Antecedentes de la Investigación

Objectives • To be able to understand the challenges of treating cancer with limited resources

Awareness • Awareness of the existence of vast heterogeneity among low- and middle-income countries (LMCs) in terms of available resources, public policy-related and social conditions and healthcare infrastructure

• Awareness of the existence of important discrepancies in cancer treatment outcomes across the globe

• Appreciation of the principles of cancer prevention in limited-resource environments

• Awareness of the variability of access to radiotherapy and cancer medicines across the globe

Knowledge • Familiarity with the epidemiology of cancer in LMCs, including incidence and mortality rates by regions of the world

• Understanding of the challenges that the current trends and the cancer epidemic will bring to LMCs

• Understanding of the aetiology of cancer in LMCs, particularly as related to infectious diseases

• Familiarity with interventions for cancer prevention and early detection in LMCs

• Understanding of common barriers to cancer control in LMCs, including public awareness and education, healthcare provider training and workforce issues, financial resources and governmental prioritisation

• Familiarity with the important discrepancies in availability of cancer care, in terms of cancer medication, access to radiotherapy and quality surgery

• Understanding of the construct of the WHO Essential Medicines List

• Familiarity with the concept of resource-stratified treatment guidelines

• Familiarity with the practice of multidisciplinary management of patients with cancer Skills • Ability to find, report and critically discuss epidemiological evidence from LMCs

• Ability to contribute to discussions on general management strategies of cancer in LMCs, including prevention

• Ability to discuss the content of the WHO Essential Medicine List for cancer

• Ability to discuss the practical application of resource-stratified guidelines

Objectives • To understand how to prescribe anticancer agents for the treatment of solid tumours and haematological malignancies

• To understand the indications for and interpretation of bone marrow aspiration and biopsy

• To understand the use of Ommaya reservoir and lumbar puncture for the administration of intrathecal cytotoxic agents

• To understand the indications for thoracentesis and paracentesis, and the role of intraperitoneal chemotherapy in the management of selected intra-abdominal tumours

Continued

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References

1. Hansen HH, Bajorin DF, Muss HB,et al. ESMO/ASCO Task Force on Global Curriculum in Medical Oncology. Recommendations for a Global Core Curriculum in Medical Oncology.Ann Oncol2004;15:1603–12. 2. Hansen HH, Bajorin DF, Muss HB,et al. ESMO/ASCO Task Force on

Global Curriculum in Medical Oncology. Recommendations for a Global Core Curriculum in Medical Oncology.J Clin Oncol2004;22:4616_–25. 3. ESMO/ASCO recommendations for a Global Curriculum in medical

oncology, 2010 update. https://www.esmo.org/content/download/ 8171/168764/file/ESMO-ASCO-Revised-Recommendations-for-a- Global-Curriculum-in-Medical-Oncology.pdf

4. ESMO/ASCO recommendations for a Global Curriculum in medical oncology, 2010 update. http://www.asco.org/sites/default/files/esmo- asco_revised_recommendations.pdf

5. ACGME Program Requirements for Graduate Medical Education in Medical Oncology (Internal Medicine), 2015. https://www.acgme.org/ acgmeweb/Portals/0/PFAssets/ProgramRequirements/147_medical_ oncology_int_med_07012015.pdf

Continued

• To be able to assess treatment response to therapy using standard Response Evaluation Criteria in Solid Tumours (RECIST) or criteria appropriate to the specific tumour type (eg, Prostate Cancer Working Group criteria) Awareness • Awareness of the interpretation of bone marrow aspirates and biopsies, including the role of cytogenetic,

immunohistochemical and flow cytometric analysis

• Appreciation of the effectiveness and potential toxicities of treatments administered intrathecally, including the appropriate doses, which agents can be safely administered intrathecally, and potential toxicities of drugs administered intrathecally

• Recognition of the specific indications for intraperitoneal therapy, including the limitations, contraindications and effectiveness of treatment administered by this route

• Appreciation of the definitions of complete and partial response, stable disease and progressive disease and of the significance of clinical benefit, and how often assessments of response to therapy should be undertaken Knowledge Anticancer agent administration

• Familiarity with the indications for each antineoplastic agent prescribed, including the role of monotherapy and combination therapy; this familiarity should include appropriate dose adjustments for toxicity, haematological, hepatic and renal dysfunction

• Knowledge of how to prescribe and safely administer anticancer agents by oral and parenteral routes Bone marrow aspiration, biopsy and interpretation

• Familiarity with the interpretation of marrow aspirations and biopsies based on fundamental knowledge about marrow interpretation

Ommaya reservoir and lumbar puncture

• Familiarity with the indications Paracentesis, thoracentesis

• Familiarity with the indications for, complications of, diagnostic and therapeutic thoracentesis and paracentesis, including appropriate laboratory evaluation of the specimen obtained

• Knowledge of the techniques of paracentesis and thoracentesis

• Familiarity with the indications for and administration of intraperitoneal chemotherapy, and the use of sclerosing agents for management of malignant pleural effusions

• Familiarity with the complications of these techniques and their management Tumour assessment

• Knowledge how to assess tumour size and response to therapy by physical examination and radiological techniques

• Familiarity with RECIST and definitions of complete and partial responses, stable disease and progressive disease

• Understanding of the appropriate use of radiological studies in the initial staging of patients and in the monitoring of response to treatment

Skills • Ability to write appropriate orders for administration of antineoplastic agents, including relevant supportive care drugs and dose modifications based on current laboratory parameters and prior toxicities

• Ability to care and access indwelling venous catheters

• Ability to handle chemotherapeutic and non-chemotherapeutic anticancer agents

• Ability to perform supervised bone marrow aspiration and biopsies that includes obtaining appropriate consent, performing the procedure with minimal patient discomfort and basic interpretation of the results

• Ability to perform supervised intrathecal administrations of chemotherapy by lumbar puncture and/or Ommaya reservoir, a subcutaneous device

• Ability to administer chemotherapy through an Ommaya reservoir including obtaining appropriate consent, performing the procedure with minimal patient discomfort and treating potential complications of the procedure

• Ability to discuss the indications, contraindications and efficacy of intraperitoneal chemotherapy

• Ability to assess the response to therapy using standard RECIST or other appropriate criteria, including which imaging modalities are most appropriate for initial assessment of disease status, as well as subsequent assessments

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