FACILITATORS ENABLING SUSTAINABLE CERVICAL CANCER CONTROL PROGRAMS IN LOW- AND MIDDLE-INCOME COUNTRIES: STRENGTHENING HEALTH SYSTEMS IN ZAMBIA

By 2030, an estimated 75% of cancer deaths will occur in low- and middle-income countries (LMICs) (Bray et al., 2018). Health systems in LMICs will need sustainable strengthening to meet the growing burden. In 2020, the World Health Organization (WHO) launched the 2020-2030 Global Strategy Towards the Global Elimination of Cervical Cancer (WHO, 2019). Screening, treatment, and early detection have proven effective in controlling cervical cancer. While sustainability of these interventions has not been extensively studied, identified barriers and facilitators to sustainability map closely to the six WHO building blocks for health systems strengthening. This linkage suggests that designing sustainable cervical cancer programs may help strengthen the broader health system. This study strives to identify the facilitators of sustainable cervical cancer screening and treatment programs that strengthen healthcare systems in an LMIC. Using a sequential mixed methods qualitative approach, the study’s aims and methods included: 1) describe the barriers and facilitators to sustaining cervical cancer programs in LMICs using a literature review and key informant interviews; 2) conduct a qualitative case study in Zambia, a country with a demonstrated sustainable cervical cancer program, using key informant interviews, document review and triangulation of data sources, to determine how the cervical cancer program strengthens the Zambian health system; and 3) develop a conceptual framework that links the identified facilitators to sustainable cervical cancer screening programs in LMICs (results from Aims 1-3) to the WHO health systems framework using a synthesis of results from aims 1 and 2. The results of this study provide insights into the facilitators and barriers of cervical cancer program sustainability, and ways that the cervical cancer program in Zambia strengthens the local health system. The findings build on the available evidence and inform a framework that provides guidance to countries as they are implementing cervical cancer screening and treatment programs. This research further highlights the need for future research, specifically implementation science, to inform future scale-up and sustainability of cervical cancer interventions.Doctor of Public Healt

Analysis of the National Cancer Institute�s Investment in Site-Specific Cancer Research Funding Involving Collaborators in Latin America and Its Correspondence to Regional Cancer Burden

PURPOSE Economic and social-behavioral changes over the last two decades in Latin America and the Caribbean (LAC) are associated with increases in the regional cancer burden. We aim to describe the National Cancer Institute�funded extramural research portfolio with collaborators in the LAC between fiscal years 2014 and 2018 and compare project numbers by site with subregional cancer burden. METHODS This analysis included National Cancer Institute�funded extramural projects with LAC collaborators from fiscal years 2014 to 2018 from the National Institutes of Health IMPAC II database. Projects were stratified by Pan American Health Organization�s Latin American subregions, tumor sites, and regional site-specific rates of cancer incidence and mortality using Globocan 2018 estimates. To better understand subregional variations in cancer incidence and mortality, this analysis focused on the top 5 sites of incidence and mortality in LAC after breast and prostate cancer. RESULTS Between fiscal years 2014 and 2018, 108 projects with LAC collaborators were funded. Project collaborators came from 22 countries in the region, and projects covered 20 tumor sites. The Southern Cone had the most projects funded, followed by the Central American Isthmus and Mexico, Andes, Latin Caribbean, and non-Latin Caribbean�this was roughly proportional to subregional populations. Variation exists at the subregional level for the top 5 cancers when comparing incidence and mortality with subregional project counts. Disparities between projects and incidence by tumor site were the largest for colorectal, lung, and uterine cancers. Disparities between projects and mortality by tumor site were the largest for lung and uterine cancers. Disparities between projects and both components of cancer burden by subregion were the largest for the Latin Caribbean and non-Latin Caribbean. The number of funded projects for Kaposi sarcoma and non-Hodgkin lymphoma largely outpaced both incidence and mortality in every subregion. CONCLUSION This analysis suggests that projects� alignment with cancer burden is variable by subregion, provides an understanding of cancer research funding by site, and highlights areas of interest for additional investigation, training, and collaboration in LAC

Global Oncology Research and Training Collaborations Led by the National Cancer Institute (NCI)–Designated Cancer Centers: Results From the 2018 NCI/ASCO Global Oncology Survey of NCI-Designated Cancer Centers

PURPOSE: The National Cancer Institute (NCI)–Designated Cancer Centers (NDCCs) are active in global oncology research and training, leading collaborations that contribute to the evidence to support global cancer control. To better understand global oncology activities led by NDCCs, the National Cancer Institute Center for Global Health (NCI-CGH) collaborated with ASCO to conduct the 2018 NCI/ASCO Global Oncology Survey of NDCCs. METHODS: The 70 NDCCs received a two-part survey that focused on global oncology programs at NDCCs and non–National Institutes of Health (NIH)–funded global oncology projects with an international collaborator led by the NDCCs. Sixty-five NDCCs responded to the survey, and 57 reported non–NIH-funded global oncology projects. Data were cleaned, coded, and analyzed by NCI-CGH staff. RESULTS: Thirty NDCCs (43%) report having a global oncology program, and 538 non–NIH-funded global oncology projects were reported. Of the NDCCs with global oncology programs, 17 report that trainees complete rotations outside the United States, and the same number enroll trainees from low- and middle-income countries (LMICs). In addition, 147 (28%) of the non–NIH-funded projects focused on capacity building or training, the second highest category after research. Of the 30 top project collaborator countries, 17 were LMICs. Compared with the NCI-funded international grant portfolio, non–NIH-funded global oncology projects were more likely to focus on prevention (12% NCI-funded v 20% non–NIH-funded); early detection, diagnosis, and prognosis (23% v 30%); and cancer control, survivorship, and outcomes research (13% v 22%). CONCLUSION: This survey shows that there is a substantial amount of global oncology research and training supported by NDCCs, and much of this is happening in LMICs. Results of the 2018 Global Oncology Survey can be used to foster opportunities for NDCCs to work collaboratively on activities and to share their findings with relevant stakeholders in their LMIC collaborator countries

Landscape of Global Oncology Research and Training at National Cancer Institute-Designated Cancer Centers: Results of the 2018 to 2019 Global Oncology Survey.

PURPOSE: The National Cancer Institute (NCI)-Designated Cancer Centers (NDCCs) are active in global oncology research and training, leading collaborations to support global cancer control. To better understand global oncology activities led by NDCCs, the NCI Center for Global Health collaborated with ASCO to conduct the 2018/2019 NCI/ASCO Global Oncology Survey of NDCCs. METHODS: Seventy NDCCs received a two-part survey that focused on global oncology programs at NDCCs and non-National Institutes of Health (NIH)-funded global oncology projects with an international collaborator led by the NDCCs. Sixty-seven NDCCs responded to the survey. Data were coded and analyzed by NCI-Center for Global Health staff. RESULTS: Thirty-three NDCCs (47%) reported having a global oncology program, and 61 (87%) reported a collective total of 613 non-NIH-funded global oncology projects. Of the NDCCs with global oncology programs, 17 reported that trainees completed rotations outside the United States and the same number enrolled trainees from low- and middle-income countries (LMIC). Primary focus areas of non-NIH-funded projects were research (469 [76.5%]) and capacity building or training (197 [32.1%]). Projects included collaborators from 110 countries; 68 of these were LMIC. CONCLUSION: This survey shows that there is a substantial amount of global oncology research and training conducted by NDCCs and that much of this is happening in LMIC. Trends in these data reflect those in recent literature: The field of global oncology is growing, advancing scientific knowledge, contributing to building research and training capacity in LMIC, and becoming a recognized career path. Results of the 2018 Global Oncology Survey can be used to foster opportunities for NDCCs to work collaboratively on activities and to share their findings with relevant stakeholders in their LMIC collaborator countries

Trends in International Cancer Research Investment 2006-2018.

The International Cancer Research Partnership (ICRP) is an active network of cancer research funding organizations, sharing information about funded research projects in a common database. Data are publicly available to enable the cancer research community to find potential collaborators and avoid duplication. This study presents an aggregated analysis of projects funded by 120 partner organizations and institutes in 2006-2018, to highlight trends in cancer research funding. Overall, the partners' funding for cancer research increased from $5.562 billion (bn) US dollars (USD) in 2006 to$8.511bn USD in 2018, an above-inflation increase in funding. Analysis by the main research focus of projects using Common Scientific Outline categories showed that Treatment was the largest investment category in 2018, followed by Early Detection, Diagnosis, and Prognosis; Cancer Biology; Etiology; Control, Survivorship, and Outcomes; and Prevention. Over the 13 years covered by this analysis, research funding into Treatment and Early Detection, Diagnosis, and Prognosis had increased in terms of absolute investment and as a proportion of the portfolio. Research funding in Cancer Biology and Etiology declined as a percentage of the portfolio, and funding for Prevention and Control, Survivorship and Outcomes remained static. In terms of cancer site-specific research, funding for breast cancer and colorectal cancer had increased in absolute terms but declined as a percentage of the portfolio. By contrast, investment for brain cancer, lung cancer, leukemia, melanoma, and pancreatic cancer increased both in absolute terms and as a percentage of the portfolio

Phenotypic alterations in type II alveolar epithelial cells in CD4+ T cell mediated lung inflammation

<p>Abstract</p> <p>Background</p> <p>Although the contribution of alveolar type II epithelial cell (AEC II) activities in various aspects of respiratory immune regulation has become increasingly appreciated, our understanding of the contribution of AEC II transcriptosome in immunopathologic lung injury remains poorly understood. We have previously established a mouse model for chronic T cell-mediated pulmonary inflammation in which influenza hemagglutinin (HA) is expressed as a transgene in AEC II, in mice expressing a transgenic T cell receptor specific for a class II-restricted epitope of HA. Pulmonary inflammation in these mice occurs as a result of CD4⁺T cell recognition of alveolar antigen. This model was utilized to assess the profile of inflammatory mediators expressed by alveolar epithelial target cells triggered by antigen-specific recognition in CD4⁺T cell-mediated lung inflammation.</p> <p>Methods</p> <p>We established a method that allows the flow cytometric negative selection and isolation of primary AEC II of high viability and purity. Genome wide transcriptional profiling was performed on mRNA isolated from AEC II isolated from healthy mice and from mice with acute and chronic CD4⁺T cell-mediated pulmonary inflammation.</p> <p>Results</p> <p>T cell-mediated inflammation was associated with expression of a broad array of cytokine and chemokine genes by AEC II cell, indicating a potential contribution of epithelial-derived chemoattractants to the inflammatory cell parenchymal infiltration. Morphologically, there was an increase in the size of activated epithelial cells, and on the molecular level, comparative transcriptome analyses of AEC II from inflamed versus normal lungs provide a detailed characterization of the specific inflammatory genes expressed in AEC II induced in the context of CD4⁺T cell-mediated pneumonitis.</p> <p>Conclusion</p> <p>An important contribution of AEC II gene expression to the orchestration and regulation of interstitial pneumonitis is suggested by the panoply of inflammatory genes expressed by this cell population, and this may provide insight into the molecular pathogenesis of pulmonary inflammatory states. CD4⁺T cell recognition of antigen presented by AEC II cells appears to be a potent trigger for activation of the alveolar cell inflammatory transcriptosome.</p

ESPEN Guideline: Clinical Nutrition in inflammatory bowel disease

Introduction: The ESPEN guideline presents a multidisciplinary focus on clinical nutrition in inflammatory bowel disease (IBD). Methodology: The guideline is based on extensive systematic review of the literature, but relies on expert opinion when objective data were lacking or inconclusive. The conclusions and 64 recommendations have been subject to full peer review and a Delphi process in which uniformly positive responses (agree or strongly agree) were required. Results: IBD is increasingly common and potential dietary factors in its aetiology are briefly reviewed. Malnutrition is highly prevalent in IBD – especially in Crohn's disease. Increased energy and protein requirements are observed in some patients. The management of malnu-trition in IBD is considered within the general context of support for malnourished patients. Treatment of iron deficiency (parenterally if necessary) is strongly recommended. Routine provision of a special diet in IBD is not however supported. Parenteral nutrition is indicated only when enteral nutrition has failed or is impossible. The recommended perioperative man-agement of patients with IBD undergoing surgery accords with general ESPEN guidance for patients having abdominal surgery. Probiotics may be helpful in UC but not Crohn's disease. Primary therapy using nutrition to treat IBD is not supported in ulcerative colitis, but is mod-erately well supported in Crohn's disease, especially in children where the adverse conse-quences of steroid therapy are proportionally greater. However, exclusion diets are generally not recommended and there is little evidence to support any particular formula feed when nutritional regimens are constructed. Conclusions: Available objective data to guide nutritional support and primary nutritional therapy in IBD are presented as 64 recommendations, of which 9 are very strong recom-mendations (grade A), 22 are strong recommendations (grade B) and 12 are based only on sparse evidence (grade 0); 21 recommendations are good practice points (GPP)