detector will determine the energy, arrival direction and the type of the primary particle. The advantage of a space-borne detector resides in the large field of view, using a target volume of about 10
12
tons of atmosphere, far greater than what is achievable from ground. Another advantage is a nearly uniform sampling of the whole celestial sphere. The corresponding increase in statistics will help to clarify the origin and sources of UHECRs and characterize the environment traversed during their production and propagation. JEM-EUSO is a 1.1 ton refractor telescope using an optics of 2.5 m diameter Fresnel lenses to focus the UV-light from EAS on a focal surface composed of about 5,000 multi-anode photomultipliers, for a total of ≃3⋅10
5
channels. A multi-layer parallel architecture handles front-end acquisition, selecting and storing valid triggers. Each processing level filters the events with increasingly complex algorithms using FPGAs and DSPs to reject spurious events and reduce the data rate to a value compatible with downlink constraints.
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