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Purpose To provide resource-stratified, evidence-based recommendations on the secondary prevention of cervical cancer globally. Methods ASCO convened a multidisciplinary, multinationalpanel of oncology, primarycare, epidemiology, health economic, cancer control, public health, and patient advocacy experts to produce recommendations reflecting four resource-tiered settings. A review of existing guidelines, a formal consensus-based process, and a modified ADAPTE process to adapt existing guidelines were conducted. Other experts participated in formal consensus. Results Seven existing guidelines were identified and reviewed, and adapted recommendations form the evidence base. Four systematic reviews plus cost-effectiveness analyses provided indirect evidence to inform consensus, which resulted in ≥ 75% agreement. Recommendations Human papillomavirus (HPV) DNA testing is recommended in all resource settings; visual inspectionwith acetic acidmaybe used in basic settings. Recommendedage ranges and frequencies by setting are as follows: maximal: ages 25 to 65, every 5 years; enhanced: ages 30 to 65, if two consecutive negative tests at 5-year intervals, then every 10 years; limited: ages 30 to 49, every 10 years; and basic: ages 30 to 49, oneto three times per lifetime. Forbasic settings, visualassessment isrecommendedas triage; in other settings, genotyping and/or cytology are recommended. For basic settings, treatment is recommended if abnormal triage results arepresent; inothersettings, colposcopy is recommendedforabnormal triageresults. For basic settings, treatment options are cryotherapy or loop electrosurgical excision procedure; for other settings, loop electrosurgical excision procedure (or ablation) is recommended. Twelve-month post-treatment follow-up is recommended in all settings. Women who are HIV positive should be screened with HPV testing after diagnosis andscreenedtwice asmanytimesper lifetimeas thegeneralpopulation. Screening is recommendedat6weeks postpartum in basic settings; in other settings, screening is recommended at 6months. In basic settings without mass screening, infrastructure for HPV testing, diagnosis, and treatment should be developed. Additional information can be found at www.asco.org/rs-cervical-cancer-secondary-prev-guideline and www. asco.org/guidelineswiki. It is the view of of ASCO that health care providers and health care system decision makers should be guided by the recommendations for the highest stratumof resources available. The guideline is intended to complement, but not replace, local guidelines. [ABSTRACT FROM AUTHOR]

Purpose: Late-stage cancer patient symptom control is a national priority in Tanzania. Mobile health promises to improve the reach of a limited pool of palliative care specialists through interprofessional, community-based care coordination. This work assessed the effectiveness of a smartphone- or Web-based app, mPalliative Care Link (mPCL), to extend specialist access via shared data and communication with local health workers. Central to mPCL is the African Palliative care Outcome Scale (POS), adapted for automated mobile symptom assessment and response., Methods: Adult patients with incurable cancer were randomly assigned at hospital discharge to mPCL versus phone-contact POS collection. Sociodemographic, clinical, and POS data were obtained at baseline. Twice-weekly POS responses were collected and managed via mPCL or phone contact with clinician study personnel for up to 4 months, on the basis of study arm assignment. Patient end-of-study care satisfaction was assessed via phone survey., Results: Forty-nine patients per arm participated. Comparison of baseline characteristics showed an insignificant trend toward more women ( P = .07) and higher discharge morphine use ( P = .09) in the mPCL group compared with phone-contact and significant between-group differences in cancer types ( P = .003). Proportions of deaths were near equal between groups (mPCL: 27%; phone-contact: 29%). Overall symptom severity was significantly lower in the phone-contact group ( P < .0001), and symptom severity decreased over time in both groups ( P = .0001); however, between-group change in overall symptoms over time did not vary significantly ( P = .34). Care satisfaction was generally high in both groups., Conclusion: Higher symptom severity scores in the mPCL arm likely reflect between-group sociodemographic and clinical differences and clinical support of phone-contact arm participants. Similar rates of care satisfaction in both groups suggest that mPCL may support symptom-focused care coordination in a more efficient and scalable manner than phone contact. A broader study of mPCL's cost efficiency and utility in Tanzania is needed., Competing Interests: Beatrice MushiResearch Funding: Cepheid, Celgene Cancer Care Links Robert S. MorseEmployment: Medtronic, HistosonicsConsulting or Advisory Role: Medtronic, Histosonics Kaley LambdenEmployment: Dimagi IncStock and Other Ownership Interests: Dimagi IncResearch Funding: Sandoz-Novartis Erin QuinnEmployment: DimagiStock and Other Ownership Interests: Dimagi Sarah B. SaganEmployment: DimagiStock and Other Ownership Interests: DimagiResearch Funding: Dimagi Yun Xian HoEmployment: DimagiStock and Other Ownership Interests: Dimagi Susan MiesfeldtResearch Funding: PfizerNo other potential conflicts of interest were reported.

Purpose: The COVID-19 pandemic significantly disrupted cancer care in Africa, further exposing major health disparities. This paper compares and contrasts the experiences of 15 clinicians in six different African cancer centers to highlight the positive aspects (silver linings) in an otherwise negative situation., Methods: Data are from personal experience of the clinicians working at the six cancer centers blended with what is available in the literature., Results: The impact of COVID-19 on cancer care appeared to vary not only across the continent but also over cancer centers. Different factors such as clinic location, services offered, available resources, and level of restrictions imposed because of COVID-19 were associated with these variations. Collectively, delays in treatment and limited access to cancer care were commonly reported in the different regions., Conclusion: There is a lack of data on cancer patients with COVID-19 and online COVID-19 and cancer registries for Africa. Analysis of the available data, however, suggests a higher mortality rate for cancer patients with COVID-19 compared with those without cancer. Positive or silver linings coming out of the pandemic include the adoption of hypofractionated radiation therapy and teleoncology to enhance access to care while protecting patients and staff members. Increasing collaborations using online technology with oncology health professionals across the world are also being seen as a silver lining, with valuable sharing of experiences and expertise to improve care, enhance learning, and reduce disparities. Advanced information and communication technologies are seen as vital for such collaborations and could avail efforts in dealing with the ongoing pandemic and potential future crises.

Purpose: The limited radiotherapy resources for global cancer control have resulted in increased interest in developing time- and cost-saving innovations to expand access to those resources. Hypofractionated regimens could minimize cost and increase access for limited-resource countries. In this investigation, we estimated the percentage cost-savings per radiotherapy course and increased radiotherapy access in African countries after adopting hypofractionation for breast and prostate radiotherapy. For perspective, results were compared with high-income countries., Methods: The cost and course of breast and prostate radiotherapy for conventional and hypofractionated regimens in low-resource facilities were calculated using the Radiotherapy Cost Estimator tool developed by the International Atomic Energy Agency (IAEA) and then compared with another activity-based costing model. The potential maximum cost savings in each country over 7 years for breast and prostate radiotherapy were then estimated using cancer incidence data from the Global Cancer Observatory database with use rates applied. The increase in radiotherapy access was estimated by current national capacities from the IAEA directory., Results: The estimated cost per course of conventional and hypofractionated regimens were US$2,232 and $1,339 for breast treatment, and $3,389 and $1,699 for prostate treatment, respectively. The projected potential maximum cost savings with full hypofractionation implementation were $1.1 billion and $606 million for breast and prostate treatment, respectively. The projected increase of radiotherapy access due to implementing hypofractionation varied between +0.3% to 25% and +0.4% to 36.0% for breast and prostate treatments, respectively., Conclusion: This investigation demonstrates that adopting hypofractionated regimens as standard treatment of breast and prostate cancers can result in substantial savings and increase radiotherapy access in developing countries. Given reduced delivery cost and treatment times, we anticipate a substantial increase in radiotherapy access with additional innovations that will allow progressive hypofractionation without compromising quality.

Purpose: To provide resource-stratified, evidence-based recommendations on the secondary prevention of cervical cancer globally., Methods: ASCO convened a multidisciplinary, multinational panel of oncology, primary care, epidemiology, health economic, cancer control, public health, and patient advocacy experts to produce recommendations reflecting four resource-tiered settings. A review of existing guidelines, a formal consensus-based process, and a modified ADAPTE process to adapt existing guidelines were conducted. Other experts participated in formal consensus., Results: Seven existing guidelines were identified and reviewed, and adapted recommendations form the evidence base. Four systematic reviews plus cost-effectiveness analyses provided indirect evidence to inform consensus, which resulted in ≥ 75% agreement., Recommendations: Human papillomavirus (HPV) DNA testing is recommended in all resource settings; visual inspection with acetic acid may be used in basic settings. Recommended age ranges and frequencies by setting are as follows: maximal: ages 25 to 65, every 5 years; enhanced: ages 30 to 65, if two consecutive negative tests at 5-year intervals, then every 10 years; limited: ages 30 to 49, every 10 years; and basic: ages 30 to 49, one to three times per lifetime. For basic settings, visual assessment is recommended as triage; in other settings, genotyping and/or cytology are recommended. For basic settings, treatment is recommended if abnormal triage results are present; in other settings, colposcopy is recommended for abnormal triage results. For basic settings, treatment options are cryotherapy or loop electrosurgical excision procedure; for other settings, loop electrosurgical excision procedure (or ablation) is recommended. Twelve-month post-treatment follow-up is recommended in all settings. Women who are HIV positive should be screened with HPV testing after diagnosis and screened twice as many times per lifetime as the general population. Screening is recommended at 6 weeks postpartum in basic settings; in other settings, screening is recommended at 6 months. In basic settings without mass screening, infrastructure for HPV testing, diagnosis, and treatment should be developed.Additional information can be found at www.asco.org/rs-cervical-cancer-secondary-prev-guideline and www.asco.org/guidelineswiki.It is the view of of ASCO that health care providers and health care system decision makers should be guided by the recommendations for the highest stratum of resources available. The guideline is intended to complement, but not replace, local guidelines., Competing Interests: 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. Jose JeronimoNo relationship to disclosePhilip E. CastleHonoraria: Roche, Cepheid Consulting or Advisory Role: Cepheid, GE Healthcare, Guided Therapeutics, Merck, Genticel, Teva, Inovio PharmaceuticalsSarah TeminNo relationship to discloseLynette DennyHonoraria: GlaxoSmithKline, Merck Speakers' Bureau: GlaxoSmithKline, Merck Research Funding: GlaxoSmithKline Travel, Accommodations, Expenses: MerckVandana GuptaNo relationship to discloseJane J. KimNo relationship to discloseSilvana LucianiNo relationship to discloseDaniel MurokoraNo relationship to discloseTwalib NgomaNo relationship to discloseYoulin QiaoConsulting or Advisory Role: MSD Research Funding: GE Healthcare Travel, Accommodations, Expenses: MSDMichael QuinnConsulting or Advisory Role: Tesaro, AstraZeneca Travel, Accommodations, Expenses: Roche, Tesaro, AstraZenecaRengaswamy SankaranarayananNo relationship to disclosePeter SasieniHonoraria: Hologic Expert Testimony: Teva, Mylan, Sandoz, Dr Reddys LaboratoryKathleen M. SchmelerResearch Funding: Becton Dickinson Patents, Royalties, Other Intellectual Property: UpToDateSurendra S. ShastriNo relationship to disclose