PURPOSEBarriers to accurate histopathologic diagnosis in lower middle-income countries (LMIC) undermine appropriate patient outcomes. We report the results of a regional LMIC twinning initiative, with the support of a high-income country institution, for building capacity in histopathologic diagnosis of pediatric cancers.METHODSA pathology review initiative was conducted between July 2019 and June 2024, where 6 cases per month from a developing center in Syria were reviewed regionally at an established center in Lebanon. Cases for which no diagnosis could be made were sent to St Jude Children's Research Hospital for a third read. Monthly meetings were held to discuss diagnoses and reasons for discrepancies. Biannual capacity building meetings were held to discuss opportunities for improvement.RESULTSA total of 81 cases were reviewed, of which 44 were extracranial solid tumors, 29 brain tumors, and eight hematologic malignancies. Of these, 77 were of sufficient quality, and seven were sent for a third read. Among the 70 cases with a regional final diagnosis, 53 (76%) were concordant, 12 (17%) had major discrepancies, and 5 (7%) had minor discrepancies. Reasons for discrepancies were morphologic interpretation (n = 9, 52%), combined interpretation and immunohistochemistry (n = 4, 24%), and unavailability of specific immunostains (n = 4, 24%). The highest number of discrepancies were in brain tumors, followed by solid tumors. Several opportunities were identified for local improvement and patient safety, including focused pathologist training and specific assay development.CONCLUSIONOur results demonstrate the feasibility of a supported regional south-south twinning initiative in building capacity for accurate pediatric oncology histopathology. Beyond knowledge transfer, it revealed areas for local improvement including specific local laboratory processes, technical training, and local reporting tools.
PURPOSE:WHO5 (2022) classification of B-lymphoblastic leukemia (B-ALL) incorporates several novel entities requiring high-throughput sequencing for their accurate characterization. The clinical relevance of this classification in the context of contemporary measurable residual disease (MRD)-directed therapy is unclear. METHODS:We analyzed 533 pediatric B-ALL uniformly treated with Indian Collaborative Childhood Leukaemia group (ICiCLe)-ALL-14 protocol as defined by WHO-2016 and reclassified them as per WHO5 using targeted sequencing, FISH, and cytogenetics. RESULTS:Subtype-defining genomic abnormalities were identified in 81.2% of the cohort as per the WHO5 classification. Among the new subtypes, PAX5alt and MEF2D-r were associated with a trend toward an inferior 3-year event-free survival (EFS) of 32.8% (P = .003) and 33.7% (P = .091), respectively. We developed a three-tier genomic risk stratification model incorporating 15 genomic subtypes and the IKZF1 deletion. Children with standard (SGR), intermediate (IGR), and high genomic risk (HGR) demonstrated 3-year EFS of 80.4%, 59.3%, and 45.8% (P < .0001), and 3-year overall survival of 89.6%, 75.3%, and 62.3% (P < .0001), respectively. Genomic risk further identified heterogeneous outcomes among ICiCLe risk groups (P < .0001). SGR was associated with superior EFS irrespective of MRD status (3-year EFS 80.5% in postinduction [PI] MRD-negative v 80.8% PI-MRD-positive patients, P = .530). On multivariable analysis, genomic risk (hazard ratio [HR], 1.7 [95% CI, 1.41 to 2.01]; P < .0001), initial ICiCLe risk (HR, 1.3 [95% CI, 1.06 to 1.49]; P = .009), and PI-MRD (HR, 2.2 [95% CI, 1.66 to 2.90]; P < .0001) independently predicted EFS. CONCLUSION:The study demonstrates the potential role of genomic risk stratification, in conjunction with MRD, in stratifying patients into clinically relevant risk categories.
PURPOSE:This study aimed to evaluate global disparities in melanoma incidence, mortality, and the mortality-to-incidence ratio (MIR) across countries according to the Human Development Index (HDI) and selected socioeconomic indicators. METHODS:We conducted an ecologic study using age-standardized melanoma incidence and mortality data from GLOBOCAN 2022 and socioeconomic variables-including HDI, education indicators, life expectancy, and gross national income-from the World Bank for 165 countries. MIR was calculated as the ratio of mortality to incidence. Socioeconomic variables were categorized into quartiles. Differences across groups were assessed using one-way analysis of variance (ANOVA), and associations were analyzed using Spearman correlation coefficients. RESULTS:Significant differences in melanoma incidence and mortality were observed across all socioeconomic indicators (ANOVA P < .001). Incidence showed positive correlations with mean years of schooling (ρ = 0.615), HDI (ρ = 0.595), expected years of schooling (ρ = 0.577), gross national income (ρ = 0.532), and life expectancy at birth (ρ = 0.500). Mortality rates were also positively correlated with these variables, although with lower magnitude (ρ range: 0.399-0.548). By contrast, MIR was inversely correlated with all socioeconomic indicators, particularly gross national income (ρ = -0.624) and HDI (ρ = -0.612). MIR values differed significantly across socioeconomic quartiles (ANOVA P < .001). CONCLUSION:Melanoma incidence and mortality increase with higher socioeconomic development, whereas MIR decreases, indicating improved survival in more developed settings. These findings highlight substantial global inequalities in melanoma outcomes and underscore the need for strategies aimed at reducing disparities in cancer detection and care worldwide.
PURPOSEMuscle-invasive bladder carcinoma (MIBC) poses major treatment challenges in low- and middle-income countries because of logistical and socioeconomic barriers limiting neoadjuvant chemotherapy (NAC) delivery. While dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) improves pathologic response and survival over gemcitabine-cisplatin, its multiday schedule reduces practicality. Accelerated MVAC (AMVAC), a single-day outpatient regimen, may offer a feasible alternative. This study evaluated the feasibility and safety of AMVAC in Indian patients with MIBC.METHODSWe conducted a single-arm feasibility study at the All India Institute of Medical Sciences, Rishikesh, India, between December 2021 and November 2024. Adults with stage II-III MIBC and cisplatin eligibility received 3-4 cycles of single-day AMVAC with pegfilgrastim support before radical cystectomy. Feasibility was defined as completion of ≥3 or 4 cycles within protocol-specified timeframes. Toxicities were graded using CTCAE v5.0, and outcomes were analyzed descriptively.RESULTSSixty patients were enrolled (mean age 55.2 ± 11.2 years; 90% male); 55 received neoadjuvant, and five adjuvant therapy. The mean number of chemotherapy cycles delivered was 3.87 ± 0.85. Feasibility outcomes were favorable, with 91.6% completing three and 76.6% completing four cycles within protocol timelines. Dose reductions for grade ≥3 toxicities were required in 13 patients (21.7%), whereas four patients discontinued treatment because of reduced creatinine clearance. Grade 3 adverse events occurred in 38.3%, most commonly anemia (16.7%), fatigue, and mucositis (13.3% each). Among neoadjuvant recipients undergoing cystectomy (n = 40), pathologic complete response (PCR) was achieved in 32.5% and pathologic downstaging was achieved in 55%.CONCLUSIONSingle-day AMVAC is a feasible and tolerable NAC regimen in a resource-constrained setting, with encouraging PCR and manageable toxicity.
PURPOSETo conduct a scoping review to identify publications that used data from Caribbean cancer registries (CRs) to characterize the type of information disseminated and identify knowledge gaps.METHODSWe searched PubMed, Scopus, Web of Science: Core Collection and SciELO, and Latin American and Caribbean Literature on Health Sciences for articles published in English, French, Dutch, or Spanish between January 2012 and May 2023. Articles that used data from a CR located in one or more Caribbean country/territory were included. In Covidence, a two-step screening process at title/abstract and full text was completed by two reviewers independently. Data were extracted from each included article independently by two reviewers using Covidence. A gray literature search of online and paper reports using CR data was also conducted to supplement the literature searches.RESULTSA total of 126 articles met the inclusion criteria and reported CR data from 1958 to 2018. Of the 33 Caribbean countries/territories included, 12 had at least one publication. Most publications (95%) used data from population-based CRs (PBCRs). Three countries/territories with PBCRs had <3 publications, and three had none. Breast, cervical, and colorectal were the most reported cancers. Ten of 14 (71%) countries/territories with a PBCR had at least one cancer incidence report available from the past 5 years.CONCLUSIONCaribbean CRs have contributed substantially to the peer-reviewed literature, but this is limited to fewer than half of the Caribbean countries and primarily those with a PBCR. Efforts are needed to establish and support PBCRs to produce high-quality data and to bridge the gap between the collection and dissemination of CR data to address key knowledge gaps, prioritize research questions, and inform cancer control policies.
PURPOSECapecitabine-induced hand-foot syndrome (HFS) is a frequent toxicity that impairs quality of life and may require chemotherapy dose modification. Although prophylactic topical diclofenac showed benefit in a randomized trial, its effectiveness in routine clinical practice remains uncertain. We evaluated the real-world effectiveness of topical diclofenac for prevention of clinically significant capecitabine-induced HFS.METHODSDICLO-HFS was a prospective, two-center observational study conducted in Türkiye between July 2023 and February 2024. Adults with colorectal or gastric cancer receiving capecitabine-based therapy were managed with either prophylactic 1% topical diclofenac twice daily or active monitoring according to routine practice. HFS was assessed weekly using Common Terminology Criteria for Adverse Events v5.0 by physicians not involved in treatment allocation. The primary end point was incidence of grade ≥2 HFS. Secondary end points included time to onset of grade ≥2 HFS and capecitabine dose reductions attributable to HFS.RESULTSA total of 151 patients were included (71 diclofenac; 80 active monitoring). During a median follow-up of 19.1 weeks, grade ≥2 HFS occurred in 12 (16.9%) of 71 patients receiving diclofenac and 11 (13.8%) of 80 patients under active monitoring (odds ratio [OR], 1.28 [95% CI, 0.52 to 3.10]; P = .591). Time to onset did not differ between groups (log-rank P = .392). HFS-related dose reductions occurred in 24 (33.8%) of 71 and 20 (25.0%) of 80 patients, respectively (OR, 1.53 [95% CI, 0.76 to 3.10]; P = .235). In multivariable analysis, female sex and capecitabine monotherapy were independently associated with grade ≥2 HFS.CONCLUSIONIn this prospective real-world study, prophylactic topical diclofenac did not reduce clinically significant capecitabine-induced HFS or delay its onset compared with active monitoring. These findings do not support routine diclofenac prophylaxis in everyday practice.
PURPOSETo evaluate feasibility, death-anchored timeliness, and acceptability of a messaging-based electronic patient reported outcomes (ALVA) for after-death Quality of Dying and Death (QODD) collection from bereaved caregivers in Chile.METHODSWe conducted a single-arm, mixed-methods pilot study. After consent, caregivers completed the Spanish QODD via ALVA on common messaging apps (no installation). The primary end point was completion among registered participants; on-time was prespecified as 14-84 days after death. Proportions include 95% CIs.RESULTSOf 36 invited, 21 registered; pre-registration losses were dominated by hospital-based consent logistics (11/36). Among registered, QODD completion was 100% (21/21) and postquestionnaire interview completion was 95.2% (20/21; 95% CI, 77.4 to 99.2); all QODD completions occurred via chat. Median time to completion was 15 minutes (IQR, 10-22; range, 0:05-23:34); 50% finished ≤15 minutes, 75% ≤20 minutes, 85% ≤60 minutes, and 100% within 24 hours (three pause/resume sessions ≥12 hours). Among those with death-anchored timing data (n = 20), on-time completion was 65.0% (13/20; 95% CI, 43.3 to 81.9); median death to completion was 74 days (IQR, 50-85; range, 7-93). Participants' mean age was 49.1 years (standard deviation, 14.2), and relationships were predominantly children (70%) and spouses (15%).CONCLUSIONALVA achieved near-universal completion among registered caregivers (100% QODD; 95% including postinterview) with rapid, same-day questionnaire completion and feasible death-anchored timeliness, supporting scale-up and a comparative trial to optimize implementation and equity.
PURPOSEDuffy-null associated neutrophil count (DANC), formerly known as benign ethnic neutropenia, is seen in people of African and Middle Eastern descent and does not represent a true neutropenic state. Individuals with DANC can be identified by the Duffy-null phenotype on red cells. There is evidence that cancer patients with DANC are not at an increased risk of infection with chemotherapy. The aims of this study were to assess the prevalence of DANC among patients with breast cancer of Middle Eastern ethnicity and to study treatment delays, infectious complications, and survival in these patients.METHODSWe retrospectively reviewed 493 patients with breast cancer treated in a referral oncology center in Bahrain. Patients with neutropenia or leukopenia at presentation with Duffy-null phenotype and no identifiable secondary causes of neutropenia were presumed to have DANC. Clinical details studied included treatment delays, filgrastim responsiveness, and episodes of febrile neutropenia. A contemporaneous group of patients with breast cancer without DANC were used for comparison.RESULTSSeventy-two patients (14.6%) had a presumed diagnosis of DANC, and the median neutrophil count at presentation was 1.2 × 103/µL (range, 0.4-2.1 × 103/µL). Treatment delays and discontinuations were significantly more common in patients with DANC (P < .001) and were not decreased by prophylactic filgrastim use. Patients with DANC were uniformly filgrastim responsive, and only one patient had neutropenic fever. There was no effect of treatment delay or DANC on OS or PFS.CONCLUSIONDANC is prevalent among patients with breast cancer in Bahrain, and Duffy phenotyping on red cells can be a surrogate marker for diagnosis. Treatment delays because of the apparent neutropenia are common in DANC; however, febrile neutropenia is uncommon. This study is of particular relevance in populations with a high prevalence of DANC.
This review critically examines the gap between policy intent and real-world performance of population-based cancer screening in India and identifies strategies for redesigning screening programs to achieve meaningful reductions in cancer mortality. This narrative review synthesizes evidence from Indian randomized trials, implementation experiences, and recent population-level data to evaluate the effectiveness and limitations of screening for oral, breast, and cervical cancers. Despite national policy endorsement since 2016, screening uptake in India remains extremely low, with marked interstate variation and a minimal population-level impact. The primary limitation is failure to ensure completion of the screening-diagnosis-treatment cascade. Cervical cancer screening has the strongest evidence base as randomized trials demonstrate mortality reduction using Human Papilloma Virus testing; however, scale-up is hindered by referral and treatment bottlenecks. For breast cancer, organized early diagnosis using clinical breast examination and streamlined diagnostic pathways is more feasible and equitable than population-wide mammography. Oral cancer screening shows high yield when it is targeted to high-risk groups and integrated with tobacco cessation programs. India's cancer screening strategy must shift from expanding coverage alone to ensuring completion of the screening cascade. A pragmatic, resource-stratified framework is needed, and it should emphasize quality assurance, real-time data systems, and equity-focused implementation. Success metrics should move beyond numbers screened to outcome-based indicators such as stage shift, time to diagnosis, and time to treatment to achieve meaningful reductions in cancer mortality.
This review shares the ongoing work of the global Worldwide Innovative Network (WIN) Consortium for Precision Medicine to synthesize emerging cancer treatment data and to define the requirements for a common global cancer database that can truly support precision oncology. We performed a narrative review of emerging cancer treatment data, molecular profiling technologies, and existing clinicogenomic databases, focusing on how tumors are characterized, how subgroups are defined, and how demographic, lifestyle, and environmental factors are captured. The growth in molecular profiling technologies and the development of new targeted therapies are transforming cancer care. Tumors, regardless of tissue origin, are increasingly defined as composites of multiple, often rare, subgroups, each with distinct biology and likely response to specific therapies, based on multidimensional profiling of the tumor and its microenvironment. The solution lies in building vast databases that capture racial and ethnic diversity, reflected in genomic data, as well as diet and lifestyle factors that may have epigenetic impact on gene expression and post-translational modifications. A truly inclusive and informative data set must reflect global diversity, and there are multiple examples of demography-dependent differences in genomic signals. With members caring for and studying patients with cancer across five continents, WIN is actively exploring pathways to create a global cancer database, rich in clinical and molecular detail, granular enough for precise analysis, and large enough to power artificial intelligence-driven insights, provided appropriate data quality, validation, and governance frameworks are in place. This review surveys the current landscape and outlines practical paths forward to achieve this goal.
PURPOSEHomologous recombination repair (HRR) pathway defects are critical drivers of hereditary cancers, yet population-specific prevalence data from India remain limited. Current testing practices disproportionately focus on BRCA1/2, potentially underidentifying patients with other HRR gene variants who could benefit from targeted therapies.METHODSA retrospective observational cohort study was conducted, analyzing 950 consecutive patients who underwent next generation sequencing-based germline testing at the Cancer Genetics Clinic, Mahamana Pandit Madanmohan Malaviya Cancer Centre, Varanasi. The core HRR panel included BRCA1, BRCA2, PALB2, RAD51C, RAD51D, ATM, CHEK2, BRIP1, BARD1, RAD50, NBN, MRE11, and FANCC.RESULTSOf 950 patients analyzed, 364 (38.3%) harbored variants in HRR genes, with 266 (28%) carrying pathogenic/likely pathogenic (P/LP) variants. BRCA1 was the most frequently altered gene (182/266, 68.4% of P/LP variants), followed by BRCA2 (37/266, 13.9%). Combined BRCA1/2 genetic variants accounted for 219/266 (82.3 17%) of all P/LP variants. Non-BRCA HRR genes contributed 47/266 (17.6%) P/LP variants, with PALB2 being the most common (14/266, 5.2%). The study identified 98 variants of uncertain significance across the HRR genes.CONCLUSIONThis large Indian cohort demonstrates a high prevalence of HRR gene alterations, with significant contribution from non-BRCA genes. These findings support the implementation of comprehensive HRR gene panels in Indian populations and highlight the therapeutic implications for poly (ADP-ribose) polymerase inhibitor and platinum-based treatment strategies.
PURPOSECancer is a leading global health issue. It is unclear how global health leaders who are not directly or actively involved in cancer care perceive the importance of and opportunities within cancer control. We sought to examine their views on past, current, and future opportunities to optimize global cancer control.METHODSWe conducted a qualitative study using in-depth, one-on-one, semi-structured interviews with internationally recognized health thought leaders external to the field of cancer using purposive sampling. Interviews took place virtually from 2023 to 2024 and were recorded and transcribed, which were read and coded using thematic analysis with the aim of achieving thematic saturation.RESULTSTwenty-seven individuals were contacted to participate: 18 (67%) responded to the invitation and 16 (59%) agreed to an interview. Six common overarching themes emerged from the interviews and were used to frame the analysis, including (1) Cancer is not well represented on the global health agenda; (2) Despite progress, cancer treatment is perceived to be costly and ineffective; (3) The concerns about treatment cost drive an emphasis on prevention; (4) The complexity of cancer control is a barrier; (5) Science and technology offer immense opportunity; and (6) Investment in cancer must rise to meet the need.CONCLUSIONStrong perceptions of cancer-related challenges and opportunities exist among health experts; understanding these opinions is crucial to advance cancer control and care.
PURPOSE:Brazil represents a promising environment for clinical research, supported by a genetically diverse population and established research infrastructure. Despite this, participation in global oncology trials remains limited, with study approval timelines among the contributing factors. Recent regulatory reforms have aimed to streamline review processes. This study evaluated ethical and regulatory approval timelines for oncology trials in Brazil. METHODS:We performed a retrospective analysis using data on regulatory approval timelines for oncology clinical trials managed by Contract Research Organizations in Brazil. A total of 196 phase I-IV trials conducted between 2013 and 2023 were included. Timelines were calculated in days from protocol submission to first response and final decision by the National Commission for Ethics in Research (Comissão Nacional de Ética em Pesquisa [CONEP]) and the Brazilian Health Regulatory Agency (Agência Nacional de Vigilância Sanitária [ANVISA]). Data were stratified into four periods: (I) preimplementation of ANVISA Collegiate Board Resolutions (Resoluções da Diretoria Colegiada) 09 and 10/2015, (II) pre-COVID-19, (III) during COVID-19, and (IV) postpandemic/current (May 2022-December 2023). RESULTS:Over the last decade, approval times decreased substantially. ANVISA's mean final approval time fell from 341 days in 2013 to 90 days in 2023, whereas CONEP's decreased from 164 to 141 days. Period analysis showed ANVISA's mean time frame declined from 309 days (period I) to 99 days (period IV). CONEP's mean time frame dropped from 266 days (period I) to 128 days prepandemic, with a slight increase to 172 days in the postpandemic/current period. CONCLUSION:Brazil's regulatory and ethical approval processes have shown significant and sustained improvement. Recent legislation introducing centralized ethical review and mandatory response deadlines is expected to further enhance Brazil's competitiveness in global oncology research.
PURPOSEChildren with cancer in low- and middle-income countries face high preventable in-hospital mortality, often because of delayed recognition of clinical deterioration. Pediatric Early Warning Systems (PEWS) enable early detection but require frequent clinician assessments that are difficult to sustain in resource-constrained settings. The Family-Assisted Severe Illness Therapy (FASTER) tool trains caregivers to perform simple bedside assessments as an alternative screening approach. We evaluated the concurrent validity, feasibility, and acceptability of caregiver-recorded FASTER scores versus clinician-recorded PEWS scores among pediatric oncology inpatients at the Uganda Cancer Institute.METHODSIn this prospective, concurrent validity study, 50 caregiver-patient pairs were enrolled. After structured training, caregivers performed FASTER assessments every 6 hours over 48 hours while a study nurse independently recorded PEWS scores every 8 hours, yielding 321 concurrent paired observations for analysis. Concurrent validity was assessed using Spearman correlation and kappa agreement statistics. Diagnostic performance for PEWS-defined deterioration (PEWS ≥3) was evaluated using sensitivity, specificity, predictive values, and AUROC. Feasibility and acceptability were assessed through adherence monitoring and structured exit interviews.RESULTSFASTER scores correlated moderately to strongly with PEWS scores (ρ = 0.65 [95% CI, 0.58 to 0.71]; P < .001), although categorical agreement was poor (unweighted κ = 0.07). For PEWS-defined deterioration, FASTER showed high sensitivity (96.7%) and modest specificity (47.5%); AUROC was 0.89 (95% CI, 0.84 to 0.94), reflecting yellow-threshold discrimination given only two PEWS-red events. The positive predictive value was 29.7%, and the negative predictive value was 98.4%. Caregiver adherence was high (98.3%), and acceptability was strong (100% useful, 78% easy/very easy), although lower education predicted greater difficulty (P = .014).CONCLUSIONFASTER demonstrated concurrent validity with PEWS and high feasibility and acceptability; its predictive validity and impact on clinical outcomes require further study.
Breast cancer represents a major public health burden in Sudan, where most patients are diagnosed at advanced stages and access to comprehensive diagnostic and molecular services remains limited. Current treatment strategies are largely extrapolated from non-African populations, despite the substantial genetic diversity across African populations that may significantly influence drug response, efficacy, and toxicity. Pharmacogenomics offers a promising approach to optimize breast cancer therapy through genetically informed treatment decisions; however, its clinical application in Sudan and across Africa remains limited. This narrative review synthesizes published evidence on pharmacogenetic determinants influencing breast cancer treatment, with a particular focus on African and Sudanese populations. Relevant studies published between 2005 and 2026 were identified through searches of PubMed, Google Scholar, and PharmGKB. A qualitative synthesis was conducted to summarize key pharmacogenes, population-specific genetic variability, and their potential clinical and therapeutic implications. Considerable interethnic variability has been reported in pharmacogenes involved in drug metabolism and transport, including CYP2D6, CYP3A4, CYP2B6, DPYD, and ATP-binding cassette transporter genes. African populations exhibit distinct allele frequency patterns that may substantially affect drug disposition, therapeutic efficacy, and toxicity, particularly for endocrine therapies and commonly used chemotherapeutic agents. These differences limit the direct applicability of pharmacogenomic data derived from European and Asian populations and underscore the need for population-specific evidence. Integrating pharmacogenomics into breast cancer management has the potential to improve treatment effectiveness and safety in Sudan. Achieving this goal requires the generation of locally relevant pharmacogenomic data, strengthened diagnostic and laboratory infrastructure, and a stepwise, context-appropriate incorporation of pharmacogenomic principles into clinical practice. Such an approach is important to support equitable and effective precision oncology for Sudanese and African populations.
PURPOSECancer care capacity in sub-Saharan Africa (SSA) is constrained by late diagnosis and limited treatment access. Few funding mechanisms support innovative, locally led programs to address these challenges. A collaborative initiative was developed to strengthen oncology care through quality improvement (QI) projects.MATERIALS AND METHODSThe program was developed by Global Bridges Oncology (GBO) at Mayo Clinic, Pfizer Global Medical Grants, and the African Organisation for Research and Training in Cancer. A committee composed primarily of African oncology experts guided the process. An RFP was disseminated across SSA in English, French, and Portuguese, inviting applications to improve diagnostic and therapeutic cancer care. Applications underwent a structured, two-stage review, with GBO providing technical support, expert guidance, and training resources.RESULTSThe RFP generated 218 applications reflecting strong demand for oncology QI funding in SSA. After review, 17 projects representing 10 African countries were selected and awarded $1.1 million USD. Funded initiatives reflected four themes: oncology training and clinical practice improvements, early detection and accurate diagnostics, pediatric cancer care, and oncology nursing and palliative medicine. As of March 2026, 11 (65%) of 17 projects are complete, with 4,565 health care professionals engaged through direct training, conference dissemination, system adoption, and sensitization activities, and program-supported services were delivered to more than 47,300 patients.CONCLUSIONThis initiative demonstrates the feasibility of a competitive, regionally guided grant program to strengthen cancer care capacity. Early implementation outcomes, including measurable improvements in diagnostic delay, treatment adherence, and care network expansion, confirm that locally led QI initiatives can generate meaningful results across diverse institutional settings. By centering African leadership and supporting diverse QI projects, it advances equitable access to funding, capacity building, and sustainability planning.
PURPOSEMolecular classification has refined risk stratification in endometrial cancer and is now incorporated into the 2023 International Federation of Gynecology and Obstetrics (FIGO) staging system. However, prospective real-world data on its impact on multidisciplinary tumor board (MDT) decision making remain limited. We evaluated the impact of molecular information on adjuvant treatment recommendations in stage I to II endometrial cancer.METHODSThis prospective observational study included patients with surgically treated FIGO 2023 stage I to II endometrial carcinoma discussed at MDT between February 2024 and December 2025. Clinicopathologic risk stratification was performed using the ESGO-ESTRO-ESP 2016 criteria. Molecular classification was determined using POLE sequencing and immunohistochemistry for mismatch repair (MMR) and TP53. Estrogen receptor status was not assessed, as no specific molecular profile (NSMP) subclassification was part of the operative framework during the study period. MDT recommendations were recorded before and after the integration of molecular results.RESULTSA total of 122 patients were included. Molecular subtypes were NSMP in 55 (45.1%), MMR-deficient in 41 (33.6%), TP53-abnormal in 24 (19.7%), and POLE-mutated in two (1.6%). Integration of molecular classification changed MDT recommendations in 25 cases (20.5%), with escalation in 15 (12.3%) and de-escalation in 10 (8.2%). Therapy modification was most frequent in TP53-abnormal tumors (62.5%) compared with other subgroups (10.2%; odds ratio, 14.7 [95% CI, 5.1 to 42.1]; P < .001). No treatment changes were observed in NSMP or POLE-mutated tumors. The net incremental treatment cost was ₹11.8 lakh across the cohort; including molecular testing, the overall incremental cost was ₹34,672 per patient (∼$418 US dollars).CONCLUSIONIntegration of molecular classification modified adjuvant treatment in approximately one fifth of patients. Changes were biologically consistent, supporting the feasibility and clinical utility of molecularly integrated MDT decision making in early-stage endometrial cancer even in resource-constrained settings.
PURPOSE:Clinical trial availability often varies between countries, independent of the local burden of disease. We aimed to evaluate the current global availability of prostate cancer clinical trials and the factors affecting it. METHODS:We searched for clinical trials involving prostate cancer between June 2019 and June 2024 through Clinicaltrials.gov. Noninterventional trials were excluded. Countries were classified according to the World Bank Ranking (WBR) as high-, upper-middle-, lower-middle-, and low-income countries (HICs, UMICs, LMICs, and LICs). Multivariable negative binomial regression was used to evaluate the association between the number of trials and country's characteristics. Multivariable logistic regression was used to evaluate the association between trial availability and country's characteristics. In addition, we collected data on sponsorship, funding, intervention, intervention intent, end point selection, trial phase, and cancer stage. RESULTS:Of the 1,531 trials identified, 1,413 met the eligibility criteria. Most trials were conducted exclusively in HICs (80.4%), included patients with metastatic disease (55.4%), and were sponsored by academia (68.8%). Pharma-funded trials had a higher number of participating countries (mean 2.7 v 1.0, P < .001) and were more likely to include metastatic disease (72.0% v 32.3%, P < .001) and to investigate systemic therapy (76.3% v 29.4%, P < .001). In the multivariable analysis, WBR, gross national income (GNI), and annual health expenditure were all associated with the presence of at least one trial (P < .001). Only GNI was independently associated with the number of trials within a country (P < .001). CONCLUSION:Prostate cancer trials are disproportionately concentrated in HICs despite a lower burden of disease. Intentional efforts are needed to ensure global representation and long-term benefits for populations historically excluded from research.
