Background: Post-mastectomy radiotherapy (PMRT) significantly reduces loco-regional recurrence and improves survival in breast cancer patients with node-positive or high-risk disease. The UK START trials established 40 Gy in 15 fractions as a safe and effective alternative to 50 Gy/25. The FAST-Forward trial later demonstrated non-inferiority of 26 Gy in 5 fractions, but only a minority of participants had undergone mastectomy. Limited prospective data exist for ultra-hypofractionated PMRT, particularly in the Indian setting, where shorter regimens could reduce patient and system burden. Methods: This prospective randomised study enrolled 50 women with stage II-IIIA invasive breast cancer treated with modified radical mastectomy. Patients were randomised equally to receive PMRT as either 40 Gy in 15 fractions (Group A) or 26 Gy in 5 fractions (Group B). CT-based planning was performed using 3D conformal radiotherapy or volumetric-modulated arc therapy techniques, with the deep inspiration breath hold (DIBH) technique implemented for left-sided cases to minimise cardiac dose. Results: Baseline demographics were balanced, though Group B had more left-sided tumours (68% versus 40%) and fewer node-positive cases (44% versus 72%). Both regimens achieved excellent planning target volume coverage (>95%). Ultra-hypofractionation (26 Gy/5) yielded lower ipsilateral lung exposure (V30 = 17% versus Group AV20 = 27%), reduced contralateral lung (300 versus 384 cGy), contralateral breast (247 versus 320 cGy) and spinal cord dose (938 versus 2,206 cGy). Mean heart dose was slightly higher in Group B (275 versus 181 cGy), but no patient exceeded a mean heart dose of 6 Gy, and all had V 25% <5%, consistent with international tolerance thresholds. Acute toxicity was minimal in both arms, limited to Grade 1 dermatitis; no Grade >= 2 toxicity was observed. At 6 months, all patients were alive and disease-free. Conclusion: Ultra-hypofractionated PMRT (26 Gy/5) is feasible, well-tolerated and dosimetrically advantageous for lungs, contralateral breast and spinal cord. Incorporating DIBH ensures safe heart sparing in left-sided disease. A longer follow-up is warranted to validate late toxicity and survival outcomes.
The Explicit Health Guarantees program in Chile ensures diagnosis and treatment for breast cancer (BC). However, access to palliative care, including physical, psychological, social and spiritual dimensions of patients, remains limited. This study explored barriers and facilitators to implementing access to physical therapy, nutritional counselling and mental health support services in the context of oncology care. We performed a mixed-methods design combined analysis of 2019-2023 administrative data from the Southeastern Metropolitan Health Service with qualitative interviews and focus groups involving healthcare professionals and BC patients at one public hospital and one private center. We observed a decline in referrals to supportive care from 30.2% in 2019 to 11.9% in 2023. Participants identified a lack of referral protocols, staff shortages, limited infrastructure and fragmented coordination as major barriers. Facilitators included interdisciplinary collaboration, electronic referral systems and strong patient satisfaction. Both professionals and patients valued physical therapy most highly, while private-sector patients prioritised mental health and nutritional counselling. Our findings suggest that systemic and institutional gaps translate into an underutilisation of supportive care for BC in Chile. Strengthening referral systems, expanding staff, integrating supportive services into oncology pathways and raising awareness are essential to achieve a more person-centered cancer care.
Introduction: Cancer-related pain remains a major public health challenge in Latin America, where systemic, professional and social barriers frequently delay access to adequate palliative care. Methods: The Palliative Care Council of the Argentine Society of Medicine organised the National Week Against Cancer Pain 2025, the second edition of a nationwide initiative first launched in 2022. The programme combined digital advocacy, community-based educational activities and a volunteer-led clinical network. Mass-media communication was amplified by public figures, alongside in-person and virtual activities for the community and free clinical consultations delivered through a dedicated web platform supported by institutional digital channels. Results: During the peak activation period, the campaign achieved nearly 50,000 direct digital impressions, with substantial additional reach generated through secondary dissemination by high-profile influencers. More than 100 free clinical consultations were provided, both virtually and in person, across 13 Argentine provinces. Community-based activities were conducted in multiple regions, supported by academic societies, provincial governments and civil organisations. The initiative generated over 50 appearances in national and regional media outlets. Conclusion: A coordinated strategy combining digital innovation, community engagement and professional volunteerism can significantly reduce barriers to cancer pain management. This experience offers a scalable and replicable model for improving early access to palliative care in middle-income countries.
Background: Protective isolation is essential for preventing infection in patients undergoing hematopoietic stem cell transplantation (HSCT). However, it is associated with significant psychosocial morbidity. Understanding the factors influencing isolation perception and its impact on care satisfaction is crucial, particularly in resource-limited settings. Methods: This cross-sectional observational study enrolled 47 adults who underwent autologous or allogeneic HSCT at a tertiary care center in India. Perceptions of isolation and satisfaction with care were measured using validated ISOLA and FAMCARE-P16 scales, respectively. Data were analysed using correlation, multivariate regression and mediation analyses. Results: Cluster analysis revealed that nearly half of the patients experienced a high-isolation (48.9%) and low-satisfaction (46.8%) profile. Multivariate regression identified that having a non-partner caregiver was the strongest predictor of higher perceived isolation (B = 5.62, p = 0.002). Regarding satisfaction, being unmarried was the most significant predictor of lower satisfaction (B = -24.66, p < 0.001), followed by non-Hindu religion, allogeneic transplant and poorer relationships with others. Critically, mediation analysis revealed that the effect of caregiver type on satisfaction was fully mediated by the patient's perceived relationship with others (indirect effect: -2.71, 95% confidence intervals: -6.22 to-0.41). Conclusion: A significant proportion of HSCT recipients experience a detrimental combination of high isolation and low satisfaction. In this exploratory study, the finding that a partner caregiver may improve satisfaction by mitigating relational alienation highlights a modifiable psychosocial target. Clinical strategies should focus on screening high-risk patients and implementing interventions to strengthen social connections for those without partners or caregivers; however, larger studies are needed to confirm these findings.
Artificial intelligence (AI) has catalyzed a revolution in the life sciences, culminating in AlphaFold's capacity to predict the static structure of proteins with atomic precision. However, this static view-analogous to a molecular radiograph-omits the fundamental dimension of protein dynamics, a critical factor for biological function and drug interaction. The phenomenon of induced fit, whereby proteins reconfigure upon ligand binding, remains largely beyond the reach of current models. This article posits that the next frontier in computational biology lies in the adoption of World Models-AI architectures such as Google DeepMind's Genie 3 and Meta AI's Joint-Embedding Predictive Architecture. Rather than predicting individual states, these models learn the underlying rules governing system evolution. We argue that applying these principles to molecular dynamics may enable the simulation of conformational trajectories, predicting how proteins move, flex, and respond to ligand binding. We explore the transformative implications for oncology, particularly in the design of allosteric modulators and in targeting historically "undruggable" proteins such as intrinsically disordered proteins. Finally, we delineate a roadmap toward 2035, highlighting challenges and opportunities at the convergence of generative AI and dynamic structural biology.
Globally, there are over 21 million children in need of palliative care. Over a quarter (28%) of these children live in the Asia Pacific region, where access to children's palliative care is limited or absent. Diversity in culture, economies, and political systems across the region has resulted in significant variation in how health services are developed, funded, and delivered. For children's palliative care, services are often poorly coordinated across health systems, with limited integration into national health policies. Despite this there is a growing group of passionate clinicians and foundations trying to establish and develop services. This paper describes a 2-day leadership workshop that was held preceding the International Children's Palliative Care Network conference in the Philippines in November 2025. The primary goal of the workshop was to introduce a health systems approach to equip children's palliative care leaders and champions to advance palliative care development in their countries, at community, institutional, national and regional levels. The workshop brought together 51 children's palliative care leaders, representing 17 countries/regions and 42 institutions across the region in addition to 28 international expert facilitators. Feedback from participants highlighted the value of this workshop for growth and development across policy, research, clinical service development, education and training. This workshop lays the foundation for further collaboration and partnerships across Asia Pacific and the world to strengthen children's palliative care.
Introduction: Targeted axillary dissection (TAD) is increasingly utilised in node-positive breast cancer patients who convert to node-negative status following neoadjuvant chemotherapy (NACT). TAD combines sentinel lymph node biopsy (SLNB) with removal of the previously marked metastatic node. Localisation of the marked node, however, remains one of the most technically challenging aspects of TAD and is a major barrier to its wider implementation. This study aimed to evaluate the clinical feasibility of using a low-cost titanium clip for lymph node (LN) marking and to determine the clipped node (CN) identification rate (IR) as well as its concordance with sentinel lymph nodes (SLNs). Materials and methods: This prospective feasibility study was conducted at Sri Shankara Cancer Hospital and Research Centre, Bangalore, between January 2024 and January 2025 after IEC approval. Patients with cN1, fine needle aspiration cytology/biopsy-proven nodal metastasis undergoing axillary LN clipping before NACT were included. The most suspicious LN was clipped using a coaxial system to deploy a titanium clip (Ligaclip, Ethicon Endo-Surgery, USA). Pre-operatively, the CN was localised using intra-operative ultrasound and direct skin marking. SLNB was performed using dual tracers: indocyanine green (ICG) combined with either methylene blue (MB) or radioisotope (RI). All patients subsequently underwent axillary lymph node dissection. Results: A total of 28 patients were included, with a mean age of 50.8 years. The CN IR was 100%, with an average CN size of 20 mm. In 92.5% of cases, the CN corresponded to the SLN. SLNB mapping success was 91.6% (11/12) with ICG + RI and 86.6% (13/15) with ICG + MB. A median of four LNs were retrieved during TAD. Nodal pathological complete response was achieved in 77.7% (21/27) of patients, more frequently among triple-negative (9/21) and Human epidermal growth factor receptor 2-positive (8/21) subtypes. Conclusion: The titanium clip demonstrated no migration and achieved 100% identification and retrieval of the CN, with high concordance to the sentinel node. These results establish clip-assisted TAD as a clinically feasible, reproducible and cost-effective approach that may facilitate wider adoption of TAD in node-positive breast cancer patients following NACT, particularly in resource-constrained settings.
Background & purpose:Normal tissue complication probability (NTCP) models require institutional validation before clinical implementation. Traditional radiobiological models, such as the Lyman-Kutcher-Burman (LKB) and Equivalent Uniform Dose (EUD) models, provide mechanistic dose-response frameworks, while machine learning (ML) approaches offer exploratory, data-driven alternatives that remain inadequately characterised in South Asian populations. Methods:This retrospective study included 51 head and neck cancer patients treated with definitive radiotherapy. Binary endpoints were Grade ≥2 xerostomia (n = 3), dysphagia (n = 5) and mucositis (n = 4), scored using Common Terminology Criteria for Adverse Events version 5.0. NTCP calculations were performed using two independent computational pipelines (MATLAB-based RBMODELv1 and a Python implementation), with agreement assessed using Bland-Altman analysis. Traditional NTCP models (LKB, EUD) were evaluated and compared with artificial neural networks and XGBoost in a hypothesis-generating framework using a stratified 70:30 train-test split. Model performance was assessed using the area under the receiver operating characteristic curve (area under the curve), accuracy and Spearman's rank correlation. Results:Excellent agreement was observed between computational pipelines (mean bias 0.8%, 95% limits -1.9% to 3.5%). Traditional models demonstrated strong rank-order correlation with toxicity grades (ρ = 0.61-0.79, p < 0.001) and high accuracy (LKB: 90.0%-94.1%). Institution-specific parameters differed from quantitative analyses of normal tissue effects in the clinic values, including a lower parotid TD50 (34.1 versus 39.0 Gy). Exploratory ML analyses showed numerically higher discrimination for parallel organs but not for mixed-architecture structures; however, severe class imbalance (3-5 events per endpoint) limits statistical reliability. Conclusion:Dual computational pipelines enable reproducible NTCP modeling for institutional use. Traditional radiobiological models perform acceptably after local calibration, while exploratory ML findings suggest potential organ-architecture-dependent patterns that require validation in adequately powered multi-institutional cohorts.
Background:Tertiary hospitals are multi-specialty centers where patients are referred for various treatment modalities, including cancer diagnosis and treatment. Often, cancer patients are admitted to hospitals several times. Palliative care (PC) promotes quality of life for patients, their families and caregivers and should be integrated into cancer care at hospitals. Aim:To review literature on PC pathways, models and frameworks for cancer care in hospitals. Setting:Hospitals in sub-Saharan Africa (SSA). Methods:The scoping review was conducted following the Preferred Reporting Items for Reviews and Meta-Analysis extension for Scoping Reviews checklist. Four databases (Medline, Embase, AMED and Scopus) were searched. Inclusion criteria were PC, pathway/ model/framework, cancer, hospital, SSA countries and articles with abstracts. Each database was searched using OR to link synonymous words, then AND to combine all keywords. Two documents of grey literature related to the topic were included. Findings were tabulated under author, year, title, location, PC pathways and cancers. Analysis was done using descriptive methods. Results:Of the 264 articles screened, 15 (13 studies and two reports) were included. These were from eight SSA countries. Six of the studies had a model of PC provision in hospitals within the outpatient department or oncology unit and provided by any health worker and/or a trained PC team. The other studies did not have a model but highlighted the need for one. Conclusion:The need for PC for cancer patients in hospitals is recognised across SSA; however, countries are at different stages of developing hospital PC pathways. Contribution:Findings will guide the formulation of a PC pathway for cervical and prostate cancer patients at a tertiary hospital in Harare Zimbabwe.
Introduction: Early diagnosis of childhood cancer depends on a high index of suspicion and timely referral by primary healthcare workers (PHCWs) to tertiary centers. This study aimed to assess the acceptability and feasibility of a mobile application among PHCWs in recognising cancer-related clinical features in children. Methods: We developed a mobile application called (PEDCan) to support PHCWs in recognising cancer-related clinical features in children, initiating remote consultations with specialists and referring suspected cases to cancer centers when necessary. In May 2021, we conducted a cross-sectional descriptive study among consenting PHCWs in southwestern Uganda to collect data on their knowledge of childhood cancer, smartphone ownership and internet usage. After training participants on the use of the application through mock clinical vignettes, we assessed their ease of use and readiness to adopt the application. Descriptive statistics were used to calculate the proportions of participants able and willing to use the application. Ethical approval was obtained from the Research and Ethics Committee of Mbarara University of Science and Technology. Results: A total of 44 PHCWs participated in the study; 25 (56.8%) were nurses or midwives, 8 (18.2%) were clinical officers, 3 (6.8%) were medical doctors and 8 (18.2%) belonged to other professional cadres. All participants had previously heard about childhood cancer, and 28 (63.6%) had previously encountered a child suspected to have cancer. Thirty-eight (86.4%) participants owned a smartphone and used the internet, while 12 (31.6%) reported having constant internet access. Thirty-eight (86.3%) participants found the PEDCan application very easy or easy to use, and all participants expressed willingness to use it. Conclusion: PHCWs in the participating health facilities were able and willing to use the PEDCan mobile application to recognise childhood cancer clinical features and initiate remote expert consultations using mock vignettes. A pilot study involving real patients would further demonstrate the application's effectiveness in real-world clinical settings.
Molecular diagnostics are an essential component of paediatric oncology care, providing critical information for disease classification, risk stratification and the selection of targeted therapies, ultimately improving patient outcomes. This study presents the results of the 2024 Latin America Regional Advisory Committee and Paediatric Oncology Latin American Society regional survey, which assessed the availability, accessibility, quality and key challenges associated with molecular diagnostics for paediatric malignancies across Latin America. While molecular testing is available in several countries, access remains heterogeneous and inconsistent, particularly in public healthcare settings. Survey findings highlight significant barriers, including financial limitations, a shortage of trained personnel and insufficient laboratory infrastructure. The study also explores potential strategies to strengthen regional capacity through international collaborations, sustainable financing models and targeted workforce development initiatives, to promote equitable access to precision diagnostics for all children with cancer in the region.
