Clinical research is essential to improving cancer treatment results. It offers patients access to state-of-the-art therapies through clinical trials when standard treatments may not be available or adequate. Latin America represents an important region for clinical research due to its large patient populations and qualified investigators. However, barriers like bureaucratic hurdles can stall development. Addressing discrepancies in cancer care globally through strategies like screening programs and vaccination could help reduce the growing cancer burden in developing areas.
- The Personalized OncoGenomics (POG) program at the British Columbia Cancer Agency conducted whole-genome analysis on tumors from 100 patients with advanced or incurable cancers to inform treatment decisions.
- Fresh tumor and blood samples were obtained from patients and underwent whole-genome and RNA sequencing. Computational analysis identified potential driver mutations, genes and pathways.
- A multidisciplinary team discussed genomic findings weekly and established guidelines for interpreting and communicating results to integrate them into patient care. Genomic findings were considered actionable in 55 of 78 cases that underwent whole-genome analysis, and motivated treatment changes in 23 cases.
- The experience demonstrated that a multidisciplinary team can implement an approach where whole-genome
Question of Quality Conference 2016 - Jonathan B. PerlinHCA Healthcare UK
This document summarizes two case studies from HCA Healthcare that demonstrate how a large healthcare system can leverage electronic health records and data to drive quality improvement and clinical research. The first case study describes the REDUCE MRSA trial, a cluster randomized trial across 43 HCA hospitals that found universal decolonization was most effective at reducing central line-associated bloodstream infections in ICUs. The second case study found that outcomes varied for babies delivered between 37-39 weeks gestation, with 39-week babies faring best, indicating a need to carefully consider timing of elective deliveries. Both examples illustrate how HCA is able to answer important clinical questions and drive practice changes using the data and infrastructure enabled by its electronic health records
A diagnosis of DCIS often brings mixed messages. Is this a real breast cancer? What is the meaning of Stage 0? If this is not life threatening, why are the treatments similar to those recommended for an invasive cancer? Deborah Collyar, founder of Patient Advocates in Research, helps us interpret the new findings that will aid you in navigating this diagnosis.
CONTEMPORARY CLINICAL QUESTIONS on HPV-Related Diseases and VaccinationMichaelFKF
I am please to announce that after a year plus of diligent work we have produced a clinical reference document to provide front line providers contemporary information at point of care decision making in HPV care management, including vaccination.
As a co editor and lead of this FAQ I am extremely proud of the national collaborative effort that made this second edition of the highly popular first edition possible.That version( the first edition) has several thousand copies distributed nationally and internationally .
This version, over 35 thousand copies will be distributed to all the family docs in Canada, SOGC,SCC, GOC members by January.
In addition a longer unabridged version will be online at the end of January that will provide a 'living' document for learners - primary care providers, residents, students etc. This version will be available to on the GOC web site www.g-o-c.org.
The potential to provide learning and reference teaching on this important women's health and cancer prevention topic cannot be underestimated. One can look for opportunities for front line providers to have access to this in clinics and public health spaces.
Earlier editions have in the past been well received by the cancer prevention community in Ontario and nationally.
Michael Fung-Kee-Fung
Designed this online educational booklet for Association of Community Cancer ...Vickie Spindler
This document summarizes the findings from a focus group and survey conducted by the Association of Community Cancer Centers (ACCC) regarding venous thromboembolism (VTE) risk assessment, prevention, and management for cancer patients in outpatient settings. The focus group and survey found significant variability in VTE risk assessment and documentation. Few oncology practices have formal protocols for VTE risk assessment or use tools to calculate risk. Additionally, VTE prevention and education for patients is not standardized. The document provides opportunities for improvement, including developing formal VTE assessment and order protocols, incorporating risk assessment into electronic health records, and improving patient education about VTE risk and prevention.
This study examined the impact of the 21-gene breast cancer assay (Oncotype DX) on adjuvant therapy decisions in a Mexican public hospital. 98 early-stage breast cancer patients were tested. Following assay results, treatment decisions changed for 32% of patients (27% of node-negative and 41% of node-positive patients). The proportion recommended chemotherapy decreased from 48% to 34% after testing. 92% of physicians reported being more confident in their recommendations after ordering the assay. The results suggest the 21-gene assay can meaningfully impact adjuvant treatment decisions and potentially reduce chemotherapy use in the Mexican public health system.
Feature story from the Garvan Institute of Medical Research's April 2013 issue of Breakthrough newsletter. More at https://www.garvan.org.au/news-events/newsletters
- The Personalized OncoGenomics (POG) program at the British Columbia Cancer Agency conducted whole-genome analysis on tumors from 100 patients with advanced or incurable cancers to inform treatment decisions.
- Fresh tumor and blood samples were obtained from patients and underwent whole-genome and RNA sequencing. Computational analysis identified potential driver mutations, genes and pathways.
- A multidisciplinary team discussed genomic findings weekly and established guidelines for interpreting and communicating results to integrate them into patient care. Genomic findings were considered actionable in 55 of 78 cases that underwent whole-genome analysis, and motivated treatment changes in 23 cases.
- The experience demonstrated that a multidisciplinary team can implement an approach where whole-genome
Question of Quality Conference 2016 - Jonathan B. PerlinHCA Healthcare UK
This document summarizes two case studies from HCA Healthcare that demonstrate how a large healthcare system can leverage electronic health records and data to drive quality improvement and clinical research. The first case study describes the REDUCE MRSA trial, a cluster randomized trial across 43 HCA hospitals that found universal decolonization was most effective at reducing central line-associated bloodstream infections in ICUs. The second case study found that outcomes varied for babies delivered between 37-39 weeks gestation, with 39-week babies faring best, indicating a need to carefully consider timing of elective deliveries. Both examples illustrate how HCA is able to answer important clinical questions and drive practice changes using the data and infrastructure enabled by its electronic health records
A diagnosis of DCIS often brings mixed messages. Is this a real breast cancer? What is the meaning of Stage 0? If this is not life threatening, why are the treatments similar to those recommended for an invasive cancer? Deborah Collyar, founder of Patient Advocates in Research, helps us interpret the new findings that will aid you in navigating this diagnosis.
CONTEMPORARY CLINICAL QUESTIONS on HPV-Related Diseases and VaccinationMichaelFKF
I am please to announce that after a year plus of diligent work we have produced a clinical reference document to provide front line providers contemporary information at point of care decision making in HPV care management, including vaccination.
As a co editor and lead of this FAQ I am extremely proud of the national collaborative effort that made this second edition of the highly popular first edition possible.That version( the first edition) has several thousand copies distributed nationally and internationally .
This version, over 35 thousand copies will be distributed to all the family docs in Canada, SOGC,SCC, GOC members by January.
In addition a longer unabridged version will be online at the end of January that will provide a 'living' document for learners - primary care providers, residents, students etc. This version will be available to on the GOC web site www.g-o-c.org.
The potential to provide learning and reference teaching on this important women's health and cancer prevention topic cannot be underestimated. One can look for opportunities for front line providers to have access to this in clinics and public health spaces.
Earlier editions have in the past been well received by the cancer prevention community in Ontario and nationally.
Michael Fung-Kee-Fung
Designed this online educational booklet for Association of Community Cancer ...Vickie Spindler
This document summarizes the findings from a focus group and survey conducted by the Association of Community Cancer Centers (ACCC) regarding venous thromboembolism (VTE) risk assessment, prevention, and management for cancer patients in outpatient settings. The focus group and survey found significant variability in VTE risk assessment and documentation. Few oncology practices have formal protocols for VTE risk assessment or use tools to calculate risk. Additionally, VTE prevention and education for patients is not standardized. The document provides opportunities for improvement, including developing formal VTE assessment and order protocols, incorporating risk assessment into electronic health records, and improving patient education about VTE risk and prevention.
This study examined the impact of the 21-gene breast cancer assay (Oncotype DX) on adjuvant therapy decisions in a Mexican public hospital. 98 early-stage breast cancer patients were tested. Following assay results, treatment decisions changed for 32% of patients (27% of node-negative and 41% of node-positive patients). The proportion recommended chemotherapy decreased from 48% to 34% after testing. 92% of physicians reported being more confident in their recommendations after ordering the assay. The results suggest the 21-gene assay can meaningfully impact adjuvant treatment decisions and potentially reduce chemotherapy use in the Mexican public health system.
Feature story from the Garvan Institute of Medical Research's April 2013 issue of Breakthrough newsletter. More at https://www.garvan.org.au/news-events/newsletters
This document provides information about an oncology social worker and their role. It discusses what an oncology social worker sees, hears, and feels in working with cancer patients. It outlines the types of support oncology social workers provide, including emotional support, practical assistance, information, and advocacy. It also summarizes the standards and scope of practice for oncology social work according to the Association of Oncology Social Work. Finally, it discusses common issues cancer survivors face and encourages patients to take advantage of oncology social work services.
5th Annual Early Age Onset Colorectal Cancer Summit - Session II: Family History Ascertainment in the US - What Steps are Needed to Improve the Well Documented Less Than Optimal Status of this Situation?
Clinical Trials for Ovarian Cancer: Fact vs. Fictionbkling
Courtney Hudson, CEO & Co-Founder of EmergingMed, explains the basics of clinical trials and the process of developing new treatments in the emerging age of personalized medicine and immunotherapy. Lean how to identify appropriate clinical trials, find strategies to determine your best options, and figure out which questions to ask when making your decisions. Watch the accompanying webinar: https://vimeo.com/203510985
The document describes a case where a 58-year-old woman underwent phenol sclerotherapy for hemorrhoids. The phenol solution used was 80% aqueous rather than the usual 5% oily solution, resulting in necrosis of tissue around the anus requiring surgery. The patient eventually recovered fully after months of treatment including a temporary colostomy.
The Asian Fund for Cancer Research is a nonprofit organization headquartered in Hong Kong that is committed to curing cancers that significantly impact Asian populations. It focuses on investigating cancers' causes in Asia and developing more effective therapies tailored for Asian patients. AFCR bridges scientific gaps in cancer research between Asia and the rest of the world by promoting international collaboration and funding projects. It supports multiple research programs investigating prevention strategies, early detection technologies, new drugs, and traditional Chinese medicines for cancers like lung, esophageal, and colorectal cancers.
Certis Oncology provides precision oncology solutions through patient-derived tumor xenograft (PDOX) mouse models. Their technique implants small samples of patients' tumors into mice to test potential drug therapies. This identifies effective and ineffective treatments faster than standard methods. It also enables tumor banking for future testing. Certis works with oncologists, patients, and pharmaceutical companies to advance precision cancer care and drug development.
The document summarizes updated systematic reviews of interventions to increase screening for breast, cervical, and colorectal cancers. Nine interventions were reviewed: group education, one-on-one education, client reminders, reducing out-of-pocket costs, reducing structural barriers, and provider assessment and feedback. New recommendations were made for group education to increase mammography screening and one-on-one education to increase colorectal cancer screening with FOBT. Evidence for the effectiveness of client reminders to increase FOBT screening was upgraded. Previous findings on the other interventions were reaffirmed. Research gaps in increasing screening, especially for colorectal cancer, were also identified.
1) Marty Tenenbaum survived metastatic melanoma after responding remarkably to an experimental vaccine in a clinical trial that otherwise failed. He started Cancer Commons to create a database of "exceptional responders" like himself to help identify effective treatments.
2) Dr. David Carbone treated a woman with advanced lung cancer who had a spectacular response to a drug not approved for her cancer. Genetic testing revealed a rare mutation that explained her exceptional response.
3) Researchers are studying exceptional responders to cancers to learn why some patients have remarkable recoveries to specific treatments and to identify genetic factors that could help match other patients with effective therapies.
The utility-visual-inspection-with-acetic-acid-cervical-cancer-screening-ecoa...Amarlasreeja
Cervical cancer is potentially preventable but still remains a leading cause of cancer mortality in in developing countries like Nigeria. Cytology-based screening programmers are difficult to maintain in these countries.
di Pier Giuseppe Pelicci, MD-PhD, Istituto Europeo di Oncologia IEO, Università degli Studi di Milano.
Slide per l'intervento tenuto in Fondazione Giannino Bassetti in occasione del primo incontro del ciclo "La medicina di precisione", primo progetto dalla convenzione tra Università di Pavia e Fondazione Bassetti.
12 marzo 2018
Impact of Multidisciplinary Discussion on Treatment Outcome For Gynecologic C...Emad Shash
Tumor conferences are multidisciplinary meetings at which the
management of cancer patients is discussed. They have been
an integral part of oncology services and are regarded
as an essential component of quality control and continuing
medical education. There are data to suggest that the tumor conference enhances patient care. Many studies of effectiveness have been conducted. Reported benefits include improved patient management and treatment. In this presentation, I'll try to assess the role of the multidisciplinary tumor conference in patient management in gynecologic oncology services.
The document provides an overview of a collaborative project between the Association of Community Cancer Centers (ACCC) and the American Psychosocial Oncology Society (APOS) to study three member programs' psychosocial distress screening processes. Site visits were conducted at three cancer centers - Bennett Cancer Center in Connecticut, Simmons Cancer Center in Texas, and CHI Health Good Samaritan Cancer Center in Nebraska. Key findings from the individual site visits are described, including tools used, staff involved, and process flowcharts. The goal is to identify effective practices that could help other cancer programs implement distress screening.
Date held: February 12, 2015
Presented by: Deb Davison, Genomic Health
Topics discussed:
The latest in genomic testing and its role in cancer treatment
The most recent results from Genomic Health’s second independent clinical validation study of Oncotype DX® in DCIS patients
Q&A session about the implications of this research
How We Do Harm: A Webinar by SHARE with Dr. Otis Brawleybkling
Dr. Otis Brawley, author of How We Do Harm, pulls back the curtain on how health care is really practiced in American. Hosted by SHARE: Self-help for Women with Breast or Ovarian Cancer.. www.sharecancersupport.org. If you would like to watch the full webinar, visit www.sharecancersupport.org/brawley.
This document summarizes the updated 2012 consensus guidelines from experts for managing abnormal cervical cancer screening tests and cervical precursors. The experts reviewed literature and data from 1.4 million women to update guidelines established in 2006. Key updates included:
- HPV-negative atypical squamous cells of undetermined significance results should have co-testing repeated at 3 years before returning to routine screening.
- Younger women aged 21-24 need less invasive management, especially for minor abnormalities.
- Post-colposcopy management incorporates co-testing results.
- Endocervical sampling reported as CIN 1 should be managed as CIN 1.
- Unsatisfactory cytology should usually be repeated, even with known HPV
Precision Medicine in Oncology InformaticsWarren Kibbe
Precision medicine in oncology aims to provide targeted cancer treatments based on a patient's individual tumor characteristics. The presentation discusses precision oncology initiatives including NCI-MATCH clinical trials which assign cancer therapies based on a tumor's molecular abnormalities rather than location. It outlines plans to expand genomically-based cancer trials, understand and overcome treatment resistance through molecular analysis, and establish a national cancer database integrating genomic and clinical data to accelerate cancer research. Cloud computing platforms are being developed to provide researchers access to large cancer genomic and clinical datasets. The goal is to advance precision cancer treatment by incorporating individual patient genetics and biomarkers into therapeutic decision making.
EAOCRC Summit Framing the Conversation: Strategic Challenges in Current Medical Care that Contribute to Young Adult Colorectal Cancer (CRC) Incidence and Mortality. Session I - The Dimensions of the EAOCRC Problem.
SHARE Webinar: Why Should I Join a Clinical Trial with Dr. Hershmanbkling
Dr. Dawn L. Hershman of the Herbert Irving Comprehensive Cancer Center at Columbia University presented the basics of clinical trials and emphasized how important it is for more patients to participate in them. She also discussed trials currently available for early stage and metastatic breast cancers. The webinar was presented on June 25, 2014. To hear the webinar, visit www.sharecancersupport.org/hershman
This project describes methods for recruiting and retaining adolescent and young adult (AYA) oncology patients in psychosocial research studies at a single institution. Key methods included:
1) Monitoring clinic schedules and patient wards daily to identify eligible patients and approach them during appointments to minimize interference.
2) Using a dedicated research assistant to have greater coverage of clinics and flexibility in approaching patients.
3) Collecting multiple contact methods and an alternate contact to facilitate retention through regular reminders via phone, email, and in-person.
4) Carefully tracking patients in databases helped with retention rates averaging over 80% at follow-up timepoints up to a year later despite the challenges of this patient group.
Over the past 20 years, improvements in cancer prevention, screening, and treatment in Australia have saved over 61,000 lives according to new Cancer Council research. Key findings include that annual lung cancer deaths have fallen by 2,154, bowel cancer deaths have fallen by 1,797, and breast cancer deaths have fallen by 773. However, cancers of the brain, pancreas, and esophagus have seen relatively small improvements, with 148, 69, and 64 fewer deaths respectively. Continued investment in research is needed to achieve further reductions in cancer deaths. Cancer Council NSW has funded over $120 million in research over the past 20 years, achieving advances such as new treatments for brain and pancreatic cancers and improved cancer survival rates.
A next generation introduction to data science and its potential to change bu...InnoTech
The document discusses the rise of data science and its potential to change business. It notes that the amount of data being generated is growing exponentially and will soon exceed 40 zettabytes. However, most companies feel overwhelmed by the data they have. Data science uses techniques from many fields to extract meaningful insights from vast amounts of data. It has become a critical business asset for companies in almost every industry. The emergence of data science is enabling real-time, predictive analytics beyond what was previously possible.
This document provides an introduction to a course on data science and R programming. The course aims to provide an overview of data science and the data science process. It introduces R, including its history and how to install R and RStudio. The first module covers basic R programming concepts such as vectors, matrices, factors, and data frames.
This document provides information about an oncology social worker and their role. It discusses what an oncology social worker sees, hears, and feels in working with cancer patients. It outlines the types of support oncology social workers provide, including emotional support, practical assistance, information, and advocacy. It also summarizes the standards and scope of practice for oncology social work according to the Association of Oncology Social Work. Finally, it discusses common issues cancer survivors face and encourages patients to take advantage of oncology social work services.
5th Annual Early Age Onset Colorectal Cancer Summit - Session II: Family History Ascertainment in the US - What Steps are Needed to Improve the Well Documented Less Than Optimal Status of this Situation?
Clinical Trials for Ovarian Cancer: Fact vs. Fictionbkling
Courtney Hudson, CEO & Co-Founder of EmergingMed, explains the basics of clinical trials and the process of developing new treatments in the emerging age of personalized medicine and immunotherapy. Lean how to identify appropriate clinical trials, find strategies to determine your best options, and figure out which questions to ask when making your decisions. Watch the accompanying webinar: https://vimeo.com/203510985
The document describes a case where a 58-year-old woman underwent phenol sclerotherapy for hemorrhoids. The phenol solution used was 80% aqueous rather than the usual 5% oily solution, resulting in necrosis of tissue around the anus requiring surgery. The patient eventually recovered fully after months of treatment including a temporary colostomy.
The Asian Fund for Cancer Research is a nonprofit organization headquartered in Hong Kong that is committed to curing cancers that significantly impact Asian populations. It focuses on investigating cancers' causes in Asia and developing more effective therapies tailored for Asian patients. AFCR bridges scientific gaps in cancer research between Asia and the rest of the world by promoting international collaboration and funding projects. It supports multiple research programs investigating prevention strategies, early detection technologies, new drugs, and traditional Chinese medicines for cancers like lung, esophageal, and colorectal cancers.
Certis Oncology provides precision oncology solutions through patient-derived tumor xenograft (PDOX) mouse models. Their technique implants small samples of patients' tumors into mice to test potential drug therapies. This identifies effective and ineffective treatments faster than standard methods. It also enables tumor banking for future testing. Certis works with oncologists, patients, and pharmaceutical companies to advance precision cancer care and drug development.
The document summarizes updated systematic reviews of interventions to increase screening for breast, cervical, and colorectal cancers. Nine interventions were reviewed: group education, one-on-one education, client reminders, reducing out-of-pocket costs, reducing structural barriers, and provider assessment and feedback. New recommendations were made for group education to increase mammography screening and one-on-one education to increase colorectal cancer screening with FOBT. Evidence for the effectiveness of client reminders to increase FOBT screening was upgraded. Previous findings on the other interventions were reaffirmed. Research gaps in increasing screening, especially for colorectal cancer, were also identified.
1) Marty Tenenbaum survived metastatic melanoma after responding remarkably to an experimental vaccine in a clinical trial that otherwise failed. He started Cancer Commons to create a database of "exceptional responders" like himself to help identify effective treatments.
2) Dr. David Carbone treated a woman with advanced lung cancer who had a spectacular response to a drug not approved for her cancer. Genetic testing revealed a rare mutation that explained her exceptional response.
3) Researchers are studying exceptional responders to cancers to learn why some patients have remarkable recoveries to specific treatments and to identify genetic factors that could help match other patients with effective therapies.
The utility-visual-inspection-with-acetic-acid-cervical-cancer-screening-ecoa...Amarlasreeja
Cervical cancer is potentially preventable but still remains a leading cause of cancer mortality in in developing countries like Nigeria. Cytology-based screening programmers are difficult to maintain in these countries.
di Pier Giuseppe Pelicci, MD-PhD, Istituto Europeo di Oncologia IEO, Università degli Studi di Milano.
Slide per l'intervento tenuto in Fondazione Giannino Bassetti in occasione del primo incontro del ciclo "La medicina di precisione", primo progetto dalla convenzione tra Università di Pavia e Fondazione Bassetti.
12 marzo 2018
Impact of Multidisciplinary Discussion on Treatment Outcome For Gynecologic C...Emad Shash
Tumor conferences are multidisciplinary meetings at which the
management of cancer patients is discussed. They have been
an integral part of oncology services and are regarded
as an essential component of quality control and continuing
medical education. There are data to suggest that the tumor conference enhances patient care. Many studies of effectiveness have been conducted. Reported benefits include improved patient management and treatment. In this presentation, I'll try to assess the role of the multidisciplinary tumor conference in patient management in gynecologic oncology services.
The document provides an overview of a collaborative project between the Association of Community Cancer Centers (ACCC) and the American Psychosocial Oncology Society (APOS) to study three member programs' psychosocial distress screening processes. Site visits were conducted at three cancer centers - Bennett Cancer Center in Connecticut, Simmons Cancer Center in Texas, and CHI Health Good Samaritan Cancer Center in Nebraska. Key findings from the individual site visits are described, including tools used, staff involved, and process flowcharts. The goal is to identify effective practices that could help other cancer programs implement distress screening.
Date held: February 12, 2015
Presented by: Deb Davison, Genomic Health
Topics discussed:
The latest in genomic testing and its role in cancer treatment
The most recent results from Genomic Health’s second independent clinical validation study of Oncotype DX® in DCIS patients
Q&A session about the implications of this research
How We Do Harm: A Webinar by SHARE with Dr. Otis Brawleybkling
Dr. Otis Brawley, author of How We Do Harm, pulls back the curtain on how health care is really practiced in American. Hosted by SHARE: Self-help for Women with Breast or Ovarian Cancer.. www.sharecancersupport.org. If you would like to watch the full webinar, visit www.sharecancersupport.org/brawley.
This document summarizes the updated 2012 consensus guidelines from experts for managing abnormal cervical cancer screening tests and cervical precursors. The experts reviewed literature and data from 1.4 million women to update guidelines established in 2006. Key updates included:
- HPV-negative atypical squamous cells of undetermined significance results should have co-testing repeated at 3 years before returning to routine screening.
- Younger women aged 21-24 need less invasive management, especially for minor abnormalities.
- Post-colposcopy management incorporates co-testing results.
- Endocervical sampling reported as CIN 1 should be managed as CIN 1.
- Unsatisfactory cytology should usually be repeated, even with known HPV
Precision Medicine in Oncology InformaticsWarren Kibbe
Precision medicine in oncology aims to provide targeted cancer treatments based on a patient's individual tumor characteristics. The presentation discusses precision oncology initiatives including NCI-MATCH clinical trials which assign cancer therapies based on a tumor's molecular abnormalities rather than location. It outlines plans to expand genomically-based cancer trials, understand and overcome treatment resistance through molecular analysis, and establish a national cancer database integrating genomic and clinical data to accelerate cancer research. Cloud computing platforms are being developed to provide researchers access to large cancer genomic and clinical datasets. The goal is to advance precision cancer treatment by incorporating individual patient genetics and biomarkers into therapeutic decision making.
EAOCRC Summit Framing the Conversation: Strategic Challenges in Current Medical Care that Contribute to Young Adult Colorectal Cancer (CRC) Incidence and Mortality. Session I - The Dimensions of the EAOCRC Problem.
SHARE Webinar: Why Should I Join a Clinical Trial with Dr. Hershmanbkling
Dr. Dawn L. Hershman of the Herbert Irving Comprehensive Cancer Center at Columbia University presented the basics of clinical trials and emphasized how important it is for more patients to participate in them. She also discussed trials currently available for early stage and metastatic breast cancers. The webinar was presented on June 25, 2014. To hear the webinar, visit www.sharecancersupport.org/hershman
This project describes methods for recruiting and retaining adolescent and young adult (AYA) oncology patients in psychosocial research studies at a single institution. Key methods included:
1) Monitoring clinic schedules and patient wards daily to identify eligible patients and approach them during appointments to minimize interference.
2) Using a dedicated research assistant to have greater coverage of clinics and flexibility in approaching patients.
3) Collecting multiple contact methods and an alternate contact to facilitate retention through regular reminders via phone, email, and in-person.
4) Carefully tracking patients in databases helped with retention rates averaging over 80% at follow-up timepoints up to a year later despite the challenges of this patient group.
Over the past 20 years, improvements in cancer prevention, screening, and treatment in Australia have saved over 61,000 lives according to new Cancer Council research. Key findings include that annual lung cancer deaths have fallen by 2,154, bowel cancer deaths have fallen by 1,797, and breast cancer deaths have fallen by 773. However, cancers of the brain, pancreas, and esophagus have seen relatively small improvements, with 148, 69, and 64 fewer deaths respectively. Continued investment in research is needed to achieve further reductions in cancer deaths. Cancer Council NSW has funded over $120 million in research over the past 20 years, achieving advances such as new treatments for brain and pancreatic cancers and improved cancer survival rates.
A next generation introduction to data science and its potential to change bu...InnoTech
The document discusses the rise of data science and its potential to change business. It notes that the amount of data being generated is growing exponentially and will soon exceed 40 zettabytes. However, most companies feel overwhelmed by the data they have. Data science uses techniques from many fields to extract meaningful insights from vast amounts of data. It has become a critical business asset for companies in almost every industry. The emergence of data science is enabling real-time, predictive analytics beyond what was previously possible.
This document provides an introduction to a course on data science and R programming. The course aims to provide an overview of data science and the data science process. It introduces R, including its history and how to install R and RStudio. The first module covers basic R programming concepts such as vectors, matrices, factors, and data frames.
This document provides an introduction to analytics and data science. It defines analytics as the use of data, analysis, modeling, and fact-based management to drive decisions and actions. The benefits of analytics include better understanding of business dynamics, improved performance, and stronger decision making. Analytics can provide competitive advantages by exploiting unique organizational data. However, analytics may not be practical when there is no time or data, or when decisions rely heavily on experience. Becoming a data scientist requires skills in statistics, programming, communication, and more.
This document discusses data science and the role of data scientists. It defines data science as using theories and principles to perform data-related tasks like collection, cleaning, integration, modeling, and visualization. It distinguishes data science from business intelligence, statistics, database management, and machine learning. Common skills for data scientists include statistics, data munging (formatting data), and visualization. Data scientists perform tasks like preparing models, running models, and communicating results.
This document provides an introduction to data science. It discusses why data science is important and covers key techniques like statistics, data mining, and visualization. It also reviews popular tools and platforms for data science like R, Hadoop, and real-time systems. Finally, it discusses how data science can be applied across different business domains such as financial services, telecom, retail, and healthcare.
Big Data e Data Science - GBG - Google Business GroupDiego Nogare
O documento apresenta os principais conceitos de aprendizado de máquina e ciência de dados, incluindo aprendizado supervisionado, não supervisionado e semi-supervisionado. Exemplos de algoritmos como regressão, classificação, cluster e detecção de anomalias são discutidos, assim como métricas para classificadores binários como acurácia, precisão, recall e F1 score.
Data Science, Big Data e Analytics são termos que escutamos constantemente hoje em dia. Mais do que buzzwords elas estão guiando o modo como empresas de diferentes de tamanhos pensam e evoluem seus modelos de negócio.
Vamos desmistificar alguns desses conceitos e mostrar como podemos começar a aplicar algumas dessas técnicas em nossos projetos. E, sendo uma das mais usadas linguagens para análise de dados, veremos como Python pode nos ajudar nessa jornada.
In this presentation, Wes Eldridge will provide a general overview on data science. The talk will cover a variety of topics, Wes will start with the dirty history of the field which will help add context. After learning about the history of data and data science Wes will discuss the common roles a data scientist holds in business and organizations. Next, he will talk about how to use data in your organization and products. Finally, he'll cover some tools to help you get started in data science. After the presentation, Wes will stick around for Q/A and data discussion.
Data Developer - Engenharia de Dados em um time de Data Science - Uai python2015Bruno Rocha
O documento discute vários tópicos relacionados a ciência de dados, incluindo: 1) Técnicas como data mining, machine learning e big data; 2) Como um funcionário do Walmart notou uma correlação entre vendas de fraldas e cerveja; 3) O que é business intelligence e suas limitações; 4) A importância de coletar diversos dados e sinais em um supermercado.
Data Science, Machine Learning and Big DataFabrício Barth
O documento discute como ciência de dados, aprendizado de máquina e big data podem ser usados para prever crimes, terremotos e recomendar itens para usuários. Ele explica que esses projetos manipulam grandes volumes de dados variados para criar modelos preditivos.
Introduction to Data Science - ESCP Europe Martin Daniel
Why Data is becoming a competitive advantage in all verticals.
Introduction to Data Science given to ESCP Europe Master 2 in Feb 15'.
Martin DANIEL - @martindaniel4
This document provides an overview of the key concepts in data science including statistics, machine learning, data mining, and data analysis tools. It also discusses classification, regression, clustering, and data reduction techniques. Additionally, it defines what a data scientist is and how they work with data to understand patterns, ask questions, and solve problems as part of a team. The document demonstrates some examples of admissions data and analyses simpson's paradox to illustrate data science concepts.
Workshop with Joe Caserta, President of Caserta Concepts, at Data Summit 2015 in NYC.
Data science, the ability to sift through massive amounts of data to discover hidden patterns and predict future trends and actions, may be considered the "sexiest" job of the 21st century, but it requires an understanding of many elements of data analytics. This workshop introduced basic concepts, such as SQL and NoSQL, MapReduce, Hadoop, data mining, machine learning, and data visualization.
For notes and exercises from this workshop, click here: https://github.com/Caserta-Concepts/ds-workshop.
For more information, visit our website at www.casertaconcepts.com
Business Intelligence, Data Visualization and Data ScienceDiego Nogare
O documento resume as principais informações sobre uma reunião sobre Business Intelligence, Dataviz e Data Science. Apresenta brevemente os tópicos de SSIS, SSAS e PowerBI para Business Intelligence e Dataviz. Para Data Science, destaca algoritmos de regressão, classificação e clusterização, além de abordar classificadores binários e a curva ROC.
Slidedeck from our seminar about Data Science (30/09/2014)
Topics covered:
- What is Data Science?
- What can Data Science do for your business?
- How does Data Science relate to Statistics, BI and BigData?
- Practical application of data mining techniques: decision trees, naive bayes, k-means clustering, a priori
- Real-world case of applied data science
This document provides an overview of data science including what is big data and data science, applications of data science, and system infrastructure. It then discusses recommendation systems in more detail, describing them as systems that predict user preferences for items. A case study on recommendation systems follows, outlining collaborative filtering and content-based recommendation algorithms, and diving deeper into collaborative filtering approaches of user-based and item-based filtering. Challenges with collaborative filtering are also noted.
Demystifying Data Science with an introduction to Machine LearningJulian Bright
The document provides an introduction to the field of data science, including definitions of data science and machine learning. It discusses the growing demand for data science skills and jobs. It also summarizes several key concepts in data science including the data science pipeline, common machine learning algorithms and techniques, examples of machine learning applications, and how to get started in data science through online courses and open-source tools.
Anastasiia Kornilova has over 3 years of experience in data science. She has an MS in Applied Mathematics and runs two blogs. Her interests include recommendation systems, natural language processing, and scalable data solutions. The agenda of her presentation includes defining data science, who data scientists are and what they do, and how to start a career in data science. She discusses the wide availability of data, how data science makes sense of and provides feedback on data, common data science applications, and who employs data scientists. The presentation outlines the typical data science workflow and skills required, including domain knowledge, math/statistics, programming, communication/visualization, and how these skills can be obtained. It provides examples of data science
This document provides an overview of cancer in Guatemala. It notes that the top causes of cancer death in Guatemala are cervical cancer in women and gastric cancer in men. It describes the country's healthcare system, which covers 18% of the population through public contributions and 70% through direct government subsidies. Cancer screening is generally only available in the private sector. The document outlines opportunities for cancer research and treatment in Guatemala, including several specialized cancer institutions and a culture open to clinical trials. It provides statistics on cancer incidence rates and the Cancer Research Center of Guatemala's experience conducting international trials.
Evidence TableEvidence TablePICOT Question
[Insert here]APA Source Reference
(Include the DOI or URL. Use the source URL, not the library link.) Indicate: Peer Reviewed,
Clinical Guideline, or
Best Practice GuidelineAim, Hypothesis,
or Research QuestionConceptual or
Theoretical FrameworkResearch Design/MethodologyMeasurement
MethodSample Population
or SettingResearch Variables Data AnalysisFindingsGaps in ResearchSignificant Findings from a Critical Appraisal of the Evidence
(level, quality of the evidence)Good QuotesAdditional NotesEnd of Worksheet
Role of Clinical Trial Participation in Cancer Research: Barriers,
Evidence, and Strategies
Joseph M. Unger, Ph.D.1, Elise Cook, M.D.2, Eric Tai, M.D.3, and Archie Bleyer, M.D.4
1Fred Hutchinson Cancer Research Center, Seattle, Washington
2The University of Texas MD Anderson Cancer Center, Houston, Texas
3Centers for Disease Control and Prevention, Atlanta, Georgia
4St Charles Health System, Quality Department, Bend, Oregon
OVERVIEW
Fewer than 1 in 20 adult cancer patients enroll in cancer clinical trials. But although barriers to
trial participation have been the subject of frequent study, the rate of trial participation has not
changed substantially over time. Barriers to trial participation are structural, clinical, and
attitudinal, and differ according to demographic and socioeconomic factors. In this paper, we
characterize the nature of cancer clinical trial barriers, and we consider global and local strategies
for reducing barriers. We also consider the specific case of adolescents with cancer, and show that
the low rate of trial enrollment in this age group strongly correlates with limited improvements in
cancer population outcomes compared to other age groups. Our analysis suggests that a clinical
trial system that enrolls patients at higher rates produces treatment advances at a faster rate and
corresponding improvements in cancer population outcomes. Viewed in this light, the issue of
clinical trial enrollment is foundational, lying at the heart of the cancer clinical trial endeavor.
Fewer barriers to trial participation would allow trials to be completed more quickly and would
improve the generalizability of trial results. Moreover, increased accrual to trials is important to
patients, since trials provide patients the opportunity to receive the newest treatments. In an era of
increasing emphasis on a treatment decision-making process that incorporates the patient
perspective, the opportunity for patients to choose trial participation for their care is vital.
INTRODUCTION
The path from initial development of a new cancer drug to diffusion of the new therapy into
the cancer treatment community relies, crucially, on clinical trials, which represent the final
step in evaluating the efficacy of new therapeutic approaches for malignancy. It has been
repeatedly estimated that <5% of adult cancer patients enroll in cancer clinical trials.1,2
...
The concept is at the very core of everything we do: the best health care products are those that help the most people by providing the greatest benefit. Those products should result from clinical trials that include the diverse and representative populations who need them most. It sounds simple, but it’s not. The fact is that while people of diverse ethnic and cultural backgrounds make up nearly 40% of the U.S. population -- and are disproportionally impacted by chronic conditions like diabetes and cardiovascular disease, they are still heavily under-represented in the clinical trials process. Women are likewise under-represented.
These gaps exacerbate existing health equity challenges by curbing access to life-changing and life-saving treatments for some, while limiting insights into how different groups respond to new therapies. So we are doing something to close those gaps. Right now. By launching an initiative to drive diversity in research and improve care among under-represented populations, we are working to advance health equity and make access a crucial aspect of product innovation, two key aspects of Abbott's 2030 Sustainability Program. The medical therapies we develop can only be as strong and inclusive as the people who design, develop and participate in our clinical trials. Their involvement will benefit all.
Cancer and the General Internist discusses how general internists can participate in cancer care. Key points include:
1. Cancer is a leading cause of death in the Philippines and costs of treatment are high, often leading to financial catastrophe for patients.
2. General internists can play roles in cancer screening, prevention through lifestyle counseling, and multidisciplinary care throughout the cancer continuum.
3. Filipinos actively search online for information about cancer signs, symptoms, and treatments. General internists are well-positioned to provide guidance and education to the public.
Cancer and Internist - Koronadal Internist Society.pdfLanceCatedral
General internists can participate in cancer care in several ways:
1) They can conduct cancer screening tests for breast, cervical, colorectal, liver, and prostate cancers to detect cancers early.
2) They can educate patients on cancer prevention strategies like maintaining a healthy weight, being physically active, not smoking, limiting alcohol, and following dietary recommendations.
3) They can manage cancer patients in a multidisciplinary setting to provide comprehensive care involving screening, prevention, treatment, palliative care, and survivorship support.
1) The non-profit health organization Clalit Health Services in Israel will fund the Oncotype DX test for breast cancer patients to determine who would benefit from chemotherapy and who could avoid it.
2) Oncotype DX testing changed the treatment recommendation in 40% of cases, avoiding chemotherapy in 84% deemed at low risk of recurrence by the test.
3) The added cost of Oncotype DX testing was partially offset by savings from avoiding chemotherapy and resulted in a cost-effectiveness ratio of $10,770 per quality-adjusted life year gained.
This document discusses principles of cancer screening and summarizes a proposed cancer screening program called CitiScreen. It begins by outlining the Wilson-Jungner criteria for cancer screening approved by the WHO. It then discusses updated screening criteria and reviews the scientific basis for cancer screening through randomized controlled trials and other methods. The document summarizes CitiScreen's goal of comprehensive cancer screening through a combination of technologies and outlines screening patterns for specific cancers like breast, ovarian, lung, and colorectal cancer.
Nikhil Wagle, MD, discusses new research and how it is leading the way toward improved treatments for ER+ metastatic breast cancer.
Wagle is a physician with the Breast Oncology Program in the Susan F. Smith Center for Women's Cancers at Dana-Farber. He is also a researcher affiliated with Dana-Farber and the Broad Institute.
This presentation was originally given as part of the Metastatic Breast Cancer Forum, held on Oct. 17, 2015 at Dana-Farber Cancer Institute in Boston, Mass.
Cancer Clinical Trials_ USA Scenario and Study Designs.pdfProRelix Research
Clinical trials in oncology are vital for the advancement of cancer treatments and
care. The US is at the forefront of these clinical trials, with many different study
designs being used to assess the efficacy and safety of new treatments. This article
will explore the current state of oncology clinical trial services in the US, as well as
discuss different types of study designs that are commonly used. It will provide
insight into how these trials are conducted, what data is collected, and how this
information can be used to improve patient care.
The United States Food and Drug Administration (FDA) has released
several guidance documents over the years through the Oncology Center
of Excellence to support the development of oncologic treatments and
diagnoses. Furthermore, information on the clinical trials for the treatment
of different types of cancer or specific interventions can be found on the
National Cancer Institute (NCI) website and Clinical Trials. Currently,
ClinicalTrials.gov, a website maintained by the National Library of
Medicine (NLM) and the National Institutes of Health (NIH) contains
listings of publicly and privately sponsored trials and includes information
on 91,937 studies related to cancer indicating the high volume of
research being conducted in this field.According to the World Health Organization (WHO), cancer is the leading
cause of death worldwide, with a death rate of one in six in 2020 (1).
Aside from the high mortality rate and morbidity associated with cancer, it
also negatively impacts the quality of life and poses a significant financial
burden on patients and payers making it imperative to develop effective
treatments for the disease. According to Global Cancer Observatory
(GLOBACAN), the United States accounted for 13.3% of all estimated
new cases of cancer in 2020 (2). In 2020, the single leading type of
cancer in the United States was breast cancer (11.1%) followed by lung
cancer (10%), prostrate (9,2%), colorectum (6.8%), and melanoma of the
skin (4.2%). Despite the significant prevalence of cancer and numerous
clinical trials conducted for oncology treatments, data have shown an
almost 95% attrition rate for anticancer drugs from Phase I trials until
marketing authorization. Various factors such as inaccurate preclinical
models, lack of suitable biomarkers in clinical trials, and a disconnect
between industry, academia, and regulators are responsible for the high
attrition rate (3). Therefore, it is vital to develop suitable study designs
and protocols for candidate molecules such that they obtain regulatory
approval and can be marketed. In addition to these challenges, the
development of anti-cancer agents comes at a monumental cost of an
estimated $2.8 billion. Several factors such as the choice of relevant
endpoints, the choice of appropriate biomarkers that are guided by tumor
biology, and careful patient selection are expected to improve the overall
fate of oncologic agents in the clinical trial phase
The article discusses a new blood-based screening test for colon cancer that was recently approved by the FDA. However, experts have raised concerns about the test because it has not been shown to improve mortality rates compared to other screening methods. The test may be more effective at detecting advanced cancers rather than improving outcomes. While the test could increase screening rates by addressing challenges with current methods, doctors need more evidence that it actually reduces colon cancer deaths before widely incorporating it into practice.
While clinical trials represent leading cancer research, less than 5% of cancer patients enroll due to a lack of awareness and resources. Physicians have little time to enroll patients, and patients and doctors have misconceptions about clinical trials. Molecular targeted trials, based on genetic markers, require less patients than traditional trials to produce meaningful results. Unlike traditional trials, targeted trials do not use placebos and allow switching to tested drugs if beneficial. While complex genetic profiling is required for targeted trials, they provide more personalized treatment with fewer side effects than chemotherapy. Focusing clinical trial searches on predefined molecular markers can help patients find more suitable targeted trials.
Precision Medicine: Opportunities and Challenges for Clinical TrialsMedpace
The momentum and muscle behind "finding the right drug for the right patient at the right dose" has further escalated with President Barack Obama’s announcement of a $215 million dollar Precision Medicine Initiative earlier this year. In this webinar, Dr. Frank Smith will explore advances in precision medicine and how it is affecting clinical research. As a pediatric hematologist/oncologist, he will use his extensive clinical and research background as a backdrop for the discussion.
Topics will include:
The evolution of "personalized medicine" to "precision medicine"
How state-of-the-art molecular biology is creating new diagnostic and prognostic strategies
How these new strategies are helping inform the design of clinical trials
Case study: How precision medicine is improving clinical trials in hematology and oncology
On Target Laboratories focuses on developing small molecule drugs that target and illuminate specific cancerous and diseased cells, avoiding healthy tissues. It is led by Dr. Sumith Kularatne, who has over 25 patents and has advanced 6 drug candidates into human clinical trials. The company's lead candidate, OTL38, has been shown safe in phase I trials and effective in phase II trials for ovarian cancer, with upcoming phase II trials for lung cancer. OTL38 and other candidates use targeted drug delivery with ligands to illuminate and treat diseases precisely while minimizing side effects.
Observational research can impact clinical decision making for cancer treatment by providing real-world evidence to complement randomized controlled trials, which have limitations. Observational studies capture long-term outcomes of various treatments in everyday practice. However, their findings are more susceptible to bias. To strengthen observational research, standards are needed for electronic health data collection and reporting, while prioritizing patient privacy and rigorous methodologies. With these improvements, observational data can better inform estimates of cancer progression and treatment effects.
Letter to MREC - application to conduct studyAzreen Aj
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This webinar helps clinicians understand the unique healthcare needs of the LGBTQ+ community, primarily in relation to end-of-life care. Topics include social and cultural background and challenges, healthcare disparities, advanced care planning, and strategies for reaching the community and improving quality of care.
R3 Stem Cell Therapy: A New Hope for Women with Ovarian FailureR3 Stem Cell
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This particular slides consist of- what is hypotension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
Hypotension, or low blood pressure, is when the pressure of blood circulating in the body is lower than normal or expected. It's only a problem if it negatively impacts the body and causes symptoms. Normal blood pressure is usually between 90/60 mmHg and 120/80 mmHg, but pressures below 90/60 are generally considered hypotensive.
Hypertension and it's role of physiotherapy in it.Vishal kr Thakur
This particular slides consist of- what is hypertension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is summary of hypertension -
Hypertension, also known as high blood pressure, is a serious medical condition that occurs when blood pressure in the body's arteries is consistently too high. Blood pressure is the force of blood pushing against the walls of blood vessels as the heart pumps it. Hypertension can increase the risk of heart disease, brain disease, kidney disease, and premature death.
Exploring the Benefits of Binaural Hearing: Why Two Hearing Aids Are Better T...Ear Solutions (ESPL)
Binaural hearing using two hearing aids instead of one offers numerous advantages, including improved sound localization, enhanced sound quality, better speech understanding in noise, reduced listening effort, and greater overall satisfaction. By leveraging the brain’s natural ability to process sound from both ears, binaural hearing aids provide a more balanced, clear, and comfortable hearing experience. If you or a loved one is considering hearing aids, consult with a hearing care professional at Ear Solutions hearing aid clinic in Mumbai to explore the benefits of binaural hearing and determine the best solution for your hearing needs. Embracing binaural hearing can lead to a richer, more engaging auditory experience and significantly improve your quality of life.
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GEMMA Wean is available in 0.1mm, 0.2mm and 0.3mm. There is also a 0.5mm micro-pellet, GEMMA Wean Diamond, which covers the early nursery stage from post-weaning to pre-growing.
MBC Support Group for Black Women – Insights in Genetic Testing.pdfbkling
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2024 HIPAA Compliance Training Guide to the Compliance OfficersConference Panel
Join us for a comprehensive 90-minute lesson designed specifically for Compliance Officers and Practice/Business Managers. This 2024 HIPAA Training session will guide you through the critical steps needed to ensure your practice is fully prepared for upcoming audits. Key updates and significant changes under the Omnibus Rule will be covered, along with the latest applicable updates for 2024.
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Encryption Standards: Learn what is necessary and what is overhyped.
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Expert Instructor: Brian Tuttle, with over 20 years in Health IT and Compliance Consulting, brings invaluable experience and knowledge, including insights from over 1000 risk assessments and direct dealings with Office of Civil Rights HIPAA auditors.
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About this webinar: This talk will introduce what cancer rehabilitation is, where it fits into the cancer trajectory, and who can benefit from it. In addition, the current landscape of cancer rehabilitation in Canada will be discussed and the need for advocacy to increase access to this essential component of cancer care.
1. ClinicalResearchasanAlternative
Porto Alegre, November 2016
TheCancerEpidemic
Carlos H. Barrios, M.D.
Hospital do Câncer Mãe de Deus
PUCRS School of Medicine
Latin American Cooperative Group, LACOG
Porto Alegre, Brazil
3. Realidade Epidemiológica
Aumento da incidência de câncer
internacionalmente
Envelhecimento
Aumento da População
Incorporação de Fatores de Risco
Mais da metade dos casos de câncer são
esperados em países em desenvolvimento
Incidência de câncer deve duplicar em 2020
Em 2030 a incidência por câncer deve
aumentar em 78% (África do Sul, China, Índia)
e em 98% em regiões menos desenvolvidas
Mortalidade por Câncer deve superar CV em
2030 (OMS) (já está acontecendo nos US)
World Health Organization, The global burden of disease: 2004 update.
The Lancet Oncology, Early Online Publication, 1 June 2012, doi:10.1016/S1470-2045
Câncer: Um Desafio Global
Novos Casos
2000 - 10,000,000
2010 - 15,000,000
2030 - 27,000,000
Mortes
2000 - 6,200,000
2010 - 10,000,000
2030 - 17,000,000
4. • Cancer poses a major threat to public health
worldwide, and incidence rates have increased in most
countries since 1990.
• In 2013, there were 14.9 million new cancer cases and
8.2 million cancer deaths.
• The trend is a particular threat to developing nations
with health systems that are ill-equipped to deal with
complex and expensive cancer treatments.
JAMA Oncol. doi:10.1001/jamaoncol.2015.0735
Published online May 28, 2015.
5. Goss P, et al. Lancet Oncology, 2103
Educação da População
Acesso ao Sistema de Saúde
Acesso à novas Tecnologias:
Métodos diagnósticos modernos
Drogas mais eficazes
Discrepâncias
Internacionais
6. INCIDÊNCIA DE CASOS DE CÂNCER POR 100.000 HABITANTES, BRASIL 2012-2014
POR ESTADO
FONTE: INCA, ESTIMATIVAS 2012 E 2014.
POR REGIÃO
O RIO GRANDE DO SUL É O ESTADO COM MAIOR INCIDÊNCIA
DE NOVOS CASOS DE CÂNCER NOS ÚLTIMOS ANOS.
7. FONTE: OMS – OPAS, 2012
INCA, 2014
COMISSIÓN HONORÁRIA DE LUCHA CONTRA EL CÁNCER (URUGUAY), 2011.
SEGUNDO A OMS, A ESTIMATIVA DE INCIDÊNCIA DE CÂNCER NO MUNDO É MAIOR EM REGIÕES DESENVOLVIDAS (NORTE
AMÉRICA E EUROPA). NO CONTINENTE SUL AMERICANO O URUGUAI É O PAÍS COM MAIOR INCIDÊNCIA.
TX - INC.
243,22
TX - INC.
306,37
TX - INC.
456,20
TX - INC.
187,13
TX - INC.
330,17
TX - INC.
374,41
TX - INC.
471,66
TX - INC.
208,77
COMPARANDO O RS E POA NO ÂMBITO GLOBAL, O CENÁRIO É EQUIVALENTE AO DE
PAÍSES COM AS MAIORES TAXAS DE INCIDÊNCIA (APRESENTANDO TAXAS MAIORES QUE
AS DO URUGUAI.
ESTIMATIVA DA INCIDÊNCIA DE CASOS DE CÂNCER PARA CADA 100.000 HABITANTES NO MUNDO (OMS, 2012)
8. PRINCIPAIS CAUSAS DE MORTE EM PORTO ALEGRE (FONTE: SECRETARIA MUNICIPAL DE SAÚDE DE PORTO ALEGRE, 2014.)
Nº MORTES POR CAUSA DE NEOPLASIAS – ULTIMOS 7 ANOS
PRINCIPAIS CAUSAS DE MORTE
Nº MORTES POR DOENÇAS CARDIOVASCULARES – ULTIMOS 7 ANOS
NOS ULTIMOS 7 ANOS EM PORTO ALEGRE, AS MORTES POR DOENÇAS CARDIOVASCULARES APRESENTARAM
QUEDA DE 4,11%, ENQUANTO AS MORTES POR NEOPLASIAS CRESCERAM EM 12,64%.
26.4%
22.9%
9. Cancer “Globalization”
Cancer is a global
challenge that
will (only) be met
by global
participation
'The Scream' by Edvard Munch 1893, National Gallery Oslo, Norway
10. • Consider strategies to address discrepancies
• 15-25% of tumors are related to smoking
• Screening for Breast Cancer, CRC, Prostate?,
Lung?...
• Screening and vaccination for Cervical Cancer
• Addressing the Obesity epidemic
• Vaccination against Hepatitis B
• Vaccination against HPV
• Clinical Research
• Other…
Danaei G et al. Lancet 366: 1784–1793, 2005
Katz IT, et al. N Engl J Med 354: 1110–1112, 2006
Cavalli F. Nature Clin Practice Oncol, 3:582, 2006
Addressing Cancer Globalization…
11. Descobrir novos
tratamentos capazes de
superar aqueles já
existentes, além de
imprimir inovação a
medicamentos já
consolidados só é possível
através de uma
investigação minuciosa: a
pesquisa clínica.
12. Pesquisa Clínica
• Desenvolvimento de
novas formas para
prevenir, diagnosticar e
tratar o câncer.
• Através de estudos
clínicos podemos
comprovar se novos
tratamentos são seguros
e/ou mais eficazes que os
tratamentos atuais.
Pesquisa
Clínica
Tratar
Diagnosticar
Manejo de
Sintomas
Doença
Prevenir
Manejo
Eventos
Adversos
15. Clinical Cancer Research in South America - 2016
World 56.232
South America 1.378 (2.4%)
Argentina 572
Brazil 977 (1.7%)
Chile 285
Colombia 207
Ecuador 24
Peru 278
Uruguay 25
Venezuela 44
Source: www.ClinicalTrials.gov Accessed August 28nd, 2016
16. Regulatory Requirements
Local Legislation
Approval Timelines
Trial design/Placebo
Intellectual Property
FDA acceptability of data
Drug approval issues
Bio-banking legislation
Academic trials
Health Care System and access issues
Standards of Care
Local Infrastructure; Quality Assurance and Control
Bio-Banking infrastructure
Faster recruitment
Diverse populations (treatment naïve)
Trial design should recognize Cultural and Ethnic diversities that
may have safety and efficacy consequences
Informed Consent and Ethical considerations
SOPs
Lower costs
Cooperative Groups
CRO’s
New Markets
Human resources and
expertise
GLOBALIZATION
OF CLINICAL
TRIALS
Infrastructure and Health
Care Environment
Cost and
Expertise
Implications
Operational
Implications
Regulatory
Implications
Barrios CH, Werutsky G, Martinez-Mesa J.
J Am Soc Clin Oncol Educ Book. 2015;35:e132-9.
doi: 10.14694/EdBook_AM.2015.35.e132.
17. Clinical Cancer Research
• Essential to improve therapeutic
results
• “Virtuous Circle” of clinical
research: all involved do benefit
• Offers “state of the art” therapy
• Qualified investigators and large
number of patients (LA)
• Should be a strategic priority
• Need to recognize and address
bureaucratic and all other
barriers that stall development
18. Brasil e a Pesquisa Clínica em Oncologia
• Oferece o melhor tratamento disponível “state
of the art” (mesmo para o grupo controle).
• Particularmente significativo para o Brasil onde
o melhor tratamento disponível NÃO esta
disponível para a maior parte da população
(SUS) e participação em pesquisa oferece NO
MÍNIMO o tratamento convencional
ideal/ótimo.
19. Breast Cancer: Number of Cases/year 57.120
Cases in the public system-SUS (73.7%) 42.097
Stages I/II/III (94%) 39.571
HER2 positive patients (20%) 7.914
Number of deaths avoided by Trastuzumab/y (8.8%) 696
Deaths in HER2 positive women (2005-2012)* 4872
Estimated number of deaths in early HER2 positive patients due
to lack of access to adjuvant Trastuzumab in the public system in
Brazil 2005-2012.
INCA. Câncer de mama. http://www2.inca.gov.br/wps/wcm/connect/tiposdecancer/site/home/mama, Jan 2014.
IBGE. Pesquisa Nacional por Amostra de Domicílios, 2008 [acesso March 2,
2014].http://www.ibge.gov.br/home/estatistica/populacao/panorama_saude_brasil_2003_2008/PNAD_2008_saude.pdfN)
Simon, SD, et al. Projeto Amazona I, GBECAM
Perez E, ate al. J Clin Oncol 32:374, 2014.
* Presumes constant incidence and mortality 2005-2012
Barrios C, et al. JCO, Brazilian Edition, 2015.
20. Why do Clinical Trials in Latin America?
• The ability to conduct research is essential
to the development of a high quality,
sustainable, health system
• Motivations of each stakeholder may differ
• Government, Institutions, Pharma, Patients,
Physicians, others
• Everyone has something to gain
21. In their paper “Clinical Trials Infrastructure as a Quality Improvement
Intervention in Low and Middle Income Countries”, Denburg and
colleagues address an important and very pragmatic issue with
potential transforming impact in health care systems in low and middle-
income countries (LMICs). They hypothesize of a clinical trials
infrastructure effect that could impact patient care unrelated and
outside the constraints of direct clinical research participation.
This infrastructure is broadly defined by the authors as being the
organizational culture, systems and expertise that develop as a
product of participation in cooperative clinical trials. This would lead
to quality improvements within a specific institution that could also be
extended to the overall health care system resulting in better outcomes
potentially benefiting other patients independent of their individual
participation in trials. They further hypothesize, escalating the impact
of the notion, that creating this infrastructure may represent a pillar of
health care system development.
22. Why do Clinical Trials in Latin America?
• The questions (hypotheses) that need to be
addressed to improve care in low resource
settings frequently differ from those that are
given highest priority in high resource
settings
• More than half of all cancer is in developing
countries – this represents a valuable, but
largely untapped source of potentially
unique knowledge of value to all
23. Saturation of Clinical Trial
Sites
Region
Number of Trial Sites
(per 1M Population)
US 82
Western Europe 11
Central / Eastern Europe 8
Latin America 2
Asia Pacific < 1
Source: Raps Focus, 2009, Latin American CTAs
29. ClinicalResearchasanAlternative
Porto Alegre, November 2016
TheCancerEpidemic
Carlos H. Barrios, M.D.
Hospital do Câncer Mãe de Deus
PUCRS School of Medicine
Latin American Cooperative Group, LACOG
Porto Alegre, Brazil
30. Why do Clinical Trials in Latin America?
• With Clinical Trials we offer State of the Art
medical management to patients that may
not have any access or the basic resources to
receive even the most basic care.
31. In their paper “Clinical Trials Infrastructure as a Quality Improvement
Intervention in Low and Middle Income Countries”, Denburg and
colleagues address an important and very pragmatic issue with
potential transforming impact in health care systems in low and middle-
income countries (LMICs). They hypothesize of a clinical trials
infrastructure effect that could impact patient care unrelated and
outside the constraints of direct clinical research participation.
This infrastructure is broadly defined by the authors as being the
organizational culture, systems and expertise that develop as a
product of participation in cooperative clinical trials. This would lead
to quality improvements within a specific institution that could also be
extended to the overall health care system resulting in better outcomes
potentially benefiting other patients independent of their individual
participation in trials. They further hypothesize, escalating the impact
of the notion, that creating this infrastructure may represent a pillar of
health care system development.
32. Clinical Cancer Research
• Essential to improve therapeutic
results
• “Virtuous Circle” of clinical
research: all involved do benefit
• Offers “state of the art” therapy
• Qualified investigators and large
number of patients (LA)
• Should be a strategic priority
• Need to recognize and address
bureaucratic and all other
barriers that stall development
33. • Consider strategies to address discrepancies
• 15-25% of tumors are related to smoking
• Screening for Breast Cancer, CRC, Prostate?,
Lung?...
• Screening and vaccination for Cervical Cancer
• Addressing the Obesity epidemic
• Vaccination against Hepatitis B
• Vaccination against HPV
• Clinical Research
• Other… Danaei G et al. Lancet 366: 1784–1793, 2005
Katz IT, et al. N Engl J Med 354: 1110–1112, 2006
Cavalli F. Nature Clin Practice Oncol, 3:582, 2006
Addressing Cancer Globalization…
36. Clinical Cancer Research in South America - 2016
World 56.232
South America 1.378 (2.4%)
Argentina 572
Brazil 977 (1.7%)
Chile 285
Colombia 207
Ecuador 24
Peru 278
Uruguay 25
Venezuela 44
Source: www.ClinicalTrials.gov Accessed August 28nd, 2016
38. ChallengesandPerspectives
Porto Alegre, November 2016
BreastCancerinLatinAmerica
Carlos H. Barrios, M.D.
Hospital do Câncer Mãe de Deus
PUCRS School of Medicine
Latin American Cooperative Group, LACOG
Porto Alegre, Brazil
39. • LA-Caribbean region
• A complex region of 600 million people, 33 countries
and 14 territories
• 320mi (54%) have no health-care coverage
• Factors behind exclusion from health care:
• Language barriers, unemployment, underemployment,
geographic isolation, low education levels and health illiteracy
• For the poorest populations:
• Even in the context of free health care, limited access by the
inability to pay medication costs, lack of affordable
transportation, inconvenient clinic operation and long waiting
times
Goss P, et al. Lancet Oncol, 2013, 14:391
Latin American Facts
40. Lee B, Liedke P, Barrios CH, et al. Lancet Oncol, 2012; 13:e95.
Latin American Facts
41. Lee B, Liedke P, Barrios CH, et al. Lancet Oncol, 2012; 13:e95.
Latin American Facts
42. • Region will be overwhelmed by cancer over the next 2
decades resulting in:
• Significant human suffering
• A sharp rise in costs
• Cancers are diseases of ageing people
• By 2020 in LA >100 million people > 60 years
• By 2030: 1∙7 million new diagnoses and 1 million deaths/y
Goss P, et al. Lancet Oncol, 2013, 14:391
Statement of the Problem: Cancer Control in LA and the
Caribbean
43. Statement of the Problem: Cancer Control in LA and the
Caribbean
Projection of Cancer Incidence Burden 2012-2030
Bray F, Piñeros M. Cancer patterns, trends and projections in Latin America and the Caribbean: a global context. Salud Publica Mex 2016;58:104-117.
International Agency for Research on Cancer. WHO Cancer Mortality Database [accessed on November 17, 2015].
Available at: http://wwwdepiarc fr/WHOdb/WHOdb htm 2014.
45. • Cancer in LA
•Less frequent than US (163 vs. 300/100.000)
•But overall mortality/incidence ratio is 60%
higher (0.59 in LA vs. 0.35 in US)
•Largely (but not only) because of more
advanced disease at diagnosis
Statement of the Problem: Cancer Control in LA and the
Caribbean
Goss P, et al. Lancet Oncol, 2013, 14:391
46. PRINCIPAIS CAUSAS DE MORTE EM PORTO ALEGRE (FONTE: SECRETARIA MUNICIPAL DE SAÚDE DE PORTO ALEGRE, 2014.)
Nº MORTES POR CAUSA DE NEOPLASIAS – ULTIMOS 7 ANOS
PRINCIPAIS CAUSAS DE MORTE
Nº MORTES POR DOENÇAS CARDIOVASCULARES – ULTIMOS 7 ANOS
NOS ULTIMOS 7 ANOS EM PORTO ALEGRE, AS MORTES POR DOENÇAS CARDIOVASCULARES APRESENTARAM
QUEDA DE 4,11%, ENQUANTO AS MORTES POR NEOPLASIAS CRESCERAM EM 12,64%.
26.4%
22.9%
47. Breast Cancer in Latin America
• Breast cancer is the most common cancer and kills
more women than any other tumor type.
• In 2012 more than 114,900 women were diagnosed
and 37,000 women died from Breast Cancer.
• If current trends continue, by 2030, the number
new diagnosis will increase 46% and the mortality
will reach 78.000 cases a year.
• Breast Cancer cases are projected to increase to
over 595,900 and breast cancer deaths to over
142,100 by 2030 in the Americas.
PAHO, Fact Sheet Breast Cancer, 2014.
GLOBOCAN 2012. Available from: http://globocan.iarc.fr.
48. Justo N, et al. The Oncologist, 2013, 18:248-256
Breast Cancer Burden and Age of Diagnosis and
Death in LA
49. Delays in Diagnosis of Breast Cancer
in Latin America
• Studies from Brazil and Mexico, showed that the
average delay between presentation to a doctor
and diagnosis of BC was around 6-7 months.
• In Peru the delay has been estimated in 4-5
months.
• Delays in diagnosis of longer than 12 weeks are
considered to affect stage and consequently
outcomes and survival
Amadou A, et al. Salud Publica Mex 2014;56:547-554
50. Mammography Screening in Latin America
A Review of Breast Cancer and Outcomes in Latin America, PAHO
51. Justo N, et al. The Oncologist, 2013, 18:248-256
Breast Cancer Stage at Diagnosis in LA
The reduced survival is partly due to the fact that around
30%-40% of patients are diagnosed in stages III and IV
52. Outcomes of Breast Cancer in Latin America
A Review of Breast Cancer and Outcomes in Latin America, PAHO, 2010.
• BC prognosis has improved significantly over the last 50 years.
• 5 year survival rates are now over 85% in countries with best outcomes.
• In LA, data on survival is scarce and fragmented
• Available information shows a wide disparity across and within countries.
• Only in a few countries 5-year survival surpasses 70%
53. Bray F, Piñeros M. Cancer patterns, trends and projections in Latin America and the Caribbean: a global context. Salud Publica Mex 2016;58:104-117.
International Agency for Research on Cancer. WHO Cancer Mortality Database [accessed on November 17, 2015].
Available at: http://wwwdepiarc fr/WHOdb/WHOdb htm 2014.
INCIDENCE MORTALITY
Despite the scarcity of cancer registries, we estimate that in most countries, breast cancer
incidence and mortality are increasing.
Trends in BC Incidence and Mortality
ASR per 100.000
54. Breast Cancer in Latin America: Mortality
A Review of Breast Cancer and Outcomes in Latin America, PAHO
• If current trends continue, by 2030, the number new diagnosis will increase 46%.
• Breast Cancer cases are projected to increase to over 595,900 and breast cancer
deaths to over 142,100 by 2030 in the Americas.
55. The Lancet. Published Online November 26, 2014
http://dx.doi.org/10.1016/S0140-6736(14)62038-9
Central analysis of population-based registry data
Individual tumour records from 279 population-based cancer registries
67 countries for 25.7 million adults (age 15–99 years) and 75 000 children (age 0–14 years)
diagnosed with cancer during 1995–2009
Stomach,
Colon,
Rectum,
Liver, Lung,
Breast,
Cervix,
Ovary, and
Prostate in
adults, and
Adult and
childhood
Leukemia.
56. Caveat:
Only 6% of the Latin
American population is
covered by PBCRs compared
with 96% of the US
population and 32% the EU
population. The Lancet. Published Online November 26, 2014
http://dx.doi.org/10.1016/S0140-6736(14)62038-9
1995-1999
2000-2004
2005-2009
78.2% (73.5-82.8)
86.9% (84.3-89.5)
87.4% (84.8-90.0)
Breast Cancer in LA – 5 year survival
57. Breast cancer deaths
registered in the
Mortality
Data System
(SIM/WHO) and
census data on the
resident population
collected by the
Brazilian Institute of
Geography and
Statistics
(IBGE/WHO)
58. Breast Cancer
Mortality to
Incidence Ratios
Goss P, et al. Lancet Oncol, 2013, 14:391
Lee B, Liedke P, Barrios CH, et al. Lancet Oncol, 2012; 13:e95
59. All Cancer
Mortality to
Incidence Ratios
Curado MP, et al. Annals of Global Health 2014;80:370-377.
The ratio between mortality
and incidence in Latin
America is 0.59, higher than the
European Union (0.43)
and the United States (0.35),
which reflects better support of
cancer treatment in developed
countries.
60. New Technologies/Drugs Uptake
in Latin America
• In Latin America, uptake of new
treatments is slow, almost marginal in
some countries.
• This is related with the health care
systems’ coverage limitations.
A Review of Breast Cancer and Outcomes in Latin America, PAHO
61. BREAKDOWN OF SALES OF
NEW MEDICINES (2009-2013)
3%
9%
10%
55%
23%
Source: IMS Health MIDAS, April 2014.
EFPIA, European Federation of Pharmaceutical Industries and Associations, 2014.
88%
62. Breast Cancer in Latin America
• The economic burden of Breast Cancer is significant,
and it can be clearly observed that countries allocate
insufficient resources to tackle the disease.
• Women go undiagnosed, uncared for or treated with
suboptimal therapies; which results in high morbidity
and the associated societal costs.
• Vast inequities exist in access to BC health care in the
region and within countries which translates in
unequal results in BC outcome.
A Review of Breast Cancer and Outcomes in Latin America, PAHO
63. Women Children Men Total
First Class
Women (servants)
Died: 4 (0)
Survived: 113 (24)
% Survived: 97% (100%)
First Class
Children
Died: 1
Survived: 6
% Survived: 86%
First Class
Men (servants)
Died: 104 (10)
Survived: 55 (2)
% Survived 34% (17%)
First Class
Total
Died: 119
Survived: 200
% Survived: 63%
Second Class
Women (servants)
Died: 13 (0)
Survived: 78 (1)
% Survived: 86%
Second Class
Children
Died: 0
Survived: 25
% Survived: 100%
Second Class
Men (servants)
Died: 135 (4)
Survived: 13
% Survived: 8% (0%)
Second Class
Total
Died: 152
Survived: 117
% Survived: 43%
Third Class - Steerage
Women
Died: 91
Survived: 88
% Survived: 49%
Third Class - Steerage
Children
Died: 55
Survived: 25
% Survived: 31%
Third Class - Steerage
Men
Died: 381
Survived: 59
% Survived: 13%
Third Class - Steerage
Total
Died: 527
Survived: 172
% Survived: 25%
www.encyclopedia-titanica.org
www.ithaca.edu/staff/jhenderson/titanic.html
65. Low and Middle Income Countries Spend
Less in Cancer Control
Medical Cancer Control spending per new cancer diagnosis
Numbers represent economic burden
per cancer patient in US$ (and as a
percentage of GDP/Capita)
Adapted from:
1. Economist Inteligence Unit. Breakaway: The global burden of cancer— challenges and opportunities [Internet]. 2009. Available de: http://www.livestrong.org/pdfs/GlobalEconomicImpact
2. United Nations. Per capita GNI at current prices [Internet]. 2012. Available de: http://data.un.org/Data.aspx?d=SNAAMA&f=grID%3A101%3BcurrID%3AUSD%3BpcFlag%3A1
3. United Nations. World Population Prospects, the 2010 Revision [Internet]. 2011. Available de: http://esa.un.org/wpp/index.htm
4. Lopes G, et al. Nature Rev Clin Oncol 2013.
Central America
and Mexico
$7.39
67. • Cancer represents a significant challenge for
all LA and Caribbean countries.
• The evolving epidemiological transition will
inevitably result in overwhelming human and
financial consequences over the next few
years.
Conclusions
68. Conclusions
• Breast Cancer represents (and will definitely
remain) a significant burden for the region.
• Significant heterogeneity among and within
countries as well as important gaps in
prevention, screening and treatment are
identified in the LA-Caribbean region.
• Outcomes remain insufficient and require the
active engagement of society and medical
professionals.
69. ChallengesandPerspectives
Porto Alegre, November 2016
BreastCancerinLatinAmerica
Carlos H. Barrios, M.D.
Hospital do Câncer Mãe de Deus
PUCRS School of Medicine
Latin American Cooperative Group, LACOG
Porto Alegre, Brazil
70. Source: IMS Health MIDAS, December 2014.
Global Oncology Trends Report, 2015.
IMS Institute for Healthcare Informatics.
45 NEW MOLECULAR
ENTITIES LAUNCHED
2010-2014
BY INDICATION