Cancer Care Facilities Research Articles

Radiotherapy for hypopharyngeal carcinoma in Senegal: Experience of the main cancer care facility

Objectives: To describe the epidemiological, diagnostic, therapeutic, and prognostic factors associated with patients treated for hypopharyngeal carcinoma at the Radiotherapy Department of the National Hospital Center Dalal Jamm. Patients and Methods: Data from 50 consecutive patients treated for hypopharyngeal carcinoma between 2018 and 2022 were retrospectively analyzed. All patients received three-dimensional conformal radiotherapy (3DCRT) with or without chemotherapy. Epidemiological and diagnostic data, treatment details, and therapeutic outcomes were collected in an Excel 2016 database created for the study. Statistical analyses were performed using SPSS version 20.0. Overall survival estimates were generated using the Kaplan-Meier method. Statistical significance was considered at p = 0.05. Uni- and multivariate analyses were conducted to identify prognostic factors associated with survival. Results: The average age of the patients was 44 years (± 14.4 years), with a male-to-female ratio of 0.56. Sixteen percent of the patients were active smokers and 4% were alcohol consumers. The mean delay to the first consultation was 6 months, and dysphagia was the primary symptom (92%). The majority of patients (89.8%) were classified as stage IVa, and 10% had metastases at diagnosis. Treatment consisted of curative concurrent chemoradiotherapy (95.92%), preceded by induction chemotherapy in 58% of patients. A radiation dose of 70 Gy was utilized in 75% of cases. The 2-year overall survival rate was 25%. Multivariate analysis indicated that the presence of feeding gastrostomy (p=0.044), use of induction chemotherapy (p=0.012), and radiation dose less than 70 Gy (p=0.020) were associated with poorer survival. Conclusion: Concurrent chemoradiotherapy using 3D conformal techniques improved management, although outcomes remain unsatisfactory. Prospective cohort studies are imperative to identify specific risk factors in our population. Additionally, timely access to appropriate treatment modalities could enhance prognosis.

Abstract C127: Patterns of mortality risk in insured patients with cancer by race/ethnicity and socioeconomic status in Southern California

Abstract Purpose. Several factors including, socioeconomic status (SES), access to screening and healthcare coverage, tumor biology, differences in disease management and care delivery in various healthcare settings, and implicit bias among healthcare providers contribute to mortality disparities in individuals with cancer. Further, health insurance is strongly associated with better survival. Previous studies that examined disparities in cancer mortality included patients with and without healthcare coverage, making it difficult to disentangle the effects of health insurance coverage from other SES factors. Thus, we evaluated the influence of race/ethnicity and geocoded SES on all-cause mortality in cancer patients with health insurance. Methods. We identified adults with health insurance coverage diagnosed with eight common cancers from 2009 to 2014 from the California Cancer Registry (stages I-IV) and followed them through 2017 (8 years maximum). Specifically, we identified those who lived in southern California counties. Patients had managed care, preferred provider organization, Medicare, Medicaid, dual Medicare and Medicaid, and other private insurance. We calculated person-year mortality rates by race/ethnicity and geocoded SES quintiles. Adjusted hazard ratios for the association between overall mortality and race/ethnicity and SES were estimated using Cox proportional hazards models accounting for other demographics, stage at diagnosis, and cancer treatments. Results. 164,197 adults were diagnosed with cancer originating from breast, prostate, lung, colon, skin melanoma, uterus, kidney, and bladder. For all racial/ethnic groups combined, the mortality rates from lowest to highest SES groups were 112.1/1000 PY (lowest); 100.2/1000 PY (lower-middle); 91.2/1000 PY (middle); 79.1/1000 PY (upper-middle); and 63.5/1000 PY (upper). These rates suggest that people with the lowest SES have a markedly increased mortality risk after cancer diagnosis even if they have health insurance. In multivariable analyses, those in the lowest SES group had a 40–78% increased risk of all-cause mortality compared to those in the upper SES group across all races/ethnicities. For example, within African Americans, the adjusted mortality risk was up to 61% higher (HR 1.61, 95% CI 1.41–1.83) in the lowest SES group compared to the highest SES group. Conclusion. This study suggests disparities in overall mortality risk after cancer diagnoses persist even in a cohort with health insurance, and that SES is an important driver of this disparity. Issues related to travel distance, access to transportation to cancer care facilities, and access to telemedicine may be magnified among those with lower SES during cancer care where optimal management becomes more complex. To potentially mitigate the effects of these social determinants, healthcare systems must either implement programs to support patients, or have partnerships with local community organizations to do so. All of this requires systems level support through social work, patient navigation, and cancer case management. Citation Format: Reina Haque, Amrita Mukherjee, Robert M. Cooper. Patterns of mortality risk in insured patients with cancer by race/ethnicity and socioeconomic status in Southern California [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C127.

"Current", "heated rods", and "hot vapour": why patients refuse radiotherapy as a treatment modality for cancer in northern Sri Lanka.

Significant proportions of patients either refuse or discontinue radiotherapy, even in the curative setting, leading to poor clinical outcomes. This study explores patient perceptions that underlie decisions to refuse/discontinue radiotherapy at a cancer care facility in northern Sri Lanka. An exploratory descriptive qualitative study was carried out among 14 purposively selected patients with cancer who refused/discontinued radiotherapy. In-depth semi-structured interviews were transcribed in Tamil, translated into English, coded, and thematically analyzed. All participants referred to radiotherapy as "current" with several understanding the procedure to involve electricity, heat, or hot vapour. Many pointed to gaps in information provided by healthcare providers, who were perceived to focus on side effects without explaining the procedure. In the absence of these crucial details, patients relied on family members and acquaintances for information, often based on second or third-hand accounts of experiences with radiotherapy. Many felt pressured by family to refuse radiation, feared radiation, or felt ashamed to ask questions, while for others COVID-19 was an impediment. All but three participants regretted their decision, claiming they would recommend radiation to patients with cancer, especially when it is offered with curative intent. Patients with cancer who refused/discontinued radiation therapy have significant information needs. While human resource deficits need to be addressed in low-resource settings like northern Sri Lanka, providing better supportive cancer care could improve clinical outcomes and save healthcare resources that would otherwise be wasted on patient preparation for radiotherapy.

Delay from Onset of Symptoms to Reporting at a Cancer Care Facility and the Impact of Alternate Medicine Usage as a Contributing Factor

Cancer patients often present after a period of certain delay from onset of symptoms. By tradition, alternate medicine has been the commonly sought after remedy for them. The objective of this study was to evaluate the delay in presentation to a cancer care facility, with respect to advanced stage at diagnosis and the use of alternate medicine. A cross-sectional study was undertaken in a tertiary care hospital from eastern India over 5 months where patients with cytological or histological proof of malignancy were interviewed using a pretested questionnaire. Comparative analysis was done with cross tables along with Kruskal–Wallis test for association between delay and the independent variables (demographic parameters and alternate medicine usage). Predictors for delay were assessed with logistic regression analysis. Spearman's rank test was used to measure the direction and strength of correlation of delay and alternate medicine use against stage at presentation. One-thousand twenty-two subjects were interviewed of whom 61.44% presented in advanced stage (either stage III and IV). About 56.1% patients had 4 to 6 months delay, while 19.1% patients presented after more than 6 months. About 27.5% patients had history of initial alternate medicine usage. Progressive increase in subjects presenting in advanced stage was observed with corresponding increase in delay, from 62.63% in more than 1 month delay to 80.48% in more than 3-month delay and 98.47% in those having more than 6-month delay. More of alternate medicine users presented with significant delay versus who did not (96.08 vs. 67.34% for >3 months delay) and the difference further increased with longer delay. About 89.67% of those who had used alternate medicine presented in advanced stage. Among them, this percentage progressively escalated with increase in delay period. Positive correlation between delay (ρ = 0.742 for total sample) and (ρ = 0.592 for alternate medicine users) advanced stage was observed. This study found a considerably high occurrence of delay in presentation among cancer patients after onset of symptoms. This delay was strongly associated with advanced stage at diagnosis and alternate medicine use initially. It provides substantial information to formulate policies for implementing awareness on symptoms of cancer and benefits of its early detection.

Reconstructive Head and Neck Microsurgery in a High-Volume Cancer Center—Long-Term Impact of an Early Experience

Objectives The aim of this study was to evaluate a 16-year-long outcome of an evolving practical approach to reconstructive microsurgery in a high volume, resource-constrained, head and neck cancer care setting. Patients and Methods Seventy-three consecutive cases of free flap reconstruction done by the Head and Neck Surgical Oncology team of Regional Cancer Centre, Thiruvananthapuram, from October 2004 to May 2020 were prospectively studied for flap viability, cosmesis, morbidity, and oncologic safety. The cases were selected based on their “emphatic” superiority to the conventional alternative as determined by two or more surgeons of the head and neck team or the recommendations of the head and neck tumor board. Results With the long-term results, this article discusses and validates our strategy for controlled patient recruitment for reconstructive microsurgery to ensure the best resource utilization in a tertiary cancer care center. Conclusions Adequate training and optimal application are the key factors determining success in microvascular reconstructive surgery in resource-constrained, high-volume cancer care facilities.

Abstract 2144: Disparities in gynecologic cancer survival outcome by treatment facility and region

Abstract Objective: To explore five-year survival of patients with gynecologic cancers by region and treatment facility in the United States. Background: Research studies have examined the risk factors associated with gynecologic cancers, specifically cervical, ovarian, and endometrial, incidence and mortality. In addition to older age, Black/African American race, living in south, less income, less education, having comorbidity, stages of cancer, and lack of insurance have reported as risk factors for the incidence and mortality of gynecologic cancers. In addition, prior studies reported the possible effects from the distance to cancer care facilities on gynecologic cancer outcomes indicated varying results. In this study, we explore the impact of distance travelled by region and treatment facility on gynecologic cancer outcomes. Methods: This study aims to assess five-year cervical, ovarian, and endometrial cancer survival. Data were obtained from the National Cancer Database (NCDB) years 2004-2017, only from patients with a minimum 5-year follow-up. Women with races other than White or Black were excluded from the study. Demographics, region, treatment center type, distance to the treatment center, and cancer stage at diagnosis were analyzed by cancer type and 5-year survival status. Multivariate logistic regression model was used to assess the relationship between distance travelled to treatment facility by region and five-year survival. SAS version 9.4 was used for statistical analysis. Results: The distribution of the demographics across the three cancers were similar. Multivariate logistic models showed significant interactions between facility type and region on five-year survival among cervical, ovarian and endometrial cancer patients. Risk factors varied by region and treatment facility type. Age and cancer stage were significantly associated with survival among all cancers. Distance was significantly associated with survival in cervical and endometrial cancers. Conclusion: Cervical cancer patients in the South Atlantic who travel longer distances to Academic/Research Programs have poorer survival. Likewise, patients with endometrial cancer who live in New England region, and travel longer distances to Integrated Network Cancer Programs, as well as those who live in the West North Central region and travel longer distances to Community Cancer Programs have poorer survival. Further research is warranted to explore the specifics of region and treatment center types among different cancers to get a better understanding of the risk factors. Moreover, to improve the clinical outcomes, further study is needed to aim to identify which of these factors are actionable. Citation Format: Sejong Bae, Vishruti Pandya, Chenguang Wang, Hao Wang, Rebecca C. Arend, Charles A. Leath, Warner K. Huh. Disparities in gynecologic cancer survival outcome by treatment facility and region [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2144.

Impact of Severe Winter Weather on Operations of a Radiation Oncology Department

IntroductionDuring winter of 2022, Western New York faced two major storms with blizzard conditions and record-breaking snowfall. The severe weather resulted in power outages, and travel bans. This study investigates the impact of these conditions on patient adherence to radiotherapy. Combining data from a large academic center and its satellite clinic, this single-center study is shedding light on the challenges faced by cancer care facilities during severe weather and proposing suggestions to prevent and mitigate harm done by severe weather. MethodsIn this study, data was collected using the MOSAIQ Record and Verify system (v. 2.81) to generate deidentified reports of scheduled and treated patients. The treatment adherence rate was calculated by dividing the number of patients treated by the total number of patients scheduled. Data was specifically collected for patients undergoing treatment on linear accelerators at a primary academic center and a satellite facility. The study focused on working days from November 1, 2022, to March 31, 2023, excluding weekends and holidays (as treatments are not routinely scheduled). Severe weather days were identified using advisories from the National Weather Service and local institution, including specific periods in November, December, and January. ResultsIn the study, 15,010 scheduled treatment visits were recorded across the academic center and the satellite clinic. The mean daily treatment adherence rate was 91.7%. Severe weather conditions led to a significant reduction in adherence, with rates dropping to 77.8%. Adherence rates during non-severe weather days were notably higher at 93.9%. Statistical analysis confirmed the substantial impact of severe weather on adherence (p<0.001). Severe weather had a more pronounced impact on the satellite clinic during periods of severe weather with absolute reduction in adherence rates of 21.9% vs. 15% in primary hospital). Moreover, adherence rates at the satellite clinic vs. primary hospital site was lower even under standard operating conditions (92.2% vs 94.0%, p<0.001). ConclusionAs a part of operational planning, it is important to be aware how severe weather can impact treatment adherence. The study findings underscore the importance of proactive measures to ensure patient access to healthcare services during adverse weather events and highlight the broader significance of incorporating Social Determinants of Health (SDOH) considerations into contingency planning for maintaining treatment continuity.

Quality of Life in Locally Advanced Carcinoma Rectum Patients During Various Phases of NACRT: An Indian Perspective.

In low- and middle-income countries (LMICs) including India, cancer patients have a poor prognosis because of late diagnosis and cases already grown to advanced stages, low cancer awareness and skewed cancer care facilities. In India, the incidence of colorectal cancer (CRC) is ranked the 4th most common (6.4%) in males and the 5th most common (3.4%) in females. The improvement in the cure rate of rectal cancer has increased life expectancy, and assessment of the quality of life (QoL) in these patients has become a fundamental requirement. Little is known about how the patients perceive these adverse effects during curatively intended radiotherapy. Although studies have investigated the various adverse effects that can occur with radiotherapy and chemotherapy in carcinoma rectum patients, these have not yet been critically appraised and synopsized to form a comprehensive review of their prevalence and effects on QoL. The study was designed to explore the QoL issues in locally advanced carcinoma rectum patients during various phases of neoadjuvant concurrent chemo-radiotherapy (NACCRT). The study was performed over a period of 2years at a single super speciality cancer hospital in North India. Patients were selected as per the inclusion criteria and followed up with a standard questionnaire incorporating various aspects depicting QoL. The interview technique was used for collecting QoL data at four points, at baseline, midway during treatment, at the end of treatment and 4weeks after completion of NACCRT, using EORTC QLQ C30, for QLQ CR29. Special care was taken to avoid observer bias in cases of language issues, and interpreters' services were utilised, and compared with the baseline pre-treatment scores, patients reported a statistically significant and large clinically meaningful change in the global health status, social functioning, fatigue (FACIT-F), appetite loss, anxiety, sore skin and male and female sexual function at the post-treatment time point. Statistically significant changes with moderate clinically meaningful changes were reported for the functional scales-physical, role and emotional functioning of the QLQ C30 questionnaire and body image and weight of the CR29 questionnaire. Similar moderate clinical changes were found in the symptom scales-fatigue, nausea and vomiting, insomnia, constipation and diarrhoea of QLQ C30 and stool frequency, embarrassment with bowel function, impotence and dyspareunia. These parameters returned to almost the pre-treatment values after 4weeks of completion of NACRT. Since QoL is a relatively subjective variable, differences in human race, culture, education and social environment will have impacts on the results. International cooperation is needed to study the QoL in patients with multiple cultural backgrounds. The existing QoL questionnaire tools have been designed with Western countries in mind, and we did face multiple social issues. We suggest that many similar multicentre studies shall be required to essentially tap the accurate QoL-related issues keeping in mind the diverse social, economic, racial and educational backgrounds. As we deal with the ever-increasing cancer menace and better life expectancy, QoL issues shall be a major determinant of treatment success besides primary treatment. These factors should form an integral part of treatment modality, and adequate counselling must be performed prior to initiation of care.

The double burden of COVID-19 and cancer at the Uganda Cancer Institute

Background Cancer is increasingly diagnosed in Africa, with more than one million new diagnoses annually. In Uganda, the Uganda Cancer Institute (UCI) is the primary cancer care facility, with patients travelling long distances to this facility to receive care. During the COVID-19 pandemic, cancer care was disrupted on several levels, including prevention, screening, diagnosis, treatment, and follow-up. National lockdowns impeded patient access to UCI and halted cancer screening. Methods This study used qualitative interviews to obtain primary data from professionals working at UCI. Interviews were conducted from April 2022 to January 2023. KI (key informants) ’s were purposively selected, identified by colleagues at UCI and recruited through email and WhatsApp messaging. Verbal consent was obtained. Thirty to 60-minute open-ended interviews conducted virtually and in person were audio recorded and transcribed verbatim. Transcripts were coded via MAXQDA software and analyzed to identify themes. Results Thematic analysis revealed three major challenges to cancer care during COVID-19. First, UCI experienced logistical barriers such as travel restrictions, staff shortages, and insufficient protective gear. Second, staff adapted to the inflexible national lockdown policy for chronic health care with modifications to treatment regimens. Third, KI reported a significant mental health burden and reflected on how care should be improved. Conclusions As colleagues got infected, UCI staff organized their training, discussed treatment plans with colleagues, and continued to care for patients at personal risk. Resilience characterized UCI’s response to COVID-19. They adapted treatment protocols to their setting, many of which remain the standard of care today. At the same time, there is a need for capacity building tailored to the Ugandan context to provide cancer care effectively in case of another pandemic.

Impact of Achieving Hospital Accreditation on Assuring Quality in Clinical Laboratories: Experience of an Oncology Hospital in low middle income country

Abstract Introduction/Objective Shefaa Al-Orman Oncology Hospital (SOH) is a leading cancer care facility in Upper Egypt dedicated to providing specialized treatment to cancer patients for free. The General Authority of Healthcare Accreditation and Regulation (GAHAR, accredited from the International Society for Quality in Health Care) is the regulatory and accreditation body that ensures that healthcare facilities in Egypt comply with the highest standards of quality and safety. Here, we aim to assess the impact of GAHAR accreditation process on: Streamlining workflow, contributing to staff professional development and knowledge, increasing loyalty, and creating a more productive and fair work environment. - Optimizing turnaround time (TAT). - Compliance with the minimum retesting interval (MRI) guidelines. - Healthcare providers' satisfaction with the laboratory services. - Patients’ satisfaction. Finally, we aim to emphasize the role of building an integrated lab quality management system that addresses different lab processes/procedures as a basis for la accreditation. Methods/Case Report laboratory personnel, healthcare providers and patients responses were measured using questionnaire method to assess the impact of accreditation on various aspects of laboratory services. Comparative lab statistics were collected from laboratory information system. Results (if a Case Study enter NA) As shown by questionnaires, 95% of lab staff reported positive impact on streamlining of workflow, 100% reported in professional development and improvement in knowledge, and increased loyalty and created a fair work environment (80% in each). Healthcare providers satisfaction reached 88%, and patient satisfaction reached 93%. TAT optimization increased from 84.1% to 98.1%. Prior to accreditation, the lab had an effective internal quality control program. GAHAR mandated enrollment in External Quality Assurance Services (EQAS) to ensure reliable results. In addition, GAHAR mandated a policy/procedure to enforce minimum retesting interval. Application of this policy led to better utilization. Finally, pre and post-analytical processes were streamlined, leading to improved overall laboratory performance. Conclusion Achieving GAHAR accreditation had positive impact on laboratory workflow, staff professional development, compliance with guidelines, ensure reliable laboratory results, and overall laboratory performance. Laboratories should consider accreditation and implementing quality assurance measures to enhance the delivery of high-quality laboratory services and patient safety.

Public Opinions about Palliative and End-of-life Care during the COVID-19 Pandemic: A Twitter-based Study.

Palliative and end-of-life care (PEoLC) played a critical role in relieving suffering and providing grief support in response to the heavy toll caused by the COVID-19 pandemic. However, little is known about public opinion concerning the PEoLC during the pandemic. Given that social media has the potential to collect real-time public opinions, analysis of this evidence is vital to guide future policymaking. To use social media data to investigate real-time public opinions toward PEoLC during the COVID-19 crisis, and explore the impact of the vaccine programme on public opinions about PEoLC. A Twitter-based study exploring tweets across three English-speaking countries - the United States, United Kingdom and Canada. From October 2020 to March 2021, 7,951 PEoLC-related tweets with geographical tags were retrieved and identified from a large-scale COVID-19 Twitter data set through Twitter API (Application Programming Interface). Topic modelling realized through a PMI-based co-occurrence network and Louvain Modularity was utilized to examine latent topics across countries and across two time periods (pre- and post-vaccination periods). Commonalities and regional differences between PEoLC topics in the United States, United Kingdom and Canada were identified specifically: (i) Cancer care and care facilities were of common interest to the public across three countries during the pandemic; (ii) The public expressed positive attitudes towards the vaccine and highlighted its protection to PEoLC professionals; (iii) Whilst Twitter users shared their personal experiences about PEoLC in the online community during the pandemic this was more prominent in the United States and Canada. The implementation of the vaccine program raised the profile of the vaccine discussion, however, this did not influence public opinions about PEoLC. Public opinions on Twitter reflected a need for enhanced Palliative and End-of-Life Care (PEoLC) services during the COVID-19 pandemic. The insignificant impact of the vaccine programme on public discussion on social media indicated that public concerns toward PEoLC continued to persist even after vaccination efforts. Insights gleaned from PEoLC public opinions could provide some clues for policymakers on how to ensure high-quality PEoLC during public emergencies. In this post-COVID-19 era, PEoLC professionals may wish to continue to examine social media and learn from online public discussion to ease the long-lasting trauma caused by this crisis and prepare for public health emergencies in the future. Besides, our results showed social media's potential in acting as an effective tool to reflect public opinions in the context of PEoLC.

Challenging Outlook of Caring for Adolescents and Young Adults With Cancer in Brazil: Results of a Nationwide Survey.

The global burden of cancer in adolescents and young adults (AYAs) emerges as a major public health issue, in which remarkable challenges and unmet needs are evident. Because of sociodemographic inequalities, initiatives to change this scenario need to be expanded globally, particularly to low-middle-income countries (LMICs). This study aimed to gain information about the standards of AYA cancer care in Brazil from the physician's perspective. Physicians involved in AYA cancer care were invited to answer a national online survey. The questions covered several aspects from health care's demographics to specialized services availability, such as fertility and genetic counseling. The availability of a specialized AYA cancer care facility was the primary study end point, and the findings were stratified by region and treatment setting (public v private). Among the physicians who responded (N = 249), 90% reported no access to a specialized AYA service. Only 20% had access to a fertility specialist, and 30% to a survivorship program in their institutions. Even external referrals to medical specialties were challenging, with 24% of the physicians reporting challenges. Despite the potential cardiotoxicity related to treatments, 43% of the respondents reported to refer patients for cardio-oncologists hardly ever. Furthermore, 36% of physicians had never enrolled AYA patients into clinical trials and 42% had never ordered a genetic test. Lack of specialized human resources was particularly evident in Northern Brazil, and delays in cancer diagnoses were frequent. This first study addresses standards of AYA cancer care across Brazil. Importantly, the data disclose significant infrastructural gaps, implying that major investments in training and infrastructure are urgently needed. These data may mirror other LMICs reality.

Abstract 68: Preparing for the Next Pandemic: An Asian National Cancer Centers Alliance (ANCCA) Initiative

Abstract Purpose: The COVID-pandemic has shown significant impact on cancer care from early detection, management plan to clinical outcomes of cancer patients. The devastating effects of COVID-19 seen worldwide have underscored the need for better preparation of the next pandemic. Methods: Based on the experiences and lessons learnt from the COVID-19 pandemic, the Asian National Cancer Centers Alliance (ANCCA) has put together the 9 “Ps” as guidelines for cancer programs to better prepare for the next pandemic. Results: The 9 “Ps” are Priority, Protocols and Processes, Patients, People, Personal Protective Equipments (PPEs), Pharmaceuticals, Places, Preparedness, and Politics. Priority: to maintain cancer care as a key priority in the health system response even during a global infectious disease pandemic. Protocols and processes: to develop a set of Standard Operating Procedures (SOPs) and have relevant expertise to man the Disease Outbreak Response (DORS) Taskforce before an outbreak. Patients: to prioritize patient safety in the event of an outbreak and the need to reschedule cancer management plan, supported by tele-consultation and use of artificial intelligence technology. People: to have business continuity planning to support surge capacity. PPEs and Pharmaceuticals: to develop plan for stockpiles management, build local manufacturing capacity and disseminate information on proper use and reduce wastage. Places: to design and build cancer care facilities to cater for the need of triaging, infection control, isolation and segregation. Preparedness: to invest early on manpower building and technology innovations through multisectoral and international collaborations. Politics: to ensure leadership which bring trust, cohesion and solidarity for successful response to pandemic and mitigate negative impact on the healthcare system. Conclusion: It is important to evaluate the lessons learnt, leverage on the silver linings arising from the crisis and re-examine our strategies, processes, and guidelines on cancer control from research and evidence related to the impact of COVID-19 on cancer prevention and control as well as the escalation in healthcare cost from delayed diagnosis of cancer and late stage cancer treatments are also urgently needed. This “9 Ps” guide put together by ANCCA aims to serve as a summary guide or reminders for cancer centres or programme to better prepare for the next pandemic. Citation Format: Sok King Ong, Laureline Gatellier, Tomohiro Matsuda. Preparing for the Next Pandemic: An Asian National Cancer Centers Alliance (ANCCA) Initiative [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 68.

Peer reviewers from low- and middle-income countries(LMIC) for open access journals in oncology can improve the equity in cancer research and clinical trials

Open access journals (OAJ) in biomedicine are promoted to improve the reach and distribution of global health research (GHR). However, in the last 20 years, article publishing charge (APC) is attracting and publishing the vast majority of papers from high-income countries (HIC) in “oncology” journals under OAJ. This paper outlines the impediments for cancer research and publication from low-and middle-income countries (LMIC): (a) existing disparities in cancer care facilities and survival outcomes between HIC and LMIC, (b) more than 70 % of OAJ in 'oncology' subject levy APC, becoming unaffordable for scientists and clinicians from LMIC, (c) impactful OAJ in oncology engage less than 10 % of members from LMIC in editorial board or as peer reviewer, whereas two-third of cancer diagnosis and management occur in these countries. Peer review serves the editors by recommending the relevant papers. Thus, peer reviewers from developing countries working for the OAJs in “oncology” can increase the diversity in publication, improving the GHR in cancer management. The cancer research and clinical trials which can bring to notice the challenges and hurdles faced by researchers, clinicians and cancer patients in LMIC will be served to some measure by engaging peer reviewers from those countries who understand the ecosystem.

Spatial inequalities in preventive breast cancer care: A comparison of different accessibility approaches for prevention facilities in Bavaria, Germany

BackgroundAccessibility analysis is a essential method for depict spatial inequalities. Healthcare services should be accessible to everyone in a timely manner and available in sufficient number. The main objective is to analyze the equivalence of access to preventive breast cancer care facilities in Bavaria, Germany. MethodsAccessibility is understood as a multidimensional concept, which is applied by different accessibility methods (Nearest facility and 2-step flow and catchment area analysis (2SFCA)) and two means of transportation. For both methodological approaches, we compare the results for individual and public transport. We use high-resolution population-based data to provide small-scale comparisons. ResultsThe access for women over 50 years varies widely. In particularly large differences were found between accessibility by car and public transport, especially in rural regions. The results also differ within urban and rural regions, in some cases strongly, depending on the share of vulnerable population groups and the infrastructural situation. The comparison of the 2SFCA indices show that the supply situation depends not only on the proximity to the population and adequate supply capacities, but also on their connection to the transport system. In the case of public transport, it was shown that within the estimated operating distances, it usually provides better supply, especially in the urban area. ConclusionsWe were able to reveal spatial inequalities in access to preventive breast cancer care facilities in Bavaria for women over 50 years. By identifying underserved regions and especially discriminate between public and individual transportation, more precise actions to overcome inequalities in accessibility for single regions and resident groups can be drawn. Especially, policy-makers and other stakeholders rely on comprehensive information to (likely) initiate interventions to reduce spatial inequalities to health care facilities. Based on demographics, trends in outpatient planning and the findings of this paper, inequality is expected to increase.

Operations Management Interventions in Cancer Care Delivery in LMICs: The Way Forward.

Cancer care sector has received significant attention worldwide after an increase in cancer incidence and related mortality every year. There is a large disparity in access to care for cancer patients in view of increasing case number, limited and urban centric cancer care facilities and resource intensive management of cancer along with many other sociodemographic factors. Cancer care delivery is facing many operational challenges at different steps of care globally and it is more pronounced in LMICs. Research directed towards Operations Management (OM) research can provide solutions to many of the challenges encountered during different steps of cancer care and can help us to manage cancer care delivery landscape with cost cutting and quality improvement. The promising abilities of OM is often overlooked for improving various aspects of cancer care despite the fact that its deployment can create OM surplus where the capitals can be tapped to improve the quality of care for the cancer patients. This paper discusses that fundamentals of OM principles must be implemented for creating resilience and gaining effectiveness and efficiency throughout the cancer care operations.

Role of digital health in coordinating patient care in a hub-and-spoke hierarchy of cancer care facilities: a scoping review.

Coordinating cancer care is complicated due to the involvement of multiple service providers which often leads to fragmentation. The evolution of digital health has led to the development of technology-enabled models of healthcare delivery. This scoping review provides a comprehensive summary of the use of digital health in coordinating cancer care via hub-and-spoke models. A scoping review of the literature was undertaken using the framework developed by Arksey and O'Malley. Research articles published between 2010 and 2022 were retrieved from four electronic databases (PubMed/MEDLINE, Web of Sciences, Cochrane Reviews and Global Health Library). The preferred reporting items for systematic reviews and meta-analyses extension for the scoping reviews (PRISMA-ScR) checklist were followed to present the findings. In total, 311 articles were found of which 7 studies that met the inclusion criteria were included. The use of videoconferencing was predominant across all the studies. The number of spokes varied across the studies ranging from 1 to 63. Three studies aimed to evaluate the impact on access to cancer care among patients, two studies were related to capacity building of the health care workers at the spoke sites, one study was based on a peer review of radiotherapy plans, and one study was related to risk assessment and patient navigation. The introduction of digital health led to reduced travel time and waiting period for patients, and standardisation of radiotherapy plans at spokes. Tele-mentoring intervention aimed at capacity-building resulted in higher confidence and increased knowledge among the spoke learners. There is limited evidence for the role of digital health in the hub-and-spoke design. Although all the studies have highlighted the digital components being used to coordinate care, the bottlenecks, Which were overcome during the implementation of the interventions and the impact on cancer outcomes, need to be rigorously analysed.

Tracking the Development of Cancer Care After 75 Years of Independence: India's Fight Against Cancer Since 1947.

India is one of the fastest developing countries with tremendous growth in industrialization and healthcare facilities. Research and development in the field of healthcare improved the quality of life and well-being of our population. Despite the availability of healthcare facilities and infrastructure, we are still facing considerable challenges in the prevention, diagnosis, and treatment of cancer. The present review focuses on the history and development of cancer care facilities since independence. The advances in cancer diagnostics for early detection of cancer and developments in the field of conventional surgery, including laparoscopic and robotic surgeries, chemotherapy, and radiation therapy, are reviewed. Immunotherapy, vaccines, and selective targeting of tumor cells using nanotechnology are emerging areas in the field of cancer research.

Similarities and differences across the underlying dimensions of social functioning in rural and nonrural cancer survivors: A mixed-methods study.

For cancer survivors, social functioning greatly influences other quality of life dimensions. While there is potential for differences in social functioning to vary as a function of geographic residence, few studies examine the social functioning of rural cancer survivors specifically. This study aims to help fill this gap. This was an embedded mixed-methods study where all participants completed a questionnaire, and some were purposively selected to complete an interview to gather more information about social functioning (ie, social roles, activities, network, support, and constraint). Participants (n = 93; 63% rural) were recruited through a state cancer registry and cancer care facility. Participants were predominately White, non-Hispanic (92.47%), roughly half female (54.84%), and on average, diagnosed in the past two years (SD = 1.68), and 61.45 (SD = 10.87) years old. Few differences in the social functioning of rural and nonrural participants were found on questionnaires, though rural participants reported larger networks and more overall support. Across groups, common themes in the interview data were the experience of both social support (eg, instrumental support) and social constraint (eg, others minimizing participants' problems or sharing their own negative experiences). This was the first cancer survivorship study to thoroughly examine social functioning by geographic residence. Rural cancer survivors described some unique strengths, but major group differences were not apparent. All participants highlighted situations when others, even with good intentions, were unhelpful to them. Future interventions to improve social functioning could work to dispel the belief that cancer survivors should handle their cancer on their own.

Assessing the psychosocial needs of women with breast cancer in Baghdad city

The purpose of this descriptive study is to investigate the psychosocial needs of breast cancer patients in Baghdad City.A descriptive study was designed and data were collected during the period from 1sr of July to 30th of September 2022. The questionnaire consists of seven categories. The respondents had the option of answering ‘important’ or ‘not important’. Data were handled using descriptive statistical data analysis approach. Mean of scores is considered as a cut-off point low, moderate, and high for evaluation.The study findings indicate that 75 (63%) of patients have psychosocial needs according to the psychosocial needs inventory categories and items. The study's overall findings can help other breast cancer care facilities in Iraq provide supportive treatment that meets their psychological needs. The study recommends that information requirements should include service recommendations as well as treatment strategies, medications and side effects.