BackgroundCoronavirus disease 2019 (COVID-19), caused by the SARS-CoV-2 virus, was first identified in late 2019 and went on to profoundly disrupt health care systems worldwide. The pandemic led to unprecedented increases in healthcare delivery costs, widespread disruption in medical supply chains, workforce instability, and a loss of typical inpatient caregiver support. These challenges affected all levels of care, from primary health services to highly specialized intensive care units (ICUs). Before vaccines were available, ICUs were overwhelmed by critically ill patients requiring mechanical ventilation, saturating capacity and straining staff.ObjectivesThis article seeks to examine the effect that COVID-19 had on ICUs globally, acknowledging its impact with an aim to identify solutions that can be used to help mitigate the overburdening of this limited resource in future pandemics.MethodsA narrative review approach was used, drawing on published literature, observational data, and institutional responses from 2020 to 2025, to analyze structural, operational, and clinical adjustments in ICU design and function.ResultsKey adaptations included physical redesigns, rapid infection-control upgrades, the use of negative pressure rooms, expansion of tele-ICU systems, and virtual family engagement strategies. These interventions were implemented to address ICU crowding, equipment shortages, and staff burnout, and helped to maintain continuity of care during surge conditions.ConclusionsThe COVID-19 pandemic demonstrated the need for ICUs to be more agile, scalable, and future-facing. Lessons learned highlight the importance of preparedness strategies that strengthen ICU resilience and support critical care delivery in future public health emergencies.
PURPOSE Bone metastases (BM) occur in approximately 30% of patients with metastatic renal cell carcinoma (mRCC) and are associated with poor survival and symptomatic skeletal events (SSEs). Radium-223, an alpha-emitting bone-seeking radioisotope, and cabozantinib, a tyrosine kinase inhibitor, have demonstrated activity in BM. RADICAL (Alliance A031801; ClinicalTrials.gov identifier: NCT04071223 ) evaluated cabozantinib ± radium-223 in mRCC with BM. METHODS This phase II trial enrolled patients with mRCC of any histology with ≥1 BM. Patients were randomly assigned 1:1 to cabozantinib ± radium-223, stratified by osteoclast-targeted therapy (OTT), prior therapy, opioid use, and International mRCC Database Consortium (IMDC) risk. The primary end point was SSE-free survival (SSE-FS). Secondary end points included safety, objective response rate (ORR), progression-free survival, and overall survival (OS). A target of 124 evaluable patients was planned, with a prespecified interim futility analysis at 50% of expected SSE-FS events; the trial would stop if the stratified hazard ratio (sHR) > 1.0. RESULTS The prespecified interim futility analysis was conducted after 90 patients were enrolled and crossed the futility boundary, leading to closure at 98 patients. The final analysis included all 98 patients. Median age was 63 years, 82.7% had clear cell histology, and 79.6% were using an OTT. IMDC risk was favorable (18.4%), intermediate (67.3%), and poor (14.3%). Median follow-up was 13.1 months. Median SSE-FS for cabozantinib with radium-223 versus cabozantinib was 16.7 versus 17.6 months (sHR, 1.46 [90% CI, 0.86 to 2.51]). Median OS was 28.3 versus 19.7 months (sHR, 1.40 [95% CI, 0.70 to 2.79]). ORR was 19.4% versus 25.0% ( P = .78). Grade ≥3 adverse events were similar across arms (69.6% v 75.5%). CONCLUSION Radium-223 did not improve SSE-FS when added to cabozantinib. The combination demonstrated a manageable safety profile.
e12765 Background: Breast cancer (BC) remains one of the most common malignancies globally and a leading cause of female mortality and disability. Although advancements in screening and treatment have improved outcomes in high- income countries, the burden attributable to modifiable risk factors—particularly behavioral risks (BRs) and metabolic risks (MRs) varies substantially over time, regions, and socio-demographic strata. Methods: We utilized the Global Burden of Disease (GBD) 2023 framework to quantify global, regional, and age-specific BC burden attributable to BRs and MRs across 204 countries from 1990 to 2023. Outcomes included deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs). Results: Globally, BC deaths attributable to all risk factors increased from 120,728 (95% UI: 71,625–165,691) in 1990 to 232,506 (133,617–322,736) in 2023 (EAPC +1.81%). YLLs rose from 3.55 to 6.43 million (+1.58%), and YLDs from 226,705 to 509,110 (+2.38%). Age-standardized mortality rates (ASMRs) declined in HI (−1.61%), High-Socio-demographic Index (SDI) (−1.51%), SEA, EA, and Oceania (−0.66%), High-middle SDI (−0.50%), and CE, EE and CA (−0.37%); remained stable in Low SDI (−0.17%); and increased in SA (+1.84%), NEMA (+1.21%), SA (+1.01%), Low-middle SDI (+0.61%), Middle SDI (+0.55%), and LA and Caribbean (+0.16%). From 1990-2023, BC burden attributable to BRs declined across all metrics: Deaths (EAPC −1.06%), DALYs (−0.97%), YLLs (−1.02%), and YLDs (−0.34%). Conversely, MR-attributable burden remained stable or slightly increased: Deaths (−0.27%), YLLs (−0.26%), YLDs (+0.41%). Age-stratified analysis showed that BR- attributable DALY rates declined in: 20–54 years (−0.35%), and ≥55 years (−1.04%). In contrast, MR- attributable DALY rates increased in 20–54 years (+0.88%) and slightly declined in ≥55 years (−0.16%). Conclusions: The global burden of BC attributable to BRs consistently declined, while that due to MRs remained stable or rose—particularly among younger and middle-aged adults. These findings highlight the shifting landscape of modifiable exposures and underscore the urgent need for targeted MR reduction strategies, especially in low- and middle-income countries (LMICs) where BC mortality is on the rise. Region Diet high in red meat High alcohol use High body-mass index High fasting plasma glucose Low physical activity Secondhand smoke Smoking High-income (HI) -1.59 -1.86 -0.99 -0.9 -1.44 -3.14 -2.26 Latin America (LA) and Caribbean 0.31 0.92 1.46 0.44 0.45 -1.83 -1.79 North Africa and Middle East (NEMA) 1.08 -2.4 2.83 2.83 1.39 0.86 0.19 South Asia (SA) 2 0.46 5.56 2.64 1.55 0.35 0.29 Southeast Asia (SEA), East Asia (EA), and Oceania -0.62 -1.18 0.98 -1.04 -0.2 -0.95 -2.05 Sub-Saharan Africa (SA) 1.8 1.71 3.54 2.99 1.94 1.01 0.17 Central Europe (CE), Eastern Europe (EE), and Central Asia (CA) -0.85 -1.02 0.5 0.29 -0.34 -1.94 -0.36
10580 Background: Cancer (CA) remains a leading global driver of disability and premature death, yet its full macroeconomic toll is rarely quantified. In this study, we estimated the global economic welfare loss attributable to all cancers in 2023 across 183 countries using a standardized Value of Lost Welfare (VLW) framework. Methods: We obtained country-level disability-adjusted life years (DALYs) for CA from the Global Burden of Disease Study 2023. Corresponding GDP (PPP, current international dollars) and population data were sourced from the World Bank. We calculated VLW by multiplying DALYs by a fixed monetary value of USD 14,403.29 per DALY, yielding estimates of total VLW, per-capita VLW, and VLW/GDP (%). CA-specific estimates were derived using cause-wise DALY distributions across global and regional levels. Results: In 2023, CA caused 268.9 million DALYs globally, resulting in a global VLW of USD 3.87 trillion—equivalent to 2.12% of global GDP, with an average per-capita economic loss of 522 billion. The largest absolute economic losses were reported in China (915.5 billion), India (458.7 billion), and the United States, followed by Japan (126.7 billion) and Brazil (108.6 billion). When adjusted for national GDP, the highest VLW-to-GDP ratios were observed in Zimbabwe (4.24%), Cambodia (4.00%), Mongolia (3.45%), India (3.09%), and Egypt (1.63%), reflecting intense economic vulnerability. Across SDI strata, high-SDI countries bore the greatest economic burden, incurring a VLW of 1.80 trillion, followed by high-middle SDI (808.7 billion), low SDI (568.0 billion), low-middle SDI (406.5 billion), and middle SDI (384.9 billion). While absolute losses were highest in high-SDI settings, VLW/GDP ratios were notably elevated in low- and low-middle SDI regions, signaling disproportionate economic strain in resource-limited contexts. By CA type, lung CA led the global burden with 672 billion in welfare losses, followed by colorectal CA (377 billion), breast CA (355 billion), stomach CA (324 billion), and esophageal CA (202 billion). Conclusions: The global macroeconomic cost of CA surpassed USD 3.6 trillion in 2023, with marked disparities across countries and regions. High-burden nations such as China, India, and the U.S. faced the steepest absolute losses, while several low-income countries suffered disproportionately high economic strain relative to GDP. The concentration of losses in five major CA types signals an urgent need for enhanced global investments in CA prevention, early detection, and control. Regional cancer burden and economic losses in 2023. Region DALYs (Millions) VLW ($ Billion) VLW/GDP (%) Sub-Saharan Africa 28.82 415.14 6.64 South Asia 43.72 629.68 3.48 Southeast Asia, East Asia & Oceania 89.19 1284.6 2.76 North Africa & Middle East 14.34 206.6 2.50 Latin America & Caribbean 18.39 264.91 2.36 Central/Eastern Europe & Central Asia 20.89 300.85 2.20 High Income 60.37 869.53 1.25
