Publications

INTRODUCTION: Healthy habits such as regular physical activity, a balanced diet and tobacco abstinence are associated with better health-related quality of life (HRQoL) in cancer survivors. However, there is limited evidence on this relationship in Latin American countries, where socioeconomic and cultural factors may influence adherence to healthy behaviours.

OBJECTIVES: To evaluate the relationship between adherence to healthy lifestyle recommendations and HRQoL in cancer survivors in Uruguay.

MATERIALS AND METHODS: A cross-sectional study was conducted with 241 early-stage cancer survivors treated at two hospitals in Uruguay. Adherence to healthy habits was assessed using a questionnaire based on the American Cancer Society recommendations. HRQoL was measured using the RAND-36 questionnaire. Categorical variables were analysed using the chi-square test, while continuous variables were analysed using Student's t-test or the Mann-Whitney test. The correlation between SF-36 dimensions and healthy habits was assessed using Spearman's coefficient.

RESULTS: The median age was 66.7 years and 55.2% were women. The most common cancers were breast (31.1%), colorectal (28.2%) and prostate (26.6%). A total of 62.7% of participants adhered to three or more healthy habits. Adherent patients showed significantly higher HRQoL scores, particularly in physical function (62.68 versus 45.67, p < 0.001), energy/fatigue (64.83 versus 45.89, p < 0.001) and emotional well-being (69.43 versus 53.02, p < 0.001). Adherence to multiple healthy habits was significantly correlated with improvements in physical and mental domains, with energy/fatigue showing the strongest correlation (rs = 0.66, p < 0.001).

CONCLUSION: Adherence to healthy habits has a cumulative positive impact on the HRQoL of cancer survivors. This study highlights the need to design comprehensive interventions to promote healthy behaviours in this population, contributing to the global evidence on cancer care and underscoring its importance in developing countries.

Merkel cell carcinoma (MCC) is a rare and aggressive tumour of the skin, characterised by a high rate of local recurrence and lymph node involvement. We present the case of a 58-year-old woman who developed a 5-cm tumour on the right lower eyelid, leading to ocular occlusion. Magnetic resonance imaging revealed an exophytic lesion in the right orbit, and a biopsy confirmed the diagnosis of MCC. After complete surgical resection and cervical emptying, the patient was treated with adjuvant radiotherapy. The final diagnosis was MCC, stage pT3 pN1 M0. The periocular location and tumour size were determinants in the treatment decision.

Amidst the global disparities in providing Paediatric Palliative Care (PPC), the compounded realities in the Eastern Mediterranean region intensify the need for palliative care for children with cancer. This region hosts 12% of children needing PPC worldwide within limited specialised services, training and resources exacerbated by political instabilities. Immediate effective responses may reside in promoting interdisciplinary capacity-building combined with action planning among healthcare professionals, stakeholders and advocates for patients and their families. In response to these pressing needs, the First Regional Interdisciplinary PPC Workshop was held in-person in Rabat, Morocco on 6-8 November 2024, aiming to strengthen regional interdisciplinary healthcare professionals' capacity through training and collaborative action planning to improve PPC integration in cancer treatment. Eighty-five attendees representing 15 countries including regional healthcare professionals, international experts, foundation representatives and policymakers united in the commitment to promote PPC integration and enhance the quality of life for children with palliative care needs, particularly those with cancer living in this region. Over 3 days, participants engaged in training, discussions and action planning. Day one provided essential skills to deliver PPC at the patient care level (micro-level), day two discussed institutional implementation of PPC services (meso-level), day three tackled national and regional endeavours to promote PPC integration (macro-level). At the conclusion of the workshop, participants gained knowledge and confidence in various PPC skills. They shared their plans to establish PPC teams/units, apply symptom management and communication skills, train colleagues within their settings, conduct research and maintain networking to encourage collaboration opportunities. The workshop marked a pivotal step to deepen understanding of the PPC landscape and resources in the region. This impactful experience laid the foundations for different opportunities in practice, research, policy and advocacy to accelerate PPC integration in the Eastern Mediterranean region, fostering collective efforts to improve childhood cancer care globally.

BACKGROUND: Palliative care research (PCR) plays a critical role in improving the quality of life for patients with serious illness, yet its global distribution and focus areas remain uneven. Understanding the trends and impact of PCR over the past decade can inform future research priorities and policy development.

METHODS: We conducted a bibliometric analysis of publications indexed in the Web of Science related to PCR between 2013 and 2022. Articles were identified using a comprehensive filter based on title keywords and specialist journals, and were further classified by research domain, disease area and study type.

RESULTS: The volume of PCR publications has grown over the past decade, increasing from 0.29% of all biomedical research outputs in 2013-14 to 0.62% in 2021-22. Countries with the highest levels of PCR output-primarily European and Anglophone nations-also ranked highly on the Economist Intelligence Unit's Quality of Death Index. Using eight different bibliometric indicators, we assessed the impact of countries' PCR outputs; while rankings varied by metric, European countries such as the Netherlands, Belgium, the United Kingdom and Ireland consistently performed strongly. Cancer emerged as the dominant disease focus, although many studies also addressed co-morbid conditions including COVID-19 in recent years. A significant proportion of PCR also examined the impact of illness on patients' families and caregivers.

CONCLUSION: The findings highlight cancer as a major area of focus and need within PCR. However, research outputs remain disproportionately concentrated in high-income countries, revealing a persistent gap in low- and middle-income settings.

RECOMMENDATIONS: To address the growing global burden of cancer and serious illness, palliative care should be integrated as a core component of national cancer control plans. This integration must be supported by a targeted research agenda that emphasises implementation and scaling of palliative care models, particularly in low- and middle-income countries. Policymakers and research funders should prioritise holistic, patient-centred approaches and ensure that impact measurement reflects meaningful outcomes for patients and families.

BACKGROUND: Zambia faces the double burden of rising cancer incidence and a disproportionate volume of mortality from delayed presentations. The Ministry of Health Zambia acknowledged cancer research as a key pillar of cancer control in the National Cancer Control Strategic Plan 2022-2026, but there remains a paucity of country-specific evidence to inform strategies, implementation, monitoring and evaluation of research activities. Our study aimed to map and critically analyse the existing cancer research landscape to inform national planning.

METHODS: We adopted a two-stage mixed-method research. First, we conducted a systematic review, including 76 Zambian cancer studies published between 2012 and 2022, adhering to PRISMA guidance. Second, we conducted an in-person modified consensus meeting in Ndola, Zambia attended by 31 domestic and international stakeholders, to co-develop priorities and strategies based on gaps and facilitators identified through the systematic review.

RESULTS: The year-on-year cancer research output in Zambia had risen and diversified beyond cervical cancer but prevention, palliative care and health economic studies were lacking. Delay in deciding to seek care was most studied (n = 17, 63.0%), especially in cervical cancer. Research activities were mostly retrospective (n = 47/76, 61.8%) with only one randomised controlled trial identified. Greater than 90% (n = 10/11, 90.9%) of the most prolific research funders were international, predominantly from the United States and the United Kingdom, and Zambian researchers were under-represented as first and last authors at 43% (n = 33/76) and 45% (n = 34/76), respectively. The existing national cervical cancer registry, active global collaboration and adoption of technology were facilitators to be leveraged to build research capacity through multi-level, stakeholder-specific strategies.

CONCLUSION: To strengthen research capacity, sustained commitment to priorities through the implementation of co-developed strategies is required at individual, organisational and institutional levels. This paradigm shift is necessary to deliver evidence-based cancer care tailored to the needs of Zambians with emphasis on value and quality.