Utilization of cancer immunotherapy in sub-Saharan Africa.
Utilization of cancer immunotherapy in sub-Saharan Africa.
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DOI：
10.3389/fonc.2023.1266514
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发表时间：
2023
影响因子：
4.7
通讯作者：
中科院分区：
文献类型：
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撒哈拉以南非洲柳叶刀肿瘤学委员会（SSA）预测，到2040年，癌症死亡人数将翻一番，从每年520，158人增加到每年超过100万人。这些惊人的数字表明，迫切需要评估该地区的癌症治疗基础设施和资源。研究发现，免疫疗法对治疗晚期癌症有效，SSA中近70%的患者患有晚期癌症。尽管免疫疗法具有显著的治疗潜力，但其在SSA中的应用并没有很好的记录。本研究的目的是评估SSA免疫治疗的前景。Qualtrics调查评估了现有的基础设施和安全免疫治疗管理的培训，并通过电子邮件和WhatsApp在线分发给SSA的3，231名医疗保健提供者，目标受众是为癌症患者服务的医疗保健提供者。该调查包含22个问题，评估SSA中免疫治疗的可及性，使用，知识和培训。于2023年1月至2月期间收集回应。使用Microsoft Excel总结并直观显示响应分布（计数和比例）。来自撒南非洲28个国家的292份答复。29%的受访者表示他们的诊所很容易获得癌症免疫治疗，46%的受访者表示他们的诊所目前正在实施免疫治疗。在实施免疫治疗的诊所（n = 133）中，12%使用基因组测序来评估肿瘤突变负荷生物标志物，44%在免疫治疗前评估PD-L1生物标志物的表达。46%的受访者熟悉免疫疗法。11%的人表示接受过充分的管理培训。其中（n=33），52%的人表示还接受过管理与免疫治疗管理相关的免疫相关不良事件的培训。免疫疗法的利用率和培训在SSA中较低，不足以应对不断上升的癌症负担。增加生物标志物检测的可及性和使用以预测免疫治疗反应，将免疫治疗培训纳入持续医学教育，以及增加免疫治疗药物的可及性可能是SSA中免疫治疗扩大使用的先决条件。
The Lancet Oncology Commission for sub-Saharan Africa (SSA) predicts that cancer deaths will double from 520,158 per year to more than 1 million per year by the year 2040. These striking figures indicate a need to urgently evaluate cancer treatment infrastructure and resources in the region. Studies have found immunotherapy to be effective for the treatment of advanced-stage cancer, which almost 70% of patients in SSA present with. Despite immunotherapy’s significant therapeutic potential, its utilization in SSA is not well documented. The purpose of this study was to evaluate the landscape of immunotherapy in SSA. A Qualtrics survey assessing the existing infrastructure and training for safe immunotherapy administration was developed and distributed online via email and WhatsApp to 3,231 healthcare providers across SSA, with a target audience of healthcare providers serving patients with cancer. The survey contained 22 questions evaluating the accessibility, use, knowledge, and training on immunotherapy in SSA. Responses were collected between January and February 2023. Microsoft Excel was used to summarize and visually present the distribution of responses as counts and proportions. 292 responses were included from 28 countries in SSA. 29% of all respondents indicated their clinic has easy access to cancer immunotherapy and 46% indicated their clinic currently practices it. Of clinics that practiced immunotherapy (n = 133), 12% used genomic sequencing to assess the tumor mutational burden biomarker, and 44% assessed expression of the PD-L1 biomarker prior to immunotherapy administration. 46% of all respondents were familiar with immunotherapy. 11% indicated being adequately trained to administer it. Of these (n=33), 52% indicated also being trained to manage immune-related adverse events related to immunotherapy administration. Immunotherapy utilization and training is low in SSA and insufficient for the rising cancer burden. Increased accessibility and usage of biomarker testing to predict immunotherapy response, incorporation of immunotherapy training into continuous medical education, and increased access to immunotherapy drugs may be prerequisites for expanded utilization of immunotherapy in SSA.
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