The European Organization for Research and Treatment of Cancer (EORTC) was founded in 1962 by research workers in the main cancer research institutes of the Common Market countries and Switzerland. This small group of cancer specialists comprising clinicians and basic science researchers decided to form an association to promote cancer research in Europe through the joint efforts of the clinical and basic research groups of several countries. Among them, were Henri TAGNON from Brussels (Belgium), Silvio GARATTINI, Director of the Institute for pharmacological Research in Milan (Italy), D. VAN BEKKUM, Director of the Radiobiological Institute TN0 at Rijswijk (Netherlands), K. BREUR, Director of the Amsterdam Cancer Institute (Netherlands), G. MATHE, D. SCHWARTZ, and M. TUBIANA from Villejuif (France). Initially the organization was called the “Groupe Europeen de Chimiotherapie anticancereuse” (GECA), 1 year later it became the EORTC and has been known all over the world under this appellation. G. MATHE was its first President from 1962 to 1965. The creation of the EORTC was immediately greeted both by the governments of the various EEC countries and by the medical and scientific circles. From the outset its two main goals were first to develop and coordinate clinical research in Europe and indeed it has organized several hundreds of cooperative multi-center controlled clinical trials and second to promote that area of basic research, which is closed, to providing significant results for diagnosis or therapy. During the past 25 years the EORTC has progressively become the largest organization for therapeutic cancer research in Europe. In 1972, the NC1 in Washington stated that its creation has been “the most important development in therapeutic research on cancer in Europe.” PRESENT STRUCTURES

The European organization for research and treatment of cancer (EORTC)

Cancer of the stomach.

Cervical Cancer Screening Programs in Latin America and the Caribbean

Background Healthcare workers (HCW) (nurses, doctors, other health professionals, cleaners and porters), have substantial rates of clinical and sub-clinical influenza during influenza seasons and may transmit influenza to those in their care, especially the vulnerable elderly. Objectives To identify and summarise comparative studies assessing the effects of vaccinating healthcare workers (HCW) on the incidence of influenza, influenza-like-illness (ILI) and its complications on elderly residents in long-term facilities. Search strategy We searched the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Database of Systematic Reviews and the NHS Database of Abstracts of Reviews of Effectiveness (DARE) (The Cochrane Library Issue 1, 2006); MEDLINE (January 1966 to Week 1, February 2006); EMBASE (1974 to March 2006); Biological Abstracts (1969 to December 2004); and Science Citation Index-Expanded (1974 to March 2006). Selection criteria Comparative randomised and non-randomised studies reporting the effects of influenza vaccines on the incidence of viral infections in institutions for the elderly of any type, in any schedule of vaccination given to HCW caring for elderly residents of long-term facilities aged 60 years or older. Data collection and analysis Two authors independently extracted data and assessed the methodological quality using criteria from the Cochrane Reviewers' Handbook and the Newcastle-Ottawa scale (for non-randomised studies). Main results We included two cluster randomised controlled trials (C-RCT) and one cohort study. Staff vaccination appears to have significant effect against ILI (absolute vaccine efficacy (VE) 86%, 95% confidence interval (CI) 40% to 97%) only when patients are vaccinated too; if patients are not vaccinated, staff immunisation shows no effect (based on one C-RCT). Based on a small number of observations from two C-RCTs, the vaccines have no efficacy against influenza (odds ratio (OR) 0.86, 95% CI 0.44 to 1.68) or lower respiratory tract infections (OR 0.70, 95% CI 0.41 to 1.20) but were effective against deaths from pneumonia (VE 39%, 95% CI 2% to 62%) and deaths from all causes (VE 40%, 95% CI 27% to 50%). All findings must be interpreted with caution given the presence of selection bias. Authors' conclusions We concluded that there is no credible evidence that vaccination of healthy people under the age of 60, who are HCWs caring for the elderly, affects influenza complications in those cared for. However, as vaccinating the elderly in institutions reduces the complications of influenza and vaccinating healthy persons under 60 reduces cases of influenza, those with the responsibility of caring for the elderly in institutions may want to increase vaccine coverage and assess its effects in well-designed studies.

Influenza vaccination for healthcare workers who work with the elderly.

Worldwide, cervical cancer is the third most common cancer in women, and the first or second most common in developing countries. Cervical cancer remains in Colombia the first cause of cancer mortality and the se­cond cause of cancer incidence among women, despite the existence of screening programs during the last 3 decades. Bucaramanga, Manizales and Cali reported rates around 20 per 100,000 and Pasto 27 per 100,000. The Cali cancer registry has reported a progressive decrease in the age standardized incidence and mortality rates of cervical cancer over the past 40 years. Reasons for the decline in incidence and mortality of cervical cancer are multiple and probably include: improvement in socio-economic conditions, decrease in parity rates and some effect of screening programs. Human papilloma Virus is the main cause of cervical cancer, HPV natural history studies have now revealed that HPVs are the commonest of the sexually transmitted infections in most populations. Most HPV expo­sures result in spontaneous clearance without clinical manifestations and only a small fraction of the infected persons, known as chronic or persistent carriers, will retain the virus and progress to precancerous and cancer. HPV 16 and 18 account for 70% of cervical cancer and the 8 most common types. (HPV 16, 18, 45, 33, 31, 52, 58 and 35) account for about 90% of cervical cancer. Case-control studies also allowed the identification of the following cofactors that acting together with HPV increase the risk of progression from HPV persistent infection to cervical cancer: tobacco, high parity, long term use of oral contraceptives and past infections with herpes simplex type 2 and Chlamydia trachomatis . The demonstration that infection with certain types of human papillomavirus (HPV) is not only the main cause but also a necessary cause of cervical cancer has led to great advances in the prevention of this disease on two fronts: (i) Primary prevention by the use of prophylactic HPV vaccines; and (ii) secondary prevention by increasing the accuracy of cervical cancer screening.

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Epidemiology of cervical cancer in Colombia

Objective: To assess cost-effectiveness of conventional cytology and HPV DNA testing for cervical-cancer screening in Colombia. Material and Methods: The National Cancer Institute of Colombia (NCIC) in 2007 developed a Markov model on the natural history of cervical cancer; no screening, conventional cytology, and HPV DNA testing were compared. Only direct costs were used. Outcomes comprise cervical cancer mortality, years of life saved, and lifetime costs. Dis counted incremental cost-effectiveness ratios were estimated and sensitivity analyses were conducted for key parameters. Results: Depending on the screening strategy a 69-81% mortality reduction might be expected. The HPV DNA tes ting every five years is a cost-effective strategy (Incremental Cost-Effectiveness Ratio (ICER): USD$44/YLS) if the cost per test is under USD$31. The effectiveness was sensitive to coverage and primarily to follow-up. Conclusions: HPV DNA testing is a cost-effective alternative for screening in Colombia. Not only high coverage but high follow-up rates are critical for successful screening programs.

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Cost-effectiveness of conventional cytology and HPV DNA testing for cervical cancer screening in Colombia

To validate the FACT-G scale for measuring quality of life of patients with cancer in Colombia. The analysis included factor analysis, confirmatory analysis, Rasch analysis, convergent validity, internal consistency (473 patients diagnosed with cancer), test–retest reliability (97 patients evaluated at two different time points) and sensitivity to change (25 patients evaluated before and after an intervention). A four-factor structure has been found (“Physical well-being”, “Social–family well-being”, “Functional well-being” and “Emotional well-being”). Two subscales (“Emotional well-being” and “Social–family well-being”) have misfitting items. Cronbach’s alpha was 0.89 for the whole scale. None of the items had significant impact on the scale’s alpha when removed. Lin’s concordance correlation coefficient indicated test–retest reliability (rho c: 0.64–0.76) adequate to the uses of the tool. Regarding sensitivity to change, repeated measures analysis demonstrated significant change of the score after an intervention [F(3, 72) = 39.89, P = 0.000]. Except for the domain “Social–family well-being”, Pearson’s correlation coefficient between equivalent domain scores on FACT-G and the EORTC QLQC-30 ranged from 0.5 to 0.7. The FACT-G scale measures a four-factor construct. Results indicate that the FACT-G scale is an instrument that performs consistently over time, with evidence of responsiveness. The finding of misfitting items in two subscales (“Social–family well-being”, and “Emotional well-being”) imposes caution in interpreting the scores of these domains.

Validation of the FACT-G scale for evaluating quality of life in cancer patients in Colombia

Objetivos Analizar, desde la perspectiva del pagador, el costo efectividad de la vacunacion contra influenza al personal de salud que tiene contacto estrecho con los pacientes oncologicos hospitalizados en Colombia. Metodos Mediante un arbol de decision, se identifico la relacion de costo-efectividad de la aplicacion de esta vacuna al personal de salud que tiene contacto estrecho con los pacientes oncologicos hospitalizados. La perspectiva es la del pagador. Los costos se valoraron en unidades monetarias y la efectividad se mide por la reduccion en dias de hospitalizacion de pacientes oncologicos como resultado de la disminucion en las probabilidades de contraer el virus por la vacunacion al personal de salud. Resultados Vacunar contra la influenza al personal de salud que tiene contacto estrecho con los pacientes oncologicos hace que, al ahorrar un dia de estancia hospitalaria, simultaneamente se ahorren $ 2 978 000 (US$ 1 324). Conclusiones Vacunar contra la influenza al personal de salud que tiene contacto estrecho con los pacientes oncologicos es costo efectivo para una probabilidad de contagio del personal de salud que no ha sido vacunado mayor o igual a 0,02.

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Economic evaluation of influenza vaccine applied to health personnel attending hospitalised oncological patients

/pdf/guia-de-practica-clinica-para-el-diagnostico-y-el-11sid845ap.pdf

Guía de práctica clínica para el diagnóstico y el tratamiento de las infecciones bacterianas y micóticas en pacientes oncológicos mayores de 15 años con neutropenia febril posquimioterapia de alto riesgo

Objetivos Evaluar economicamente la vacuna contra S pneumoniae en pacientes oncologicos para Colombia. Metodos Dado que la efectividad de la vacuna en este tipo de pacientes no esta comprobada, se calculo el costo de los primeros seis anos de un programa de vacunacion para pacientes oncologicos y se estimo el costo de oportunidad con alternativas de deteccion temprana de cancer. Resultados Un programa de vacunacion de pacientes oncologicos contra S pneumoniae costaria en sus primeros seis anos cerca de treinta y un mil millones de pesos constantes de 2006. Con estos recursos se podrian realizar aproximadamente 170 000 colonoscopias o pruebas de deteccion temprana de VPH, 500 000 mamografias o mas de 3 800 000 citologias. Conclusiones Dada la escasez de recursos, es preferible economicamente destinar estas cifras a adelantar programas cuya efectividad este comprobada, ya sea para deteccion temprana de cancer o para vacunacion de ninos sanos.

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Mónica Ballesteros

Papers

Cost-effectiveness of conventional cytology and HPV DNA testing for cervical cancer screening in Colombia

Validation of the FACT-G scale for evaluating quality of life in cancer patients in Colombia

Economic evaluation of influenza vaccine applied to health personnel attending hospitalised oncological patients

Guía de práctica clínica para el diagnóstico y el tratamiento de las infecciones bacterianas y micóticas en pacientes oncológicos mayores de 15 años con neutropenia febril posquimioterapia de alto riesgo

Impacto Económico de la Vacuna contra el Neumococo en Pacientes Oncológicos