Longitudinal quality of life data can provide insights on the impact of adjuvant treatment for pancreatic cancer-Subset analysis of the ESPAC-1 data

The European Study Group for Pancreatic Cancer (ESPAC-1) study is the largest study of adjuvant treatment for pancreatic ductal adenocarcinoma to date and confirmed a survival advantage for adjuvant chemotherapy but not for chemoradiation. The importance of parallel evaluation of survival and quality of life (QoL) has been recognized as fundamental and the aim was to assess QoL and quality adjusted survival. A longitudinal QoL study on a subset of ESPAC-1 patients who prospectively completed the EORTC QLQ C-30 questionnaire during treatment and follow-up. An integrated quality-survival product method was used to adjust any treatment effect on survival by a function of measured QoL, calculated over a restricted 24-month-period (QALM-24). Three hundred and sixteen patients completed 1,201 questionnaires. There were no differences between treatment groups in dimension scores at baseline (randomization). For the chemotherapy group, the mean Quality Adjusted Life Months over 24 months (QALM-24) was 9.6 (95% CI: 8.7, 11.2) months compared with the mean QALM-24 of 8.6 (95% CI: 7.6, 10.5) months for the no chemotherapy group. For the chemoradiation group, the mean QALM-24 was 7.1 (95% CI: 6.0, 9.0) months compared with the mean QALM-24 of 8.1 (95% CI: 7.0, 10.0) months for the no chemoradiation group. The previously reported survival advantage supporting the use of adjuvant chemotherapy is maintained when adjusted using quality adjusted survival methodology. Chemotherapy provided on average an additional 1.0 quality-adjusted life months within a restricted 2-year time period from the time of resection

Enhancing waste management strategies in Latin America under a holistic environmental assessment perspective: A review for policy support

Waste remains a serious environmental and human health hazard in developing nations, including those in Latin America and the Caribbean (LA&C). Despite important breakthroughs in waste management in LA&C, the region still faces many challenges that require special attention, such as the existence of uncontrolled open dumpsters (33%) or the low recovery rates of waste fractions (below 4%). Moreover, the adoption of sophisticated waste management technologies, such as incineration or anaerobic digestion, is still lagging. This review paper provides environmentally-sound and relevant policy support for municipal solid waste management stakeholders through a critical review of the current situation of the waste management sector in LA&C from an environmental perspective. Thereafter, Life Cycle Assessment (LCA) bibliography linked to waste management, namely collection, sorting, recycling and landfilling applications and technologies worldwide, is used in order to understand potential alternative waste management strategies in LA&C, as well as the potential environmental benefits that could be attained. Finally, based on the holistic review and analysis, the adoption of more sophisticated technologies in landfill sites (e.g. landfill gas flaring), waste-to-energy, as well as higher recycling rates, would enhance waste management in the region and mitigate environmental impacts. A holistic view to support policy formulations, including climate action, for the adoption of integrated waste management strategies in LA&C is imperative.This work has been supported by the Cantabrian government R&D project 2018-2020 entitled “Obtaining, processing and dissemination of data on production and waste management and adaptation of the current indicators to the new waste plan of Cantabria”