scholarly journals Colorectal Cancer in Ukraine: Regional Disparities and National Trends in Incidence, Management, and Mortality

2018 ◽  
pp. 1-8 ◽  
Author(s):  
Nelya Melnitchouk ◽  
Galyna Shabat ◽  
Pamela Lu ◽  
Heather Lyu ◽  
Rebecca Scully ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Colon Cancer ◽  
Screening Program ◽  
Specific Treatment ◽  
Specific Therapy ◽  
Annual Percent Change ◽  
Middle Income ◽  
Middle Income Countries ◽  
National Trends ◽  
Improve Access

Purpose The incidence of colorectal cancer (CRC) is increasing worldwide, and the greatest increase is in low- to middle-income countries, such as Ukraine. Better knowledge of epidemiology of CRC in Ukraine is needed to understand how best to decrease the burden of disease. Methods The National Cancer Registry of Ukraine (NCRU) was queried for CRC incidence, mortality, stage, and treatment in Ukraine and assessed for regional variation from 1999 to 2015. Joinpoint analysis was used to analyze the trends. Results The incidence of colon cancer increased from 10.6 to 13.3 occurrences per 100,000, which provided an average annual percent change (AAPC) of 1.48 (95% CI, 1.3 to 1.7; P < .05). The incidence of rectal and anal cancers also increased from 9.9 to 11.5 occurrences per 100,000, which provided an AAPC of 1.0 (95% CI, 0.8 to 1.3; P < .05). Mortality remained the same (AAPC, 0.1; 95% CI, −0.3 to 0.2; P = .4). The proportion of patients who received cancer-specific treatment increased from 54.6% to 68.5% for colon cancer and from 61% to 74.4% for rectal and anal cancers. Overall, 34.5% of patients with colon cancer and 27.5% of patients with rectal cancer died within a year of diagnosis in 2015. Great regional variations in 1-year mortality and treatment received were identified. Conclusion The incidence of CRC in Ukraine is increasing. Despite stable mortality rates, many do not receive cancer-specific treatment, and a large proportion of patients die within a year of diagnosis. These findings illustrate the need to promote establishment of a screening program and to improve access to cancer-specific therapy in Ukraine.

scholarly journals Faecal immunochemical test-based colorectal cancer screening in Mexico: an initial experience

2020 ◽  
Vol 37 (3) ◽  
pp. 321-324 ◽  
Author(s):  
José María Remes-Troche ◽  
Gabriela Hinojosa-Garza ◽  
Priscilla Espinosa-Tamez ◽  
Arturo Meixueiro-Daza ◽  
Peter Grube-Pagola ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Potential Benefit ◽  
Large Scale ◽  
Screening Program ◽  
Preliminary Evidence ◽  
Premalignant Lesions ◽  
Middle Income ◽  
Screening Programs ◽  
Crc Screening ◽  
Middle Income Countries

Abstract Background In middle-income countries, the burden of colorectal cancer (CRC) is increasing in parallel with resources for diagnosis and treatment. There is a potential benefit of CRC screening programs in Mexico. Objective Since there are no organized screening programs in the country, we explored the willingness of individuals to complete a faecal immunochemical testing (FIT) based CRC screening program and its potential benefit in Mexico. Methods We conducted a CRC screening program pilot in Veracruz, Mexico, during 2015–16 using FIT. Individuals with FIT results &gt;100 ng of haemoglobin/ml buffer were referred for diagnostic colonoscopy. Results Of 473 FIT kits distributed to adults aged 50–75, 85.8% (406) were completed by participants and analysed in the laboratory. Of these, 5.9% (24/406) of test results showed &gt;100 ng haemoglobin/ml. Twenty-one participants completed colonoscopy. The positive predictive value of FIT &gt;100 ng haemoglobin/ml for premalignant lesions was 33%. Conclusion These results provide preliminary evidence of the willingness of individuals to complete FIT-based CRC screening program in Mexico. However, further evaluation of health systems resources will be needed prior to large-scale implementation of CRC screening programs.

scholarly journals Colorectal Cancers in Low- and Middle-Income Countries—Demographic Pattern and Clinical Profile of 970 Patients Treated at a Tertiary Care Cancer Center in India

2021 ◽  
pp. 1110-1115
Author(s):  
S. V. S. Deo ◽  
Sunil Kumar ◽  
Sandeep Bhoriwal ◽  
N. K. Shukla ◽  
Atul Sharma ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Colon Cancer ◽  
Advanced Stage ◽  
Middle Income ◽  
Female Ratio ◽  
Histologic Subtype ◽  
Middle Income Countries ◽  
Rectal Cancers ◽  
Low And Middle Income

PURPOSE Globally, colorectal cancer (CRC) ranks third in terms of incidence and second in terms of mortality. A relatively low burden of CRC has been reported from low- and middle-income countries (LMIC), and there is a paucity of publications related to CRC from LMIC. PATIENTS AND METHODS A computerized comprehensive structured CRC clinical database was developed. All the patients with histopathologically proven CRC undergoing either curative and palliative multimodality management or surgical interventions between 2000 and 2019 were included in the study. A descriptive analysis of the demographic profile and clinical spectrum was performed. RESULTS A total of 970 patients of CRC were treated between 2000 and 2019. Of these, 401 patients (41.3%) had colon cancer and 569 (58.7%) had rectal cancer. The male-to-female ratio was 1.79:1. The mean age at presentation was 47.7 years. A total of 337 (34.7%) patients qualified as young CRC (≤ 40 years of age at diagnosis). The commonest symptom among patients with colon cancer was abdominal pain; 55.6% of patients had a right-sided primary tumor as compared with 42.2% with left-sided tumors. The commonest symptom among patients with rectal cancer was bleeding per rectum. The predominant location of the tumor was in the lower rectum (58%). Majority of patients with CRC presented with locally advanced stage II and III disease. The most common histologic subtype encountered for both colon and rectal cancers was adenocarcinoma (84.8% and 81.2%, respectively). CONCLUSION This study has revealed certain important findings related to CRC in LMIC including a higher burden of young colorectal cancer, a relatively higher proportion of rectal cancers in comparison with colon cancer, a high percentage of patients with low-rectal cancer, and advanced stage at presentation.

Abstract WP280: Barriers to the Early Management of Patients With Transient Ischemic Attack in Low and Middle Income Countries

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Fernanda J Teixeira ◽  
Bernardo C Portal ◽  
Gustavo H Tomasi ◽  
Paula C Gasperin ◽  
Viviane M Vedana ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Admission ◽  
Average Length ◽  
Specific Treatment ◽  
Imaging Features ◽  
Middle Income ◽  
Early Management ◽  
Middle Income Countries ◽  
Imaging Characteristics ◽  
Low And Middle Income

Background: Although much progress has been made in the acute ischemic stroke care in low- and middle-income countries (LMIC), there is a paucity of specific data on the early management of TIA patients. Patients with TIA present a substantial risk of stroke during the first few hours of symptom onset, when secondary prevention therapies should be urgently initiated. Therefore, hospital admission may offer some advantages for early management. Our aim was to evaluate the benefit of hospital admission of TIA patients in a LMIC. Methods: All TIA patients who arrived at our emergency room (ER) between March 2015 to March 2016 were admitted to the hospital. All patients were submitted to the following diagnostic protocol: brain imaging, intra and extracranial vascular imaging, echocardiography (TT and or TEE) and ECG. Baseline, imaging characteristics and early outcome were analyzed. Results: Among 845 consecutive stroke patients evaluated at our ER, 12.8% were diagnosed as TIA. Although vascular risk factors and presentation with weakness or speech disturbances were frequent findings among our TIA patients, only 1 in 5 patients (17.4%) required specific treatment (anticoagulation or carotid revascularization). In addition, half of our patients were classified as cryptogenic TIA. The average length of stay was 7.03 and there were no in-hospital stroke or death. We did not detect significant differences in demographics, risk factors and imaging features between patients that received standard vs. specific treatment. Conclusions: Many TIA patients with mild symptoms may not have reached our ER and among those who were evaluated some may not have required hospital admission. Clustering of risk factors among TIA patients may not be a variable helpful to identify high-risk patients in LMIC. A 24/7 emergency TIA clinic may be an option to improve urgent treatment and reduce acute care cost.

scholarly journals Affordable stroke therapy in high-, low- and middle-income countries: From Theradrive to Rehab CARES, a compact robot gym

2017 ◽  
Vol 4 ◽  
pp. 205566831770873 ◽  
Author(s):  
Michelle Jillian Johnson ◽  
Roshan Rai ◽  
Sarath Barathi ◽  
Rochelle Mendonca ◽  
Karla Bustamante-Valles
Keyword(s):  
Stroke Rehabilitation ◽  
Low Cost ◽  
Lessons Learned ◽  
Stroke Therapy ◽  
Robot Assisted ◽  
Community Based ◽  
Middle Income ◽  
Middle Income Countries ◽  
The Usa ◽  
Improve Access

Affordable technology-assisted stroke rehabilitation approaches can improve access to rehabilitation for low-resource environments characterized by the limited availability of rehabilitation experts and poor rehabilitation infrastructure. This paper describes the evolution of an approach to the implementation of affordable, technology-assisted stroke rehabilitation which relies on low-cost mechatronic/robot devices integrated with off-the-shelf or custom games. Important lessons learned from the evolution and use of Theradrive in the USA and in Mexico are briefly described. We present how a stronger and more compact version of the Theradrive is leveraged in the development of a new low-cost, all-in-one robot gym with four exercise stations for upper and lower limb therapy called Rehab Community-based Affordable Robot Exercise System (Rehab C.A.R.E.S). Three of the exercise stations are designed to accommodate versions of the 1 DOF haptic Theradrive with different custom handles or off-the-shelf commercial motion machine. The fourth station leverages a unique configuration of Wii-boards. Overall, results from testing versions of Theradrive in USA and Mexico in a robot gym suggest that the resulting presentation of the Rehab C.A.R.E.S robot gym can be deployed as an affordable computer/robot-assisted solution for stroke rehabilitation in developed and developing countries.

scholarly journals Is Colorectal Cancer Screening Appropriate in Nigeria?

2019 ◽  
pp. 1-10
Author(s):  
Gregory C. Knapp ◽  
Olusegun I. Alatise ◽  
Olalekan O. Olasehinde ◽  
Ademola Adeyeye ◽  
Omobolaji O. Ayandipo ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Parasitic Infection ◽  
Molecular Profile ◽  
Future Research ◽  
Middle Income ◽  
Crc Screening ◽  
Middle Income Countries ◽  
Incidence And Mortality ◽  
Prospective Trials ◽  
The Impact

PURPOSE The global burden of colorectal cancer (CRC) will continue to increase for the foreseeable future, largely driven by increasing incidence and mortality in low- and middle-income countries (LMICs) such as Nigeria. METHODS We used the Wilson-Jungner framework (1968) to review the literature relevant to CRC screening in Nigeria and propose areas for future research and investment. RESULTS Screening is effective when the condition sought is both important and treatable within the system under evaluation. The incidence of CRC is likely increasing, although the exact burden of disease in Nigeria remains poorly understood and access to definitive diagnosis and treatment has not been systematically quantified. In high-income countries (HICs), CRC screening builds on a well-known natural history. In Nigeria, a higher proportion of CRC seems to demonstrate microsatellite instability, which is dissimilar to the molecular profile in HICs. Prospective trials, tissue banking, and next-generation sequencing should be leveraged to better understand these potential differences and the implications for screening. Fecal immunochemical test for hemoglobin (FIT) is recommended for LMICs that are considering CRC screening. However, FIT has not been validated in Nigeria, and questions about the impact of high ambient temperature, endemic parasitic infection, and feasibility remain unanswered. Prospective trials are needed to validate the efficacy of stool-based screening, and these trials should consider concomitant ova and parasite testing. CONCLUSION Using the Wilson-Jungner framework, additional work is needed before organized CRC screening will be effective in Nigeria. These deficits can be addressed without missing the window to mitigate the increasing burden of CRC in the medium to long term.

scholarly journals Developing a Breast Cancer Screening Program in Nigeria: Evaluating Current Practices, Perceptions, and Possible Barriers

2017 ◽  
Vol 3 (5) ◽  
pp. 490-496 ◽  
Author(s):  
Olalekan Olasehinde ◽  
Carla Boutin-Foster ◽  
Olusegun I. Alatise ◽  
Adewale O. Adisa ◽  
Oladejo O. Lawal ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Low Income ◽  
Screening Program ◽  
Cross Sectional Survey ◽  
Middle Income ◽  
Screening Programs ◽  
Middle Income Countries ◽  
Low And Middle Income

Purpose In low- and middle-income countries like Nigeria, women present with advanced breast cancer at an earlier age. Given the limited resources, development of screening programs that parallel resource capabilities of low- and middle-income countries is imperative. The objective of this study was to evaluate the perceptions, practices, and barriers regarding clinical breast examination (CBE) screening in a low-income community in Nigeria. Materials and Methods A cross-sectional survey of women age 40 years or older in Ife, Nigeria, using multistaged sampling was performed. Information on sociodemographics, knowledge of breast cancer, screening practices, and willingness to participate in CBE screening was obtained using an interviewer-administered questionnaire. Results A total of 1,169 women whose ages ranged from 40 to 86 years (mean age, 47.7 years; standard deviation, 8.79 years) were interviewed. The majority of women (94%) knew about breast cancer, whereas 27.5% knew someone who had had breast cancer, the majority of whom (64.5%) had died of the disease. Of the 36% of women who had breast screening recommended to them, only 19.7% had an actual CBE. Of these, only 6% had it in the last year. The majority of women (65.4%) were willing to have regular CBEs and did not care about the sex of the examiner in most instances. Lack of perceived need was the reason cited by women unwilling to participate. Conclusion The majority of women were aware of breast cancer and knew it as a fatal disease. With the relatively encouraging number of those willing to be examined, a carefully designed CBE program coupled with advocacy to correct uneducated beliefs seems promising.

Comparison of rituximab originator (MabThera®) to biosimilar (Truxima®) in patients with multiple sclerosis

2020 ◽  
pp. 135245852091217 ◽  
Author(s):  
Thomas Perez ◽  
Audrey Rico ◽  
Clémence Boutière ◽  
Adil Maarouf ◽  
Marjorie Roudot ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Adverse Events ◽  
Efficacy And Safety ◽  
Middle Income ◽  
Middle Income Countries ◽  
Disability Status ◽  
Baseline Characteristics ◽  
Magnetic Resonance Imaging Mri ◽  
Improve Access

Background: Rituximab’s originator MabThera® or Rituxan® has demonstrated high efficacy in multiple sclerosis (MS). Because of the patent expiration, rituximab biosimilars have been developed. However, because a biosimilar is not the exact copy of the originator, the efficacy and safety of a biosimilar may significantly differ. Objectives: To compare the efficacy and safety of the biosimilar Truxima® and the originator MabThera® in MS. Methods: Consecutive MS patients receiving MabThera® or Truxima® were prospectively followed during 1 year after treatment introduction. Allocation to each treatment depended on the period of introduction and not the physician’s choice. Lymphocyte count, clinical and magnetic resonance imaging (MRI) activity, Expanded Disability Status Scale (EDSS), and adverse events were compared. Results: In total, 105 and 40 patients received MabThera® and Truxima®, respectively. The two groups did not differ in baseline characteristics. Effect on CD19+ lymphocytes and disease activity were similar during follow-up. EDSS remained stable, with no difference between groups. Adverse events were similar between groups. Conclusion: The efficacy and safety of the rituximab biosimilar Truxima® seem equivalent to the originator MabThera® in MS patients. Truxima® could represent a relatively cheap and safe therapeutic alternative to MabThera® and could improve access to highly efficient therapy for MS in low- or middle-income countries.

scholarly journals Compulsory Licenses for Cancer Drugs: Does Circumventing Patent Rights Improve Access to Oncology Medications?

2016 ◽  
Vol 2 (5) ◽  
pp. 292-301 ◽  
Author(s):  
Cinthia Leite Frizzera Borges Bognar ◽  
Brittany L. Bychkovsky ◽  
Gilberto de Lima Lopes
Keyword(s):  
Cancer Control ◽  
Compulsory License ◽  
Legal Framework ◽  
Essential Medicines ◽  
Cancer Drugs ◽  
Middle Income ◽  
Middle Income Countries ◽  
Life Saving ◽  
Poor Outcomes ◽  
Improve Access

Worldwide, there are enormous inequities in cancer control that cause poor outcomes among patients with cancer who live in low- and middle-income countries (LMICs). One of the biggest challenges that oncology faces today is how to increase patient access to expensive, but life-saving, therapies in LMICs. Access to cancer medications in LMICs is a major problem, especially in recent years, as the costs of these therapies continue to rise exponentially. One mechanism available to LMICs to improve access to cancer medications allows a country to pursue a compulsory license for a given drug. Here, we will review how the legal framework in the World Trade Organization's Trade-Related Aspects of Intellectual Property Rights Agreement and the Doha Declaration supports countries to circumvent patent laws and acquire compulsory licenses for essential medicines. We will also discuss the current and future role of compulsory licenses in oncology and how compulsory licenses may improve access to cancer drugs in LMICs.

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