Physician and facility drivers of spending variation in locoregional prostate cancer

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/154672/1/cncr32719.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/154672/2/cncr32719_am.pd

Expanding global access to radiotherapy

Radiotherapy is a critical and inseparable component of comprehensive cancer treatment and care. For many of the most common cancers in low-income and middle-income countries, radiotherapy is essential for effective treatment. In high-income countries, radiotherapy is used in more than half of all cases of cancer to cure localised disease, palliate symptoms, and control disease in incurable cancers. Yet, in planning and building treatment capacity for cancer, radiotherapy is frequently the last resource to be considered. Consequently, worldwide access to radiotherapy is unacceptably low. We present a new body of evidence that quantifies the worldwide coverage of radiotherapy services by country. We show the shortfall in access to radiotherapy by country and globally for 2015-35 based on current and projected need, and show substantial health and economic benefits to investing in radiotherapy. The cost of scaling up radiotherapy in the nominal model in 2015-35 is US$26·6 billion in low-income countries,$62·6 billion in lower-middle-income countries, and $94·8 billion in upper-middle-income countries, which amounts to$184·0 billion across all low-income and middle-income countries. In the efficiency model the costs were lower: $14·1 billion in low-income,$33·3 billion in lower-middle-income, and $49·4 billion in upper-middle-income countries-a total of$96·8 billion. Scale-up of radiotherapy capacity in 2015-35 from current levels could lead to saving of 26·9 million life-years in low-income and middle-income countries over the lifetime of the patients who received treatment. The economic benefits of investment in radiotherapy are very substantial. Using the nominal cost model could produce a net benefit of $278·1 billion in 2015-35 ($265·2 million in low-income countries, $38·5 billion in lower-middle-income countries, and$239·3 billion in upper-middle-income countries). Investment in the efficiency model would produce in the same period an even greater total benefit of $365·4 billion ($12·8 billion in low-income countries, $67·7 billion in lower-middle-income countries, and$284·7 billion in upper-middle-income countries). The returns, by the human-capital approach, are projected to be less with the nominal cost model, amounting to $16·9 billion in 2015-35 (-$14·9 billion in low-income countries; -$18·7 billion in lower-middle-income countries, and$50·5 billion in upper-middle-income countries). The returns with the efficiency model were projected to be greater, however, amounting to $104·2 billion (-$2·4 billion in low-income countries, $10·7 billion in lower-middle-income countries, and$95·9 billion in upper-middle-income countries). Our results provide compelling evidence that investment in radiotherapy not only enables treatment of large numbers of cancer cases to save lives, but also brings positive economic benefits

The Human Sweet Tooth

Humans love the taste of sugar and the word "sweet" is used to describe not only this basic taste quality but also something that is desirable or pleasurable, e.g., la dolce vita. Although sugar or sweetened foods are generally among the most preferred choices, not everyone likes sugar, especially at high concentrations. The focus of my group's research is to understand why some people have a sweet tooth and others do not. We have used genetic and molecular techniques in humans, rats, mice, cats and primates to understand the origins of sweet taste perception. Our studies demonstrate that there are two sweet receptor genes (TAS1R2 and TAS1R3), and alleles of one of the two genes predict the avidity with which some mammals drink sweet solutions. We also find a relationship between sweet and bitter perception. Children who are genetically more sensitive to bitter compounds report that very sweet solutions are more pleasant and they prefer sweet carbonated beverages more than milk, relative to less bitter-sensitive peers. Overall, people differ in their ability to perceive the basic tastes, and particular constellations of genes and experience may drive some people, but not others, toward a caries-inducing sweet diet. Future studies will be designed to understand how a genetic preference for sweet food and drink might contribute to the development of dental caries

Schizophrenia-associated somatic copy-number variants from 12,834 cases reveal recurrent NRXN1 and ABCB11 disruptions

While germline copy-number variants (CNVs) contribute to schizophrenia (SCZ) risk, the contribution of somatic CNVs (sCNVs)—present in some but not all cells—remains unknown. We identified sCNVs using blood-derived genotype arrays from 12,834 SCZ cases and 11,648 controls, filtering sCNVs at loci recurrently mutated in clonal blood disorders. Likely early-developmental sCNVs were more common in cases (0.91%) than controls (0.51%, p = 2.68e−4), with recurrent somatic deletions of exons 1–5 of the NRXN1 gene in five SCZ cases. Hi-C maps revealed ectopic, allele-specific loops forming between a potential cryptic promoter and non-coding cis-regulatory elements upon 5′ deletions in NRXN1. We also observed recurrent intragenic deletions of ABCB11, encoding a transporter implicated in anti-psychotic response, in five treatment-resistant SCZ cases and showed that ABCB11 is specifically enriched in neurons forming mesocortical and mesolimbic dopaminergic projections. Our results indicate potential roles of sCNVs in SCZ risk

Radiotherapeutic Management of Non–Small Cell Lung Cancer in the Minimal Resource Setting

AbstractLung cancer is the most common cancer worldwide and the fifth most common cause of death globally. Its incidence continues to increase, especially within low- and middle-income countries (LMICs), which have limited capacity to address the growing need for treatment. The standard of care for lung cancer treatment often involves radiation therapy (RT), which plays an important therapeutic role in curative-intent treatment of early-stage to locally advanced disease, as well as in palliation. The infrastructure, equipment, and human resources required for RT may be limited in LMICs. However, this narrative review discusses the scope of the problem of lung cancer in LMICs, the role of RT technologies in lung cancer treatment, and RT capacity in developing countries. Strategies are presented for maximizing the availability and impact of RT in settings with minimal resource availability, and areas for potential future innovation are identified. Priorities for LMICs involve increasing access to RT equipment and trained health care professionals, ensuring quality of care, providing guidance on priority setting with limited resources, and encouraging innovation to increase the economic efficiency of RT delivery. Several international initiatives are currently under way and represent important first steps toward scaling up RT in LMICs to treat lung cancer

Global Task Force on Radiotherapy for Cancer Control.

Cancer is an immense, fast-growing challenge to health and health systems worldwide. Previously thought to be restricted to high-income populations, it is now also recognised as an emerging and critical issue for low-income and middle-income countries. Although the challenge of cancer control in low-income and middle-income countries has been highlighted before,1 a comprehensive, integrated and global health system response was first forged with the work of the Global Task Force on Expanded Access to Cancer Care and Control, which began in 2009

Enhancing career paths for tomorrow's radiation oncologists

The purpose for this manuscript is to enhance career opportunities for radiation oncologists (ROs) by expanding the scope of work as a prelude to redefining the scope of our contributions at this critical inflection point in our history. The direct stimulus is the speculation and debate over the ROs' future, a logical issue in today's rapidly changing world of health care economics, cancer biology, artificial intelligence, and global resource disparities. 123456 To be proactive and effective in adapting to—and with—these external factors, the data upon which decisions are based should be well understood. Yet accuracy of workforce forecasts for ROs are notoriously inconsistent, partly because of the imperfect assumptions inherent in such complex models. 1234 Nonetheless, over 50% of ROs are concerned about a future oversupply, 56 and the downstream effects already appear to have negatively affected specialty choice among highly talented and pragmatic medical students. Discussions of practitioner supply and demand imbalance often focus on the numerator—are there too many? Better solutions may reside in a broadening of the denominator—the talent and contributions that ROs bring to cancer care and greater society. 78 Regardless of how one views these complex issues, this is a critical juncture for exploring how to evolve ROs' skills and ensure that our contributions continue to help solve the challenges facing health care and patients