Radiating hope: Advancing cancer care by increasing global access to radiation therapy.

Introduction: Cancer is the expected leading cause of death in Low and Middle Income Countries (LMIC), with higher mortality than that from malaria, tuberculosis and HIV/AIDS combined; more than 9 million cancer-related deaths are estimated in LMIC annually by 2030. Presenting at more advanced stages, 70% of LMIC cancer patients would benefit from radiation therapy (RT); less than 25% will receive RT. 358 million people in 55 LMIC have no access to RT. With a projected need of over 9000 teletherapy units by 2020 the cancer care gap for RT availability is enormous; 60% of the world\u27s cancer patients having access to 30% of the global RT units. Materials/Methods: RadiatingHope (RH) is a non-profit organization founded by radiation oncologists committed to increasing global access to radiation therapy. Through many advocacy and fundraising efforts, including mountain climbing, RH has increased awareness of this dearth of radiation oncology resources in the developing world. RH also facilitates radiation equipment donation (linear accelerators, HDR afterloaders), provides training needed for self-sustaining treatment delivery infrastructure and hosts meetings that encourage collaboration between developing, developed nations and industry to advance cancer care. Results: Since 2010, RH has facilitated the donation of over ten teletherapy units, including five linear accelerators sent to Peru, Ukraine, Tanzania and Honduras; ten HDR afterloaders have been donated, including Senegal\u27s first brachytherapy unit which provided a cure for cervical cancer. Training projects include visits to Panama and Senegal, weekly technical support, as well as financing attendance of international meetings to train physicists. RH volunteers have assisted in calibrating donated physics equipment and plan to do the same for two HDR after loaders en route to Ghana, where on site training will ensure safe use of the new equipment. In addition, RH has held over five mountain climbs (Everest Base Camp, Kilimanjaro) and three international symposia (Greater Horn Oncology Symposium, Cuban Radiation Oncology Symposium) to continue advocacy and provide platforms to discuss the global advancement of cancer care. Conclusions: RH will sustain its mission to advance global cancer care access, however, the universal need for radiation therapy equipment, human resources and infrastructure is staggering. Additional efforts in advocacy, education, fundraising, equipment donation and international collaborations are needed to overcome this global void in cancer care

Antitubercular Nanocarrier Combination Therapy: Formulation Strategies and in Vitro Efficacy for Rifampicin and SQ641

Tuberculosis (TB) remains a major global health concern, and new therapies are needed to overcome the problems associated with dosing frequency, patient compliance, and drug resistance. To reduce side effects associated with systemic drug distribution and improve drug concentration at the target site, stable therapeutic nanocarriers (NCs) were prepared and evaluated for efficacy in vitro in Mycobacterium tuberculosis-infected macrophages. Rifampicin (RIF), a current, broad-spectrum antibiotic used in TB therapy, was conjugated by degradable ester bonds to form hydrophobic prodrugs. NCs encapsulating various ratios of nonconjugated RIF and the prodrugs showed the potential ability to rapidly deliver and knockdown intracellular M. tuberculosis by nonconjugated RIF and to obtain sustained release of RIF by hydrolysis of the RIF prodrug. NCs of the novel antibiotic SQ641 and a combination NC with cyclosporine A were formed by flash nanoprecipitation. Delivery of SQ641 in NC form resulted in significantly improved activity compared to that of the free drug against intracellular M. tuberculosis. A NC formulation with a three-compound combination of SQ641, cyclosporine A, and vitamin E inhibited intracellular replication of M. tuberculosis significantly better than SQ641 alone or isoniazid, a current first-line anti-TB drug

The Impact of Radiation Oncologists on the Early Adoption of Hypofractionated Radiation Therapy for Early-Stage Breast Cancer.

PurposeDespite multiple randomized trials showing the efficacy of hypofractionated radiation therapy in early-stage breast cancer, the United States has been slow to adopt this treatment. The goal of this study was to evaluate the impact of individual radiation oncologists on the early adoption of hypofractionated radiation therapy for early-stage breast cancer.MethodsWe identified 22,233 Medicare beneficiaries with localized breast cancer that was diagnosed from 2004 to 2011 who underwent breast-conserving surgery with adjuvant radiation. Multilevel, multivariable logistic models clustered by radiation oncologist and geographic practice area were used to determine the impact of the provider and geographic region on the likelihood of receiving hypofractionated compared with standard fractionated radiation therapy while controlling for a patient's clinical and demographic covariates. Odds ratios (OR) describe the impact of demographic or clinical covariates, and the median OR (MOR) describes the relative impact of the individual radiation oncologist and geographic region on the likelihood of undergoing hypofractionated radiation therapy.ResultsAmong the entire cohort, 2333 women (10.4%) were treated with hypofractionated radiation therapy, with unadjusted rates ranging from 0.0% in the bottom quintile of radiation oncologists to 30.4% in the top quintile. Multivariable analysis found that the individual radiation oncologist (MOR 3.08) had a greater impact on the use of hypofractionation than did geographic region (MOR 2.10) or clinical and demographic variables. The impact of the provider increased from the year 2004 to 2005 (MOR 2.82) to the year 2010 to 2011 (MOR 3.16) despite the publication of long-term randomized trial results in early 2010. Male physician and radiation oncologists treating the highest volume of breast cancer patients were less likely to perform hypofractionation (P<.05).ConclusionsThe individual radiation oncologist strongly influenced the likelihood of a patient's receiving hypofractionated radiation therapy, and this trend increased despite the publication of long-term data showing equivalence to standard fractionation. Future research should focus on physician-related factors that influence this decision

The Impact of Radiation Oncologists on the Early Adoption of Hypofractionated Radiation Therapy for Early-Stage Breast Cancer.

PurposeDespite multiple randomized trials showing the efficacy of hypofractionated radiation therapy in early-stage breast cancer, the United States has been slow to adopt this treatment. The goal of this study was to evaluate the impact of individual radiation oncologists on the early adoption of hypofractionated radiation therapy for early-stage breast cancer.MethodsWe identified 22,233 Medicare beneficiaries with localized breast cancer that was diagnosed from 2004 to 2011 who underwent breast-conserving surgery with adjuvant radiation. Multilevel, multivariable logistic models clustered by radiation oncologist and geographic practice area were used to determine the impact of the provider and geographic region on the likelihood of receiving hypofractionated compared with standard fractionated radiation therapy while controlling for a patient's clinical and demographic covariates. Odds ratios (OR) describe the impact of demographic or clinical covariates, and the median OR (MOR) describes the relative impact of the individual radiation oncologist and geographic region on the likelihood of undergoing hypofractionated radiation therapy.ResultsAmong the entire cohort, 2333 women (10.4%) were treated with hypofractionated radiation therapy, with unadjusted rates ranging from 0.0% in the bottom quintile of radiation oncologists to 30.4% in the top quintile. Multivariable analysis found that the individual radiation oncologist (MOR 3.08) had a greater impact on the use of hypofractionation than did geographic region (MOR 2.10) or clinical and demographic variables. The impact of the provider increased from the year 2004 to 2005 (MOR 2.82) to the year 2010 to 2011 (MOR 3.16) despite the publication of long-term randomized trial results in early 2010. Male physician and radiation oncologists treating the highest volume of breast cancer patients were less likely to perform hypofractionation (P<.05).ConclusionsThe individual radiation oncologist strongly influenced the likelihood of a patient's receiving hypofractionated radiation therapy, and this trend increased despite the publication of long-term data showing equivalence to standard fractionation. Future research should focus on physician-related factors that influence this decision