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Aging is a heterogeneous process. Most newly diagnosed cancers occur in older adults, and it is important to understand a patient's underlying health status when making treatment decisions. A geriatric assessment provides a detailed evaluation of medical, psychosocial, and functional problems in older patients with cancer. Specifically, it can identify areas of vulnerability, predict survival and toxicity, assist in clinical treatment decisions, and guide interventions in routine oncology practice; however, the uptake is hampered by limitations in both time and resources, as well as by a lack of expert interpretation. In this review, we describe the utility of geriatric assessment by using an illustrative case and provide a practical approach to geriatric assessment in oncology.

Aging is a heterogeneous process. Most newly diagnosed cancers occur in older adults, and it is important to understand a patient's underlying health status when making treatment decisions. A geriatric assessment provides a detailed evaluation of medical, psychosocial, and functional problems in older patients with cancer. Specifically, it can identify areas of vulnerability, predict survival and toxicity, assist in clinical treatment decisions, and guide interventions in routine oncology practice; however, the uptake is hampered by limitations in both time and resources, as well as by a lack of expert interpretation. In this review, we describe the utility of geriatric assessment by using an illustrative case and provide a practical approach to geriatric assessment in oncology. [ABSTRACT FROM AUTHOR]

Purpose There is a paucity of data about current usage of oncology guidelines in low- and middleincome countries (LMICs), specifically in terms of the availability and quality of those guidelines. Our objective was to determine usage of oncology guidelines and the barriers and facilitators to their usage among radiation oncologists in LMICs. Methods An online cross-sectional survey was conducted among practicing radiation oncologists in Nigeria via e-mail and the social media database of the Association of Radiation and Clinical Oncologists of Nigeria. In addition, paper questionnaires were administered at regional clinical meetings. Results The survey response rate was 53.4% in a sample of 101 radiation oncologists from the database. Sixty-nine percent of respondents were consultants and 30% were residents. Approximately 43% had < 5 years' experience. All of the respondents were involved in administering chemotherapy during the treatment of patients with cancer, whereas approximately half were involved in diagnosing cancer. Ninety-three percent reported using guidelines in treating patients, the top two guidelines being those from the National Comprehensive Cancer Network (90%) and the American Society of Clinical Oncology (50%). The two major barriers to guideline usage were that facilities were inadequate for proper guideline implementation and that the information in guidelines were too complex to understand. Potential facilitators included providing adequate facilities, developing local guidelines, and increasing awareness of guideline usage. Conclusion Our study shows that clinicians involved in the treatment of patients with cancer in LMICs are aware of cancer treatment guidelines. However, implementation of these guidelines hinders their usage because the facilities are inadequate, guidelines are not applicable to the local setting, and the information in the guidelines is too complex. [ABSTRACT FROM AUTHOR]

Purpose: There is a paucity of data about current usage of oncology guidelines in low- and middle-income countries (LMICs), specifically in terms of the availability and quality of those guidelines. Our objective was to determine usage of oncology guidelines and the barriers and facilitators to their usage among radiation oncologists in LMICs. Methods: An online cross-sectional survey was conducted among practicing radiation oncologists in Nigeria via e-mail and the social media database of the Association of Radiation and Clinical Oncologists of Nigeria. In addition, paper questionnaires were administered at regional clinical meetings. Results: The survey response rate was 53.4% in a sample of 101 radiation oncologists from the database. Sixty-nine percent of respondents were consultants and 30% were residents. Approximately 43% had < 5 years' experience. All of the respondents were involved in administering chemotherapy during the treatment of patients with cancer, whereas approximately half were involved in diagnosing cancer. Ninety-three percent reported using guidelines in treating patients, the top two guidelines being those from the National Comprehensive Cancer Network (90%) and the American Society of Clinical Oncology (50%). The two major barriers to guideline usage were that facilities were inadequate for proper guideline implementation and that the information in guidelines were too complex to understand. Potential facilitators included providing adequate facilities, developing local guidelines, and increasing awareness of guideline usage. Conclusion: Our study shows that clinicians involved in the treatment of patients with cancer in LMICs are aware of cancer treatment guidelines. However, implementation of these guidelines hinders their usage because the facilities are inadequate, guidelines are not applicable to the local setting, and the information in the guidelines is too complex. [ABSTRACT FROM AUTHOR]

Purpose: Across the Caribbean, too many women are presenting with advanced breast cancer and dying with little or no access to palliative care. No comprehensive assessment of the current capacity to deliver palliative care in the region exists, largely because of limited data. Cancer is the second leading cause of death, and significant numbers of patients present with advanced disease. Breast cancer is no exception, with an incidence rate of more than 26% and a mortality rate accounting for 17% of all cancer-related deaths in women. In this paper, we assess the challenges and opportunities that are faced by small island states in delivering palliative care through the lens of women with breast cancer. Methods: We performed a systematic review of the literature on palliative care provision in the region. Background information and country statistics were obtained from recognized databases, such as GLOBOCAN and Pan American Health Organization country cancer profiles, and information on opioid usage from the Pain and Policy Study Group. Much of the detailed information gleaned for this paper was through personal communication. Results: Palliative care provision in the Caribbean exists in isolated pockets throughout the region. Capturing data on the palliative care capacity in the Caribbean was challenging, as electronic health records and robust data collection is not yet the norm. Challenges included insufficient health care infrastructure to support the spectrum of cancer care, tremendous unmet need for palliative care, pervasive opiophobia that resulted in limited access to opioids for pain relief, patients' reluctance to engage early with clinical care, and widespread use of complementary and alternative medicines before the acceptance of conventional care. Conclusion: This is the first study to our knowledge to examine the extent of palliative care service provision across the Caribbean. We conclude that there is an urgent need to improve access to palliative care and pain relief for patients with cancer in the region. Our proposed solutions include strengthening regional collaboration through policy and guideline development, human resource training, improved availability and accessibility of opioid medicines, and in-country development of information technology infrastructure to support patient care and research. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc. No COIs from the authors. [ABSTRACT FROM AUTHOR]

Background: The AMPATH Consortium has served to greatly expand healthcare in western Kenya. Gaps and limitations in care still exist, especially in oncology care in rural areas. Telemedicine provides a lower cost, practical method to maximize physician resources and limit cost and stress to families with socioeconomic limitations in rural Kenya. The following paper seeks to discuss the importance of developing a telemedicine model in western Kenya and the many advantages telemedicine can bring, as well as discuss the telemedicine model being developed by AMPATH Oncology. Aim: Integrate paper-based medical records into the AMPATH AIDS EMR; Identify sustainable telemedicine tools to integrate into the EMR; Establish networking in rural clinics; Budget in IT personnel at each clinic to assist in patient setup with central site; use solar as primary power source for devices to aid in power issues. Only 45% of Kenyans have access to power; Use cellular networks for communication; Maximize time allocated for physicians to see patients; Decrease travel time to clinics as only 32% of Kenyans live in urban environments. Methods: Cost analysis of remote clinic locations and associated costs; Clinic budget estimate for networking and telemedicine support position; Cost summary and savings Results: Estimated costs for the operations budget for the 17 rural outreach clinics include the costs of hardware, solar networking setup, and internet at a total $3400/wk. This will decrease after the first year to $1700 for maintenance costs of equipment. Personnel consists of 1 local person to support the system and will be a weekly cost of $1870. Lost time for physicians due to road travel totals ∼100 hours weekly. Estimated salaries for an oncologist at $30/h leads to a cost of $3007/wk in lost productivity. It should be noted that lodging and per diem expenses are not included in the estimated expenses that total $6114/wk. By doing telemedicine at the rural clinics in an ideal 48 workable week situation. The savings of $528,000 is a clear evidence that this is financially feasible solely based on travel savings over 5 years. For this reason, the actual savings is ∼$264,000 and still makes a strong argument for this being the right move. Conclusion: Telemedicine is a viable and necessary resource for developing oncologic care in rural Kenya. We believe that telemedicine represents a natural evolution in healthcare in Kenya to support its rural population. Telemedicine helps maximize the limited physician resources and allows them to reach a larger audience without tying up their time in lengthy commutes. Last, telemedicine should assist patients to overcome the barriers of cost and time that limit their treatment. Future challenges and gains will be made with the evolution of the newly formed national health insurance system. Gaining support and reimbursement from telemedicine visits will be crucial to ensuring the success of telemedicine. [ABSTRACT FROM AUTHOR]

Background: When global health and cancer care are discussed, it is usually in the context of underserved communities, inadequate resources, standards of care below that in the developed world, loss of talented individuals to upper-income countries and the inability to recruit and retain a robust regional workforce. While such conditions may now exist, they are by no means "guaranteed" to be so in the future. Aim: To consider a visionary future for the radiation sciences to encourage investment by individuals in their careers and countries in their cancer care resources such that the current resource-limited facilities will be on the leading edge of accurate, precision radiation medicine. Such a change in perspective can greatly impact recruiting and retaining expertise. Methods: As part of building a visionary strategic plan for radiation oncology and the radiation sciences for the next few decades, a personal opinion paper was prepared by authors from the US National Cancer Institute, Conseil Européen pour la Recherche Nucléaire (CERN)/European Organization for Nuclear Research and the International Conference on Translational Research in Radio-Oncology/Physics for Health in Europe. Considering the critical role for global involvement in the future of radiation sciences, the paper provides a path forward via "win-win" sustainable partnerships formed by current resource-limited and resource-rich countries, as envisioned by the International Cancer Expert Corps (www.iceccancer.org). Results: The manuscript " Accurate, precision radiation medicine: a meta-strategy for impacting cancer care, global health, nuclear policy, and mitigating radiation injury from necessary medical use, space exploration and potential terrorism " is in press. A figure (the Radiation Rotary) illustrates that there are a number of crossroads facing the radiation sciences best addressed as part of a rotary. Four sets of issues are illustrated: 1) cancer care with radiation therapy as both technology and biology, 2) global collaboration in technology development ranging from improved linear accelerators for resource-challenged environments to particle therapy for highly specialized uses, 3) nuclear policy, from energy to the potential for nuclear terrorism and conflagration, and 4) mitigating radiation injury including enabling long-term space exploration, helping reduce the fear of radiation and producing drugs to mitigate radiation injury. Conclusion: Many of these technology, research and development issues must involve LMICs. This is in addition to understanding the differences between upper- and lower-income regions in cancer biology and the environment, including infectious etiologies, diet and the microbiome. The talent and capability of radiation oncologists and related professionals within LMICs are essential to global health and economic development and provide incentives and unique opportunities for world-leading careers and contributions. Disclaimer: The content is the personal opinion of the authors and not their organizations [ABSTRACT FROM AUTHOR]

Background and context: Nigeria and most of the low and middle-income countries in West Africa have been unable to successfully transition from a paper based medical health records system to an electronic one. This is due to such constraints as lack of skilled manpower in development and maintenance of electronic records, erratic electric power supply and poor uptake of innovative means of securing and saving medical records. In a tertiary hospital that receives over 1500 new patients per year and manages about 5000 known patients per year, it is important to provide a fast, less cumbersome way of storing data. We need an enabling environment to make app use in healthcare functional. Aim: 1. To show that a mobile application used in a hospital setting can reduce the time spent by patients in accessing healthcare. 2. To show the medical information collected by a mobile medical application is reproducible, and secure. 3. To show that deployment of an electronic mobile health application for patient health care is both possible and necessary. Strategy/Tactics: A Web-based application was developed to be used as an electronic medical record. It was used in the oncology clinic of a tertiary institution in Lagos, Nigeria to take history and record examination findings as well as other aspects of personal medical data from new patients presenting in the clinic. The information so gathered was saved online on a cloud service and a copy was printed and placed in the hospital's paper-based records to reduce the stress of transitioning from paper-based records to electronic records. The application was built using C# for the backend, ASP.Net, HTML5, jQuery, JavaScript, Microsoft SQL database, jQuery Select 2 and jQuery for easy upgradability. Program/Policy process: A pilot study was carried out in which new outpatients were seen first with the application. Their history was taken and entered into the software. The examination findings and a summary of their investigation results were also entered into the software. A pdf file containing a summary of the data so entered into the software was generated automatically and printed. This printed copy of the patients' information was placed in the hospital's folder for review. Outcomes: 1. Stress of capturing and documenting patients data were grossly reduced in the clinic. 2. Time taken for patient assessment was reduced. 3. Data could be accessed anywhere online for the first time. This will facilitate telemedicine and research. What was learned: 1. Oncologists went through less pressure when attending to patients with this application as the intuitive outlook made clerking easy. 2. Access to steady Internet coverage and a stable power supply are issues to be tackled using this system. 3. There is a definite demand for just such a system both among patients and care givers. DOI: https://doi.org/10.1200/jgo.18.40800 [ABSTRACT FROM AUTHOR]

Globally, the pipeline of oncology drugs in clinical development has seen a robust growth over the past decade. Oncology clinical trials remain the top 3 industry-sponsored trials in Malaysia for the last five years. To be successful in the development of new cancer therapies, sponsors and contract research organizations (CROs) need access to sufficient numbers of trained and interested investigators, besides highly trained staff and resources to offer those trials to patients. Unfortunately, in Malaysia, the number of oncologists stands between 105 and 110. About half of all oncologists are GCP certified, and from this, even a lesser number are found active in industry-sponsored research (ISR). A public–private partnership in oncology was initiated by the Ministry of Health, Malaysia, to address the shortage of oncologists at the public sector where most oncologists are saturated with clinical work and unable to take up oncology trials. At the same time, despite the majority of oncologists working in the private sector, their willingness to conduct clinical trials are hampered by difficulties in access to patients due to the fact that the pool of cancer patients is mostly concentrated in public hospitals. This paper describes the development and implementation of a public–private partnership in oncology to address the lack of uptake of industry-sponsored oncology clinical trials in the country by allowing oncologist from the private sector to tap into the patient pool of public hospitals. As part of this policy, a pilot project was initiated at three public hospitals to allow clinical specialists (e.g., hematologists, surgeons, gynae-oncologists) to collaborate with oncologists from the private sector in industry sponsored research. [ABSTRACT FROM AUTHOR]

Background: Smoking following a diagnosis of cancer is a powerful clinical risk indicator, with known poorer health outcomes and associated health care costs. In Australia, smoking rates are higher in rural and regional areas. There are established and effective interventions to promote smoking cessation after a diagnosis of cancer yet these are not in routine practice. Aim: This protocol paper reports on a study that aims to embed evidence-based smoking cessation strategies for people with cancer who are current smokers into routine care, resulting in in system wide improvements, an implemented program and model for further dissemination. Methods: Across three rural/regional sites, and with partners Quit Victoria and Western Alliance, this study employs a variety of methodologies to embed smoking cessation support to improve outcomes for people with cancer who currently smoke. Specifically, the project will embed a system of responsibilities and training in rural and regional health services to routinely engage people with cancer who smoke in support services. The program will: · Promote routine delivery of smoking cessation care by trained oncology staff (oncologists/nurses/ allied health) · Establish referral pathways to Quitline · Correspond with general practitioners, to: i) outline the benefits of quitting in this context, ii) promote access to nicotine replacement therapy and iii) support quitting in the community. · Improve routine recording of smoking status and documentation of provision of brief intervention (personalised advice given, resources provided) and outcomes. Participants: are oncology staff and general practitioners across three health services: Ballarat Health Service, East Grampians Health Service (Ararat), Wimmera Health Care Group (Horsham), all located in Victoria, Australia. Data collection will occur across four sources: 1) Oncology staff: qualitative and quantitative data collection understanding confidence and views on provision on cessation advice; 2) Monitoring Quitline calls, 3) Interview with local general practitioners and 4) Medical record reviews to explore frequency of recording of smoking status. Data will be collected pre/postintervention. Results: The project is underway with the intervention manuals in development. The project is due for completion in 2020. Conclusion: This project takes a health services approach to integration of smoking cessation support in routine care for people with cancer in rural and regional areas. This program of work has capacity to determine best approaches to integrate smoking cessation into routine care, resulting in reduced mortality and morbidity, improved effectiveness of anticancer treatments, and reduced health care costs; by establishing internationally relevant, embedded health care interventions. [ABSTRACT FROM AUTHOR]