| Popis: |
The adaptation and practice of evidence-based oncology guidelines vary across continents for reasons such as cultural and genetic influences on therapeutic choices, available resources, access to medications and clinical interventions as well as expertise of clinicians. Low- and middle-income countries (LMIC) are made up of a heterogeneous mix of economies with a wide range of economic strengths and available health infrastructure which intend influences the strength of oncology practices. Benefits of the recent rapid evolution of cancer treatments are not translated into many LMIC. The strength of the oncology teams influences choice of treatments, and qualified oncology nurses, physicians and pharmacists are required to improve outcomes of cancer patients even with limited resources. Delays in initiating and inappropriate sequencing of therapies leading to higher mortality and morbidity from anticancer agents are some of the major shortfalls of non-oncology health workers managing cancer patients. Cheaper generic chemotherapeutic agents are frequently used without verifying quality and may affect outcomes. Molecular-targeted agents are beyond the reach of many patients and are not without toxicities which limit application in LMIC. Even when available, they may be inappropriately applied in the absence of biomarker testing. Pharmacodynamics and genomics influence drug tolerability and responses and vary among ethnic populations; therefore, cancer management guidelines may need to be modified based on clinical trial findings for separate regions. This chapter briefly discusses applicability, availability and modification of chemotherapy, hormonal and targeted therapies in general and for specific common cancers in low-resource settings. |
