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Recomendaciones generales e informe de la situación de impacto del SARSCoV2 en niños con cáncer en Latinoamérica
(0000) Sociedad Latinoamericana de Cuidados Intensivos Pediátricos (SLACIP)
Limited Education as a Risk Factor in Cervical Cancer
(Bull Pan Am Health Organ, 1996-12) Corral, Fabián; Cueva, Patricia; Yépez, José; Montes, Elizabeth
Cytogenetic and Molecular Characterization of Hematological Neoplasm in an Ecuadorian population
(Open Journal of Blood Diseases, 2013-12-01) Paz-y-Miño, César; Sánchez, María Eugenia; Araujo, Santiago; Ocampo, Ligia; Espín, Víctor Hugo; Leone, Paola E.
Cancer is one of the major causes of mortality in Ecuador and annually, hematological malignancies are within the top ten most common cancers. In this multicentric study, we analyzed a series of patients diagnosed with different hematological disorders between the years 1984 and 2012. Chromosome abnormalities were detected in 1886 (45.9%) patients. FISH and RT-PCR techniques were used in order to determine the presence of genetic rearrangements and complement conventional cytogenetics results. Using FISH and RT-PCR, positive cases were increased by 1.8% and 6.9% respec- tively. We analyzed fusion genes resulting from t(8;21), t(15;17), inv(16), t(9;22), 11q23 rearrangements, t(4;11) and t(1;19). The frequency of transcripts of some of these fusion genes was of particular interest as our results differ from studies on other populations. Specifically, the fusion gene BCR-ABL was present in the form of the b2/a2 transcript in 95% of CML patients and in the form of b3/a2 transcript in the remaining 5%. The PML-RARA fusion gene also showed a distinct pattern of transcript expression. This fusion gene exhibited the bcr2 (36%) and bcr3 (64%) transcripts, how- ever the bcr1 transcript was absent from our sample population. All cases carrying the CBFB-MYH11 fusion gene ex- hibited the F transcript. This was also of interest due to the rarity of this particular transcript worldwide. Finally all cases carrying the MLL-AF4 fusion gene displayed the e7-e8 transcript. The frequency of the subtypes of some fusion genes differ from those reported in other populations, possibly due to the particular genetic make-up of the Ecuadorian population, mostly mestizo, as well as environmental factors.
Planning and Developing Population-Based Cancer Registration in Low- and Middle-Income Settings
(Agency for Research on Cancer, 2014) Bray, Freddie; Znaor, Ariana; Cueva, Patricia; Korir, Anne; Swaminathan, Rajaraman; Ullrich, Andreas; Wang, Susan A.; Parkin, Donald Maxwell
Cover Page Table of contents Contributors Acknowledgements, Foreword, Preface, Executive summary, Abbreviations Chapter 1 – Introduction Chapter 2 – The role and status of population-based cancer registration Chapter 3 – Planning and developing a population-based cancer registry Chapter 4 – Sources of information for the population-based cancer registry Chapter 5 – Quality control at the population-based cancer registry Chapter 6 – Making the population-based cancer registry heard – reporting the results References – References Annex 1. – CanReg5 Annex 2. – Selected data quality indicators by country or region List of corrections
Stomach cancer burden in Central and South America
(2016) Sierra, Monica S.; Cueva, Patricia; Bravo, Luis Eduardo; Forman, David
Rationale and objective: Stomach cancer mortality rates in Central and South America (CSA) are among the highest in the world. We describe the current burden of stomach cancer in CSA. Methods: We obtained regional and national-level cancer incidence data from 48 population-based registries (13 countries) and nation-wide cancer deaths from WHO’s mortality database (18 countries). We estimated world population age-standardized incidence (ASR) and mortality (ASMR) rates per 100,000 and estimated annual percent change to describe time trends. Results: Stomach cancer was among the 5 most frequently diagnosed cancers and a leading cause of cancer mortality. Between CSA countries, incidence varied by 6-fold and mortality by 5–6-fold. Males had up to 3-times higher rates than females. From 2003 to 2007, the highest ASRs were in Chile, Costa Rica, Colombia, Ecuador, Brazil and Peru (males: 19.2–29.1, females: 9.7–15.1). The highest ASMRs were in Chilean, Costa Rican, Colombian and Guatemalan males (17.4–24.6) and in Guatemalan, Ecuadorian and Peruvian females (10.5–17.1). From 1997 to 2008, incidence declined by 4% per year in Brazil, Chile and Costa Rica; mortality declined by 3–4% in Costa Rica and Chile. 60–96% of all the cancer cases wereunspecified in relation to gastric sub-site but, among those specified, non-cardia cancers occurred 2–13- times more frequently than cardia cancers. Conclusion: The variation in rates may reflect differences in the prevalence of Helicobacter pylori infectionand other risk factors. High mortality may additionally reflect deficiencies in healthcare access. The high proportion of unspecified cases calls for improving cancer registration processes. ã 2015 International Agency for Research on Cancer; Licensee Elsevier Ltd. This is an open access article under the CC BY-NC-ND IGO 3.0 license (https://creativecommons.org/licenses/by-nc-nd/3.0/igo/).
Global Cancer Institute multidisciplinary tumor boards as a tool to improve patterns of clinical practice for breast and gynecologic cancer in resource-limited settings.
(J Clin Oncol [Internet], 2017) Louis, Jessica St.; Bukowski, Alexandra; Rodrigues, Angelica Noguelra; Moreno, Joel; Ferreyra, Mayra; Lopes, Andre; De La Serna, Frances; Tindwa, Chakou Halfani; Baki Mollah, Obayedullah; Villarreal-Garza, Cynthia; Duarte, Carlos; Hambardzumyan, Vahagn; Salman, Pamela; Soria, Tannia; Goss, Paul E.
Background: Multidisciplinary tumor boards (MTBs) are commonly practiced in high-income countries (HICs) to ensure adherence to guidelines through a team approach to patient care. The Global Cancer Institute (GCI) established online MTBs in 2012 to facilitate live telemedicine discussions of breast and gynecologic case scenarios between specialists in low- and middle-income countries (LMICs) and expert specialists in HICs. GCI MTBs aim to improve clinical knowledge and patterns of practice for specialists in LMICs through an interactive online forum. Methods: In each monthly MTB, three patient case scenarios are presented by specialists in LMICs for live discussion with an expert panel of specialists based in HICs. Guideline or clinical trial-based discussions are held for each case scenario. Best practices for clinical care in limited resource settings are also discussed. Links to clinical practice guidelines, clinical trials, and resources are provided to all MTB attendees. For educational purposes, each MTB is live streamed and uploaded to a private YouTube channel for viewing by community oncologists and trainees worldwide. Results: The GCI MTBs program has recruited over 500 LMIC participants from 48 hospitals in 24 countries across Latin America, Eastern Europe, Africa, and Asia. 17 expert breast cancer specialists and 13 expert gynecologic cancer specialists provide multidisciplinary guidance. To date, 130 breast cancer case scenarios and 80 gynecologic cancer case scenarios have been presented. For breast MTBs, 73% of case scenarios were invasive ductal carcinomas. Common subtypes presented were ER/PR+ (63%), HER2+ (30%), and triple negative disease (28%). 56 cases involved advanced disease management (43%). For gynecologic MTBs, common gynecologic cancer case scenarios were cervical (74%) and ovarian (15%). 37 cases involved advanced disease management (46%). Conclusions: GCI MTBs are a useful educational tool for specialists in LMICs to improve patterns of clinical practice and engage in multidisciplinary discussions. GCI continues to expand its MTBs to cancer facilities in LMICs.
Evaluación de los conocimientos generales de los profesionales de la salud ecuatorianos acerca del cáncer renal
(Práctica Fam Rural, 2018) Torres, Fausto Gady; Soria, Tannia; Moreno, Andrea; Ruilova, Erika; Irigoyen Paulina
Introducción: el cáncer renal, como toda patología oncológica, tiene un mejor pronostico si es diagnosticada tempranamente, de manera general los médicos especialistas no son la puerta de entrada de esta enfermedad al sistema de salud, por lo que es indispensable tener ciertos indicios clínicos en médicos no especialistas o de diferentes especialidades. Objetivo: Evaluar el nivel de conocimientos de los Médicos Ecuatorianos sobre el Cáncer Renal. Metodología: Se realizó un estudio de corte transversal, la información fue recolectada a través de una encuesta diseñada para esta investigación. se calcula la muestra en base a prevalencias de conocimientos regionales con un nivel de confianza de 95%. Resultados: en general los aciertos a las preguntas de conocimientos fueron elevados (61%), el puntaje fue más alto en especialidades directamente relacionadas. El componente más afectado fue el de tratamiento (38%). El 78% de los médicos percibe que no existe medicación adecuada en el mercado ecuatoriano y más de la mitad piensa que la tecnología es aún insuficiente. Un 15% de profesionales aún cree que el manejo de Cáncer Renal debe hacerse exclusivamente por un médico oncólogo. Conclusiones: Existen vacíos de conocimiento en los profesionales de la salud, éstos se dan en todos los componentes evaluados, es necesario fortalecer los esfuerzos de Educación continua para evitar retrasos en el diagnóstico de patologías cuyo pronóstico depende de un manejo temprano.
Se requieren más médicos especialistas para tratar el cáncer: urge la formación prioritaria y un número suficiente de oncólogos en Ecuador
(Rev la Fac Ciencias Médicas, 2018) Villacrés, Tatiana; Soria, Tannia; Buizza, Cristiano; González-Andrade, Fabricio
Contexto: el cáncer ha tomado extrema importancia en la población ecuatoriana, debido al rápido aumento de las tasas de incidencia y de mortalidad; implica que el Sistema Nacional de Salud debe responder a las necesidades de los afectados por cáncer. Es imperioso disponer del talento humano suficiente en lo relacionado a diagnóstico, tratamiento y seguimiento oportu-nos. Con este antecedente, el objetivo del estudio es determinar y estimar la brecha de talento humano especializado en oncología en base a datos de Quito y Guayaquil como ciudades de referencia nacional. Método: las estimaciones se realizaron en dos etapas. La primera basada en el cálculo de las proyecciones de oferta y demanda de los servicios médicos oncológicos en Quito y Guayaquil, en función de la información histórica contenida en bases de datos publicadas por el INEC. La segunda etapa se basó en la transformación de los valores estimados, en base a la capacidad de visitas de los profesionales de salud para la proyección de necesidades. Con estos dos escena-rios se determinó la brecha de talento humano. Resultados: Quito y Guayaquil presentan una brecha importante y creciente de profesionales médicos y del talento humano de apoyo (imagen y laboratorio). Utilizando las proyecciones rea-lizadas, tanto en la tendencia de variación y en la capacidad de visitas, se necesita un aumento importante de personal capacitado en oncología, iniciando con el número de médicos oncólogos. Conclusión: para cubrir la demanda real y potencial de servicios médicos para el tratamien-to del cáncer en Ecuador hasta el 2021, se requiere especializar al menos 3142 médicos para Guayaquil y 4546 para Quito. En relación al número de tecnólogos, auxiliares, nutricionistas, enfermeras y psicólogos por tipo de especialidad, para el 2021 se requiere formar 5232 pro-fesionales para Guayaquil y 8938 para Quito. En ambos casos, la brecha hasta el 2021 será de 7688 especialistas médicos y 14170 profesionales afines. No se ha estimado la brecha para el resto de provincias en Ecuador.Descriptores DeCS: salud pública, tratamiento de cáncer, Ecuador, brecha profesional, médi-cos especialistas
Lung cancer: EGFR-ALK mutation in the high lands
(Journal of Clinical Oncology, 2018) Villacrés, Leonardo David; Villarroel, Nelson; Moreno, Pablo; Carrasco, Edison A.; Castillo, José; Muñoz, María José; Caballero, Henry; Soria, Tannia
Background: It has been shown that oxygen is a driver of damage forming free radicals, at higher areas of altitude the risk of developing lung cancer decreases, the primary endpoint was to identify the incidence of EGFR-ALK mutation in the high lands and as a secondary endpoint was to determine the relationship among a pulmonary lobe location, EGFR-ALK mutation and tobacco use. Methods: All patients with lung cancer living at an altitude between 2500( meters above sea level) masl to 3000 masl treated at the Hospital Solon Espinosa Ayala "Quito-Ecuador" between the year 2010 and 2015. The characteristics of the patients included in this study were: living in the high lands for more than 30 years, to have a EGFR and ALK mutation reported. All this data were collected from the electronic medical records. A descriptive analysis of the EGFR and ALK mutation were performed in our city, the Fisher test was used to compare the mutation of EGFR with the location of a pulmonary lobe in a physiological way, whether the tumor is located in superior or inferior lobe and also with tobacco use. Results: Among 191 individuals, 154 individuals were excluded as the did not meet the inclusion criteria, with a total of 37 individuals, with an EGFR mutation in 48.6% (18/37) and an ALK mutation in 3% ( 1/37) of patients. Although 50% of the EGFR mutations belonged to a superior lobe location, this was not significant statistically OR = 2.25 IC 95% (0.61 - 8.18); p = 0.15, the EGFR mutation was not affected by tobacco consumption in our data, presented in the non-smoker individuals OR = 1.47 IC 95% (0.80 - 2.71); p = 0.21. Conclusions: The incidence of EGFR mutation is high, practically presenting a 1: 1 ratio, while the incidence of ALK mutation was very low; Although the EGFR mutation was higher in the upper lobe tumor location, it was not significant, and it was a finding that tobacco consumption was not related to the EGFR mutation present.
Personalizing Precision Oncology Clinical Trials in Latin America: An Expert Panel on Challenges and Opportunities
(The Oncologist, 2019) Arai, Roberto Jun; Guindalini, Rodrigo Santa Cruz; Llera, Andrea Sabina; O'Connor, Juan Manoel; Muller, Bettina; Lema, Mauricio; Freitas, Helano C.; Soria, Tannia; Delgado, Lucía; Landaverde, Denis; Montenegro, Paola; Riechelmann, Rachel P.
Abstract The participation of patients in precision oncology trials needs to fulfill molecular-based selection criteria. This strongly limits accrual, and as a consequence, screening successes have decreased, costs have increased, and fewer subjects are enrolled. To achieve narrowed targets, studies have been forced to be multicenter and multinational to reach a larger pool of candidates. However, this globalization faces many challenges, as, for example, in the case of precision oncology trials. These trials have a complex structure that is dependent upon a high-tech infrastructure and knowledge in a dynamic environment. Given the movement of precision clinical cancer research to regions other than Europe and the U.S., it is important to evaluate the feasibility of performing such trials in lower-middle- and low-income countries. Here we critically discuss the advantages of conducting precision oncology clinical trials in Latin America and make suggestions on how to overcome the main challenges involved. IMPLICATIONS FOR PRACTICE: Precision clinical trials in oncology are studies that require candidates to have tumors with specific molecular alterations, which are considered the target for the trial experimental therapy. Because many molecular alterations are rare, fewer patients are enrolled. This has led to trials being forced to be multicenter and multinational, including trials in Latin America. This article discusses the challenges and opportunities to conduct precision oncology trials in Latin America, aiming to help sponsors and investigators to solve complex issues that ultimately lead to more of such trials being run in the region, potentially benefiting more Latin American patients with cancer. Keywords: Cancer; Clinical trials; Global oncology; Precision oncology.
Survival of Thymoma Is Extensive in Latin-American Patients: Results from over 10 Years of Experience (CLICaP-LATimus)
(J Thorac Oncol, 2019) Mas, L.; Patane A.K.; Arrieta, O.; Soria, Tannia.; Cardona, A.F.; Martín, C.; Ruiz-Patiño, A.; Ruiz, R.; Rioja, P.; Lozano, S.; Zatarain Barron, L.; Barrón, F.; Corassa, M.; Freitas, H.; Cordeiro De Lima, V.C.; Corrales-Rodriguez, L.; Sotelo, C.; Rodríguez, J.; Ricaurte, L.; Ávila, J.; Mayorga, D.; Bravo, M.; Archila, P.; Otero, J.; Carranza, H.; Vargas, C.; Rosell, R.; Remon, J.
Background Thymomas are a group of rare neoplasm of the anterior mediastinum. Due to their low incidence, large cooperative studies are required to evaluate outcomes. The objective of this study is to present the results and experience in treatment of this pathology in Latin-America. Method A retrospective multicenter cohort study was conducted by The Latin-American Consortium for the Investigation of Lung Cancer (CLICaP). Patients with histologically proven thymomas between 1997 and 2018 were included in the analysis. Variables including clinical, pathological and therapeutic outcomes were registered in a centralized manner. Results A total of 105 patients were included. Median age at diagnosis was 54 years old (20-84), and with 60% (n = 38) of the included patients were female. Only 11% (n=7) of the patients had an ECOG performance score >1. Twenty-four patients (22.9%, 95%CI 14.8-30.9) presented with pulmonary or distant metastatic involvement with a median of 2 metastatic sites. Furthermore, 21.9 % of patients (n=23, 95%CI 13.9-29.8%) concurrently presented myasthenia gravis. Surgery was performed in 55 patients (52.3%, 95%CI 42.8 – 61.9%), comprising of 15 tumorectomies, 37 thymectomies and 5 biopsies achieving an R0 resection rate of 78% (95%CI 67.3-89.1%). Adjuvant treatment in the form of either chemotherapy, radiotherapy or both was offered to 3(5%), 7(12.7%) and 5(9%) patients, respectively. Disease progression was documented in 10 cases (9%, 95%CI3.9-15.1%) of which 6 (60%) were locoregional, 1 (10%) distant progression and 3 (30%) both locoregional and distant. Median overall survival (OS) was estimated at around 139.5 months (95%CI 86.1-NA). Cox regression indicated that OS was significantly improved by resection (139.5 vs 25.7 months, HR 4.17 [95%CI 12.6-17.8 months]). Conclusion Survival in patients with thymomas continues to be very favorable, especially in patients who receive adequate local control. The benefit of adjuvant treatment in this setting remains unclear. Keywords Local control, Adjuvant therapy, Survival
Real World Characterization and Treatment of Patients with Thymic Carcinoma: Lessons from a Latin-American Study (CLICaP-LATimus)
(J Thorac Oncol, 2019) Mas, L.; Patané, A.; Arrieta, O.G.; Soria, Tannia; Cardona, A.F.; Martin, C.; Ruiz-Patiño, A.; Rojas L.L.; Ruiz, R.; Rioja, P.; Lozano, S.; Zatarain Barrón, Z.L.; Corassa, M.; Freitas, H.; Cordeiro de Lima, V.; Corrales, L.; Sotelo, C.; Rodriguez, J.; Ricaurte, L.; Ávila, J.; Bravo, M.; Mayorga, D.; Archila, P.; Otero, J.; Carranza, H.; Vargas, C.; Rosell, R.; Remon, J.
Background Thymic carcinoma is a rare tumor that represents a clinical challenge, especially in resource limited settings. The objective of the present study was to characterize patients who presented this disease in Latin-America. Method From 2014 until 2018, a multinational Latin-American cooperative retrospective cohort study was performed. Patients with histologically confirmed thymic carcinoma were included. Clinical, pathological and treatment variables were collected across 7 participating nations. Result A total of 31 patients were included. Median age at diagnosis was 58 years old (34-69), 48% (n=15) of individuals were women with all but 2 patients (6.5%) achieving an ECOG performance score <2. All patients debuted with Stage IV disease; 24 patients (66%, [95%CI 62-92%]) as stage IVa and 7 as stage IVb (33%, [95%CI 7-37%]) with a median LDH level of 396.5 U/L (153-1529 U/L) and a median of 2 metastatic sites. 13 (41.9%, [95%CI 25-59%]) patients received preoperatory treatment consisting of chemotherapy (n=8, 42%) and chemoradiotherapy (n=5, 16%). Among these patients only 4 (12.9%) were subjected to surgery, two of which underwent a tumorectomy and 2 a thymectomy. 28 (90%, [95%CI 79.9-100%]) received palliative chemotherapy either with sunitinib (n=7, 25%) or cytotoxic agents. Median overall survival (OS) was reached at 20.2 months (95%CI 19-NA months). Patients who received preoperative treatment had a significantly prolonged OS (17.6 vs 26 months, HR 2.93 [95%CI 1.04-8.27 months], p = 0.03). Conclusion Thymic carcinoma constitutes an aggressive disease that is often diagnosed in advanced stages. These results suggest that multimodal treatment can be beneficial even in locally advanced cases. Larger clinical trial validating these conclusions are warranted. Keywords Real world data, Latin America, thymic sarcoma
Stagnation in Decreasing Gastric Cancer Incidence and Mortality in Quito: Time Trend Analysis, 1985–2013
(Journal of Cancer Epidemiology, 2019) Tarupi Montenegro, Wilmer; De Vries, Esther; Cueva, Patricia; Yépez, José
Background: Despite the significant global decline in mortality and incidence, gastric cancer (GC) remains a very common cause of illness and death in the Latin American region. This article seeks to describe, in depth, the time trend of incidence and mortality of GC in the city of Quito, from 1985 to 2013. Methods: Using data from the Quito Cancer Registry, annual sex-specific age-standardized incidence and mortality rates were calculated. The analysis included all types of GC together, as well as by histological subtype. Joinpoint regression analysis was performed to estimate the annual percentage change (EAPC). To evaluate cohort and period effects, Age-Period-Cohort (APC) modeling was performed. Results: Over time, incidence rate decreased from 30.4 to 18.8 cases in men and from 20.1 to 12.9 cases in women. The mortality rate decreased from 17.5 to 14.4 deaths in men and from 14.2 to 10.9 deaths in women. The incidence trend was composed of a first period (1986-1999) of strong decline (EAPC Men= -2.6, 95% Confidence Interval [CI]: -4.2, -0.9; EAPC Women= -3.2, 95% CI: -4.6, -1.9), followed by a less important decrease in men (EAPC= -0.8, 95% CI:-2.5, 0.9) and a slight increase in women (EAPC= 0.7, 95% CI: -1.4; 2.8). Mortality rates were constantly decreasing in both men (EAPC= -0.5, 95% CI: -0.9, -0.1) and women (EAPC= -0.9, 95% CI: -1.7, -0.1) throughout the period of analysis. Conclusions: The declines in incidence and mortality rates are stagnating. It is important to take measures to further reduce the high burden of GC.
Global surveillance of trends in cancer survival 2000-14 (CONCORD-3)
(The Lancet, 2019-03) Allemani, Claudia; Matsuda, Tomohiro; Di Carlo, Veronica; Harewood, Rhea; Matz, Melissa; Nikšić, Maja; Bonaventure, Audrey; Valkov, Mikhail; Johnson, Christopher J; Estève, Jacques; Ogunbiyi, Olufemi J; Chen, Wan-Qing; Eser, Sultan; Engholm, Gerda; Stiller, Charles; Monnereau, Alain; Woods, Ryan; Visser, Otto; Hsiang Lim, Gek; Aitken, Joanne; Weir, Hannah K; Coleman Michel P.; CONCORD Working Group
Background—In 2015, the second cycle of the CONCORD programme established global surveillance of cancer survival, as a metric of the effectiveness of health systems and to inform global policy on cancer control. Methods—CONCORD-3 updates the world-wide surveillance of cancer survival to 2014, with individual data for 37.5 million patients diagnosed with cancer during the 15-year period 2000–2014. Data were provided by 322 population-based cancer registries in 71 countries and territories, of which 47 provided data with 100% population coverage. The study includes 18 cancers or groups of cancers: oesophagus, stomach, colon, rectum, liver, pancreas, lung, breast (women), cervix, ovary, prostate and melanoma of the skin in adults, and brain tumours, leukaemias and lymphomas in both adults and children. Standardised quality control procedures were applied; errors were rectified by the registry concerned. We estimated five-year net survival. Estimates were age-standardised with the International Cancer Survival Standard weights. Findings—For most cancers, five-year net survival remains among the highest in the world in the US and Canada, in Australia and New Zealand, and in Finland, Iceland, Norway and Sweden. For many cancers, Denmark is closing the survival gap with the other Nordic countries. Survival trends are generally increasing, even for some of the more lethal cancers: in some countries, survival has increased by up to 5% for cancers of the liver, pancreas and lung. For women diagnosed during 2010–2014, the predicted five-year survival for breast cancer is now close to 90% in the US and in Australia, but international differences remain very wide, with levels as low as 40% in South Africa. For gastrointestinal cancers, the highest levels of five-year survival are seen in South-East Asia, in Korea for cancers of the stomach (69%), colon (72%) and rectum (71%), in Japan for oesophageal cancer (36%) and in Taiwan for liver cancer (28%). By contrast, in the same world region, survival is generally lower than elsewhere for melanoma of the skin (60% in Korea, 52% in Taiwan, 50% in China), and for both lymphoid malignancies (53% in Korea, 51% in Taiwan, 38% in China) and myeloid malignancies (46% in Korea, 33% in Taiwan, 25% in China). For children diagnosed during 2010–2014, five-year survival for acute lymphoblastic leukaemia ranged from 66% in Thailand to 95% in Finland. Five-year survival from brain tumours in children is higher than for adults, and the global range is very wide (from 45% in Thailand to 80% in Sweden and Denmark). Interpretation—The CONCORD programme enables timely comparisons of the overall effectiveness of health systems in providing care for 18 cancers that collectively represent 75% of all cancers diagnosed world-wide every year. It contributes to the evidence base for global policy on cancer control. From 2017, the Organisation for Economic Co-operation and Development will use findings from the CONCORD programme as the official benchmark of cancer survival, among their indicators of the quality of health care in 48 countries world-wide. It is crucial for governments to recognise population-based cancer registries as key policy tools that can be used to evaluate both the impact of cancer prevention strategies and the effectiveness of health systems for all patients diagnosed with cancer
Quality and capacity indicators for hospitalized pediatric oncology patients with critical illness: A modified delphi consensus
(2020) Arias, Anita V; Garza, Marcela; Murthy, Srinivas; Cardenas, Adolfo; Diaz, Franco; Montalvo, Erika; Nielsen, Katie R; Kortz, Teresa; Sharara-Chami, Rana; Friedrich, Paola; McArthur, Jennifer; Agulnik, Asya
Background Hospitalized pediatric hematology‐oncology (PHO) patients are at high risk for critical illness, especially in resource‐limited settings. Unfortunately, there are no established quality indicators to guide institutional improvement for these patients. The objective of this study was to identify quality indicators to include in PROACTIVE (PediatRic Oncology cApaCity assessment Tool for IntensiVe carE), an assessment tool to evaluate the capacity and quality of pediatric critical care services offered to PHO patients. Methods A comprehensive literature review identified relevant indicators in the areas of structure, performance, and outcomes. An international focus group sorted potential indicators using the framework of domains and subdomains. A modified, three‐round Delphi was conducted among 36 international experts with diverse experience in PHO and critical care in high‐resource and resource‐limited settings. Quality indicators were ranked on relevance and actionability via electronically distributed surveys. Results PROACTIVE contains 119 indicators among eight domains and 22 subdomains, with high‐median importance (≥7) in both relevance and actionability, and ≥80% evaluator agreement. The top five indicators were: (a) A designated PICU area; (b) Availability of a pediatric intensivist; (c) A PHO physician as part of the primary team caring for critically ill PHO patients; (d) Trained nursing staff in pediatric critical care; and (e) Timely PICU transfer of hospitalized PHO patients requiring escalation of care. Conclusions PROACTIVE is a consensus‐derived tool to assess the capacity and quality of pediatric onco‐critical care in resource‐limited settings. Future endeavors include validation of PROACTIVE by correlating the proposed indicators to clinical outcomes and its implementation to identify service delivery gaps amenable to improvement. Keywords: clinical cancer research, pediatric cancer, translational research
Reduciendo el impacto de COVID-19 sobre la radioterapia oncológica en países en desarrollo: revisión rápida y consenso de expertos
(MEDwave, 2020-07-09) Montero Oleas, Nadia; Imbaquingo Cabrera, Andrés; Silva, Mónica; Gamarra, Elizabeth; Álvarez Rodas, Byron; Segovia, Nelson; Aldaz Roldan, Pablo; Nuñez Silva, Cristina; Zurita Vivero, Karina; Carrión, Alex; Molina Jaramillo, José; Rodiriguez Balarezo, Andrés; Betancourt, Yuri; De Los Reyes, Luis; Puente Vallejo, Raúl
Objetivo Establecer recomendaciones para la toma de decisiones de manejo en radioterapia durante la pandemia de COVID-19, adaptadas a un país con recursos de salud limitados. Métodos A través de una revisión rápida de la literatura se buscaron publicaciones que describieran medidas para reducir el riesgo de infección por COVID-19, así como también pautas de manejo para reducir la carga de trabajo en las unidades de radioterapia. Se incluyeron en el alcance de esta revisión las siguientes patologías: tumores ginecológicos, cáncer de mama, tumores gastrointestinales, tumores genitourinarios, tumores de cabeza y cuello, cáncer de piel, tumores del sistema nervioso central y linfomas. Un grupo de expertos discutió en línea los datos extraídos y redactó las recomendaciones. Mediante un método Delphi modificado, se evaluó el consenso entre 14 radio-oncólogos certificados. Se evaluó la calidad de la evidencia que sustentó las recomendaciones sobre esquemas de tratamiento. Resultados Se incluyeron un total de 57 documentos. De 25 trabajos se extrajeron las estrategias para reducir el riesgo de infección. De los restantes, se obtuvieron las recomendaciones para cada patología. Las recomendaciones están orientadas a establecer escenarios específicos donde se pueden omitir, diferir, priorizar y acortar los tratamientos. En el ítem de acortar se recomiendan esquemas de tratamiento para cada patología, priorizando los esquemas hipofraccionados cuando fue posible. Conclusión Se plantean estrategias para la gestión de los servicios de radioterapia con el objetivo de garantizar que los tratamientos de alta calidad para pacientes oncológicos sigan entregándose, pese a la crisis sanitaria ocasionada por COVID-19
Ibero-American Expert Consensus on Squamous Cell Carcinoma of the Head and Neck Treatment in Patients Unable to Receive Cisplatin: Recommendations for Clinical Practice
(Cancer Management and Research, 2021) Falco, Agustín; De Oliveira, Thiago Bueno; Cacicedo Jon; Ospina, Aylen Vanessa; Ticona, Miguel Ángel; Galindo, Héctor; Pereira, Marcos David; Aguilar-Ponce, José Luis; Rueda-Domínguez, Antonio; Soria, Tannia; Taberna, Miren; Iglesias, Lara; Sowley, Taysser; Mesía, Ricard; TTCC group (Spanish Group for the Treatment of the Head and Neck Cancer)
Abstract: Cisplatin is the standard of treatment for squamous cell carcinoma of the head and neck (SCCHN) that has demonstrated efficacy, either in locally advanced disease when combined with radiotherapy at high doses, or in metastatic/recurrent disease when combined with other agents. However, the usual toxicities related to cisplatin, such as neurotoxicity, nephrotoxicity, ototoxicity, and hematologic toxicities, especially when high doses have been administered, have important implications in the patients’ quality of life. The decision to administer cisplatin depends on several patient factors, such as age, performance status, weight loss, comorbidities, previous toxicities, chronic viral infection, or even the current SARS-CoV-2 pandemic. In order to establish recommendations for the management of patients with SCCHN, a group of experts in medical and radiation oncology from Spain and Latin-American discussed how to identify patients who are not candidates for cisplatin to offer them the most suitable therapeutic alternative. Keywords: age, cisplatin, comorbidities, contraindication, frailty, toxicity
Characteristics and outcomes of thymomas in Latin America: Results from over 10 years of experience (CLICaP-LATimus)
(Thorac Cancer, 2021) Martín, Claudio; Enrico, Diego; Mas, Luis; Patane, Ana Karina; Arrieta, Oscar; Soria, Tannia; Cardona, Andres F.; Ruiz-Patiño, A.; Ruiz, Rossana; Rioja, Patricia; Lozano, Sophia; Zatarain-Barrón Zyanya Lucia; Barrón, Feliciano; Puparelli, Carmen; Tsou Florencia; Corassa, Marcelo P.; Freitas, Helano C.; Cordeiro de Lima, Vladmir Cláudio; Rojas, Leonardo; Ordóñez-Reyes, Camila; Corrales, Luis; Sotelo, Carolina; Rodríguez, July; Ricaurte, Luisa; Ávila, Jenny; Archila, Pilar; Rosell, Rafael; Cuello, Mauricio; Remon, Jordi
Background: Thymomas are a group of rare neoplasms of the anterior mediastinum. The objective of this study was to describe the demographics, clinical characteristics and treatment approaches in Latin America. Methods: This was a retrospective multicenter cohort study including patients with histologically proven thymomas diagnosed between 1997 and 2018. Demographics, clinicopathological characteristics and therapeutic outcomes were collected locally and analyzed in a centralized manner. Results: A total of 135 patients were included. Median age at diagnosis was 53 years old (19-84), 53.3% (n = 72) of patients were female and 87.4% had an ECOG performance score ranging from 0-1. A total of 47 patients (34.8%) had metastatic disease at diagnosis. Concurrent myasthenia gravis occurred in 21.5% of patients. Surgery was performed in 74 patients (54.8%), comprising 27 (20%) tumorectomies and 47 (34.8%) thymectomies. According to the Masaoka-Koga system, overall survival (OS) at five-years was 73.4%, 63.8% and 51%, at stages I-II, III-IVA and IVB, respectively (p = 0.005). Furthermore, patients with low lactate dehydrogenase (LDH) (≤373 IU/L) at baseline and myasthenia gravis concurrence showed significantly better OS (p = 0.001 and p = 0.008, respectively). In multivariate analysis, high LDH levels (HR 2.8 [95% confidence interval [CI]: 1.1-7.8]; p = 0.036) at baseline and not performing a surgical resection (HR 4.1 [95% CI: 1.3-12.7]; p = 0.016) were significantly associated with increased risk of death. Conclusions: Our data provides the largest insight into the clinical characteristics and outcomes of patients with thymomas in Latin America. Survival in patients with thymomas continues to be very favorable, especially when subjected to adequate local control. Keywords: Latin America; cohort studies; medical oncology; thymoma.
The histology of brain tumors for 67 331 children and 671 085 adults diagnosed in 60 countries during 2000- 2014: a global, population-based study (CONCORD-3)
(Neuro-Oncology, 2021) Girardi, Fabio; Rous, Brian; Stiller, Charles A.; Gatta, Gemma; Fersht Naomi; Storm, Hans H.; Rodrigues, Jessica R.; Herrmann, Christian; Marcos-Gragera, Rafael; Peris-Bonet, Rafael; Valkov, Mikhail; Weir, Hannah K.; Woods, Ryan R.; You, Hui; Cueva, Patricia A.; De, Prithwish; Di Carlo, Veronica; Børge Johannesen, Tom; Lima, Carlos A.; Lynch, Charles F.; Coleman, Michel P.; Allemani, Claudia; CONCORD Working Group
Background. Global variations in survival for brain tumors are very wide when all histological types are con sidered together. Appraisal of international differences should be informed by the distribution of histology, but little is known beyond Europe and North America. Methods. The source for the analysis was the CONCORD database, a program of global surveillance of cancer sur vival trends, which includes the tumor records of individual patients from more than 300 population-based cancer registries. We considered all patients aged 0-99 years who were diagnosed with a primary brain tumor during 2000-2014, whether malignant or nonmalignant. We presented the histology distribution of these tumors, for pa tients diagnosed during 2000-2004, 2005-2009, and 2010-2014. Results. Records were submitted from 60 countries on 5 continents, 67 331 for children and 671 085 for adults. After exclusion of irrelevant morphology codes, the final study population comprised 60 783 children and 602 112 adults. Only 59 of 60 countries covered in CONCORD-3 were included because none of the Mexican records were eligible. We defined 12 histology groups for children, and 11 for adults. In children (0-14 years), the proportion of low-grade astrocytomas ranged between 6% and 50%. Medulloblastoma was the most common subtype in coun tries where low-grade astrocytoma was less commonly reported. In adults (15-99 years), the proportion of glio blastomas varied between 9% and 69%. International comparisons were made difficult by wide differences in thproportion of tumors with unspecified histology, which accounted for up to 52% of diagnoses in children and up to 65% in adults. Conclusions. To our knowledge, this is the first account of the global histology distribution of brain tumors, in children and adults. Our findings provide insights into the practices and the quality of cancer registration worldwide.
Progress, challenges and ways forward supporting cancer surveillance in Latin America
(International Journal of Cancer, 2021) Piñeros, Marion; Abriata, María Graciela; Vries, Esther; Barrios, Enrique; Bravo, Luis Eduardo; Cueva, Patricia; De Camargo Cancela, Marianna; Fernández, Leticia; Gil, Enrique; Luciani, Silvana; Pardo, Constanza; Zoss, Walter; Bray, Freddie; Mery, Les
Population-based cancer registries (PBCRs) are the only means to provide reliable incidence and survival data as a basis for policy-making and resource allocations within cancer care. Yet, less than 3% and 10% of the respective populations of Cen tral America and South America are covered by high-quality cancer registries. The Global Initiative for Cancer Registry Development provides support to improve this situation via the International Agency for Research on Cancer Regional Hub for Latin America. In this paper, we summarize activities (advocacy, technical assistance, train ing and research) over the last 5 years, their impact and current challenges, including the implementation of new PBCR in four countries in the region. Despite the favor able political support to cancer registration in many countries, the sustainability of cancer registration remains vulnerable. Renewed efforts are needed to improve data quality in Latin America while ensuring maximum visibility of the data collected by disseminating and promoting their use in cancer control

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