A Reflection on the Work of Gianni Bonadonna from the Viewpoint of the Global Challenge of Adolescents and Young Adults with Cancer

2017 ◽  
Vol 103 (6) ◽  
pp. 489-494 ◽  
Author(s):  
Ronald D. Barr ◽  
W. Archie Bleyer
Keyword(s):  
Young Adults ◽  
Survival Rates ◽  
Great Majority ◽  
Adolescents And Young Adults ◽  
Care Providers ◽  
Middle Income ◽  
Late Professor ◽  
Global Challenge ◽  
Middle Income Countries ◽  
The Impact

Adolescents and young adults (AYAs – ages 15 to 39) constitute approximately 40% of the world's population and contribute an estimated one million new cases of cancer annually, the great majority in low- and middle-income countries (LMICs). In high-income countries (HICs) cancer is the commonest cause of disease-related death in AYAs, though overall 5-year survival rates now exceed 80%. A very different circumstance likely holds in LMICs, but accurate assessments are not readily available. Breast cancer accounts for 40% of tumours in female AYAs and this age group includes the peak incidence of Hodgkin lymphoma. The late Professor Gianni Bonadonna contributed importantly to improved survival in patients with these two diseases. Accordingly, he would be justifiably proud of the advances in AYA oncology that are being made in Italy, especially the impact of his colleagues at the Istituto Nazionale dei Tumori (INT). The initiatives of the Associazione Italiana Ematologia Pediatrica and the Società Italiana Adolescenti con Malattie Onco-ematologiche are particularly noteworthy, with the accomplishment of productive collaboration between paediatric and adult cancer care providers serving as a model for other countries to emulate. Exporting these advances can be successful through the vehicle of “twinning”: establishing sustainable cooperation between institutions in HICs and partners in LMICs. Colleagues in Monza and at INT have been leaders in such programmes for decades. Cancer in AYAs remains a global challenge to which Gianni Bonadonna surely would have risen with enthusiasm and leadership while securing measurable achievements.

scholarly journals Global trends in survival from brain tumours in adolescents and young adults: a systematic review.

2019 ◽  
Author(s):  
Fabio Girardi ◽  
Claudia Allemani ◽  
Michel P Coleman
Keyword(s):  
Systematic Review ◽  
Young Adults ◽  
Brain Tumours ◽  
Time Trends ◽  
Population Based ◽  
Adolescents And Young Adults ◽  
Who Grade ◽  
Middle Income ◽  
Middle Income Countries ◽  
Astrocytic Tumours

Abstract Background Brain tumours represent an important cause of cancer-related death in adolescents and young adults. Most are diagnosed in low-income and middle-income countries. We aimed to conduct the first systematic review of time trends and geographical variation in survival in this age group. Methods We included observational studies describing population-based survival from astrocytic tumours in patients aged 15-39 years. We queried six electronic databases from database inception to 30 September 2018. This review is registered with PROSPERO, number CRD42018111981. Results Among 5,245 retrieved records, 20 studies fulfilled the inclusion criteria. Only one study was partly conducted in middle-income countries. Five-year survival from astrocytoma (broad morphology group) varied between 48% and 71% (1973-2004), without clear trends or geographic differences. Adolescents with astrocytoma had better outcomes than young adults, but survival values were similar when non-malignant tumours were excluded. During 2002-2007, five-year survival for WHO grade I-II tumours was in the range 75-93% in England, Germany, and the US, but lower in South-Eastern Europe (59%). Five-year survival for anaplastic astrocytoma varied between 40% and 55% (2002-2007). Five-year survival from glioblastoma was in the range 15-23% (1991-2009). Conclusions Survival from astrocytic tumours remained somewhat steady over time, with little change between 1973 and 2009. Survival disparities were difficult to examine, because nearly all the studies were conducted in affluent countries. Studies often adopted the International Classification of Childhood Cancer, which, however, did not allow to accurately describe variation in survival. Larger studies are warranted, including under-represented populations and providing more recent survival estimates. Keywords Population-based survival, brain tumours, adolescents, young adults, time trends.

Informal mental health interventions for people with severe mental illness in low and lower middle-income countries: A systematic review of effectiveness

2019 ◽  
Vol 65 (3) ◽  
pp. 194-206 ◽  
Author(s):  
Trang Nguyen ◽  
Sara Holton ◽  
Thach Tran ◽  
Jane Fisher
Keyword(s):  
Systematic Review ◽  
Mental Illness ◽  
Severe Mental Illness ◽  
Community Care ◽  
Cochrane Central Register ◽  
Care Providers ◽  
Middle Income ◽  
Middle Income Countries ◽  
Informal Community ◽  
The Impact

Background: The effectiveness of interventions for people with severe mental illness delivered by informal community care providers in low and lower middle-income countries is not known. The aim was to conduct a systematic review of the impact of community-based interventions implemented by the informal sector for people with severe mental illness in these settings. Methods: Five electronic databases (MEDLINE, EMBASE, PsycINFO, CINAHL, and Cochrane Central Register of Controlled Trials) were searched for English-language publications using both keywords and MeSH terms. All study designs were included. Results: Five papers, reporting data from five studies conducted in four low and lower middle-income countries in 2017, met the inclusion criteria for the review. Of the five included studies, three had a before and after design, one was a randomized controlled trial, and one a qualitative investigation. Most interventions with a low-moderate quality of evidence used informal community care providers to deliver either self-help groups, traditional healing treatments, and/or a rehabilitation program. The investigators reported data about improvements in the outcomes of intervention participants (psychosocial functioning, psychotic symptoms, and social inclusion) and positive impacts on their families (family’s knowledge and skills of mental illness management, caregiving burden, social exclusion/stigma against people with severe mental illness, and financial burden). Cost-effectiveness of the intervention (in one study) found that it had a higher financial cost but greater effectiveness than the usual standard of care. Conclusion: Although only a small number of studies were identified, the review provides promising evidence of the professionally developed interventions for people with severe mental illness, delivered by the informal community workforce in low and lower middle-income settings. Training and supportive supervision for informal community care providers are crucial components of effective interventions.

scholarly journals Use of Paclitaxel to Successfully Treat Children, Adolescents, and Young Adults with Kaposi Sarcoma in Southwestern Tanzania

Children ◽  
2021 ◽  
Vol 8 (4) ◽  
pp. 275
Author(s):  
Hamidu Adinani ◽  
Liane Campbell ◽  
Nader Kim El-Mallawany ◽  
Jeremy Slone ◽  
Parth Mehta ◽  
...  
Keyword(s):  
Young Adults ◽  
Treatment Failure ◽  
Kaposi Sarcoma ◽  
Adolescents And Young Adults ◽  
Term Survival ◽  
Middle Income ◽  
Middle Income Countries ◽  
Special Circumstances ◽  
Lost To Follow Up

Treating Kaposi sarcoma (KS) in children, adolescents, and young adults (AYA) remains a challenge in low- and middle-income countries (LMIC) where chemotherapy options and availability are limited. We describe a retrospective cohort review of pediatric patients with KS treated with paclitaxel in Mbeya, Tanzania, between 1 March 2011 and 31 December 2019. Paclitaxel was given to patients who had KS relapse, a contraindication to bleomycin, vincristine, and doxorubicin (ABV), special circumstances in which a clinician determined that paclitaxel was preferable to ABV, or experienced treatment failure, defined as persistent KS symptoms at the completion of treatment. All patients also received multidisciplinary palliative care. Seventeen patients aged 5.1–21.3 years received paclitaxel, of whom 47.1% (8/17) had treatment failure, 29.4% (5/17) received paclitaxel as initial treatment, and 23.5% (4/17) had relapsed. All HIV positive patients (16/17) were given anti-retroviral therapy (ART) and 87.5% (14/16) achieved viral load <1000 cp/mL. At censure, 82.3% (14/17) of patients were alive—71.4% (10/14) achieved complete clinical remission and 28.6% (4/14) achieved a partial response. The median follow up was 37.3 months (range 8.0–83.5, IQR 19.7–41.6), and no patients were lost to follow up. In this cohort, high rates of long-term survival and favorable outcomes were possible with paclitaxel treatment.

scholarly journals Evaluation of a Worksite Cervical Screening Initiative to Increase Pap Smear Uptake in Malaysia: A Cluster Randomized Controlled Trial

2013 ◽  
Vol 2013 ◽  
pp. 1-7
Author(s):  
Fauziah Abdullah ◽  
Michael O’Rorke ◽  
Liam Murray ◽  
Tin Tin Su
Keyword(s):  
Cervical Cancer ◽  
Pap Smear ◽  
Cervical Screening ◽  
Pap Test ◽  
Control Group ◽  
Care Providers ◽  
Middle Income ◽  
Middle Income Countries ◽  
Cluster Randomized ◽  
The Impact

Background. Despite the significant burden of cervical cancer, Malaysia like many middle-income countries relies on opportunistic cervical screening as opposed to a more organized population-based program. The aim of this study was to ascertain the effectiveness of a worksite screening initiative upon Papanicolaou smear test (Pap test) uptake among educated working women in Malaysia.Methods. 403 female teachers who never or infrequently attended for a Pap test from 40 public secondary schools in Kuala Lumpur were recruited into a cluster randomized trial conducted between January and November 2010. The intervention group participated in a worksite cervical screening initiative whilst the control group received usual care from the existing cervical screening program. Multivariate logistic regression was performed to determine the impact of the intervention program on Pap smear uptake after 24 weeks of followup.Results. The proportion of women attending for a Pap test was significantly higher in the intervention than in the control group (18.1% versus 10.1%,Pvalue < 0.05) with the worksite screening initiative doubling the Pap smear uptake, adjusted odds ratio 2.44 (95% CI: 1.29–4.62).Conclusion. Worksite health promotion interventions can effectively increase cervical smear uptake rates among eligible workers in middle-income countries. Policy makers and health care providers in these countries should include such interventions in strategies for reducing cervical cancer burden. This trial is registered withIRCT201103186088N1.

scholarly journals Drug Recovery and Copay Assistance Program in a Community Cancer Center: Charity and Challenges

2019 ◽  
Vol 15 (7) ◽  
pp. e628-e635 ◽  
Author(s):  
Robert D. Siegel ◽  
Richard G. Slough ◽  
Howland E. Crosswell ◽  
Theresa M. Standifer ◽  
Michael E. Borron ◽  
...  
Keyword(s):  
Young Adults ◽  
Cancer Care ◽  
Financial Burden ◽  
Cost Savings ◽  
Adolescents And Young Adults ◽  
Cancer Center ◽  
Care Providers ◽  
Assistance Program ◽  
The Cost ◽  
The Impact

PURPOSE: The cost of cancer care is escalating dramatically, in part because of the rising expense of systemic cancer therapy. This creates financial dilemmas for patients and insurers and potential economic disruption for institutions attempting to provide cancer care to the underserved. Our institution initiated a drug recovery and copay assistance program (DRCAP) to mitigate the impact of the rising cost of parenteral medications. METHODS: We performed a 3-year review of our strategies to mitigate financial burden of parenteral therapeutics and supportive care medicines. Financial metrics were established and analyzed before and after implementing DRCAP. Medication encounters and associated costs were stratified by adolescents and young adults (15 to 39 years of age), and adults 40 years of age and older and were annualized from 2016 to 2018. RESULTS: The DRCAP resulted in a total of nearly $3.5 million worth of drugs replaced or copay assistance yearly in 2017 and 2018. This accounted for approximately 10% of our pharmacy budget for parenteral medications in each of these years. The vast majority was received in the form of drug replacement. The DRCAP resulted in assistance to 173 and 256 patients in 2017 and 2018, respectively. CONCLUSION: A DRCAP increased availability of otherwise unaffordable parenteral oncolytics and resulted in cost savings for our institution. Adolescents and young adults were disproportionately represented because of inadequate or no insurance. Despite the salutary benefits, such programs likely inflate the overall cost of cancer care. Cancer care providers participating in a DRCAP will remain in this conundrum until market forces can affect the cost of oncology therapeutics.

The Impact of Covid 19 on Pregnant Women and Child Health

2020 ◽  
Vol 11 (SPL1) ◽  
pp. 1367-1373
Author(s):  
Nikhil Sanjay Mujbaile ◽  
Smita Damke
Keyword(s):  
Social Issues ◽  
Middle Income ◽  
Web Based ◽  
Middle Income Countries ◽  
Low Middle Income Countries ◽  
The Social ◽  
Social Separation ◽  
The Impact ◽  
And Child Health ◽  
General Wellbeing

The Covid illness (COVID-19) pandemic has spread rapidly all through the world and has had a drawn-out impact. The Pandemic has done incredible damage to society and made genuine mental injury to numerous individuals. Mental emergencies frequently cause youngsters to deliver sentiments of relinquishment, despondency, insufficiency, and fatigue and even raise the danger of self-destruction. Youngsters with psychological instabilities are particularly powerless during the isolate and colonial removing period. Convenient and proper assurances are expected to forestall the event of mental and social issues. The rising advanced applications and wellbeing administrations, for example, telehealth, web-based media, versatile wellbeing, and far off intuitive online instruction can connect the social separation and backing mental and conduct wellbeing for youngsters. Because of the mental advancement qualities of youngsters, this investigation additionally outlines intercessions on the mental effect of the COVID-19 Pandemic. Further difficulties in Low Middle-Income Countries incorporate the failure to actualize successful general wellbeing estimates, for example, social separating, hand cleanliness, definitive distinguishing proof of contaminated individuals with self-disconnection and widespread utilization of covers The aberrant impacts of the Pandemic on youngster wellbeing are of extensive concern, including expanding neediness levels, upset tutoring, absence of admittance to the class taking care of plans, decreased admittance to wellbeing offices and breaks in inoculation and other kid wellbeing programs. Kept tutoring is critical for kids in Low Middle-Income Countries. Arrangement of safe situations is mainly testing in packed asset obliged schools. 

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