SummaryBackgroundGlobal inequalities in access to health care are reflected in differences in cancer survival. The CONCORD programme was designed to assess worldwide differences and trends in population-based cancer survival. In this population-based study, we aimed to estimate survival inequalities globally for several subtypes of childhood leukaemia.MethodsCancer registries participating in CONCORD were asked to submit tumour registrations for all children aged 0–14 years who were diagnosed with leukaemia between Jan 1, 1995, and Dec 31, 2009, and followed up until Dec 31, 2009. Haematological malignancies were defined by morphology codes in the International Classification of Diseases for Oncology, third revision. We excluded data from registries from which the data were judged to be less reliable, or included only lymphomas, and data from countries in which data for fewer than ten children were available for analysis. We also excluded records because of a missing date of birth, diagnosis, or last known vital status. We estimated 5-year net survival (ie, the probability of surviving at least 5 years after diagnosis, after controlling for deaths from other causes [background mortality]) for children by calendar period of diagnosis (1995–99, 2000–04, and 2005–09), sex, and age at diagnosis (<1, 1–4, 5–9, and 10–14 years, inclusive) using appropriate life tables. We estimated age-standardised net survival for international comparison of survival trends for precursor-cell acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML).FindingsWe analysed data from 89 828 children from 198 registries in 53 countries. During 1995–99, 5-year age-standardised net survival for all lymphoid leukaemias combined ranged from 10·6% (95% CI 3·1–18·2) in the Chinese registries to 86·8% (81·6–92·0) in Austria. International differences in 5-year survival for childhood leukaemia were still large as recently as 2005–09, when age-standardised survival for lymphoid leukaemias ranged from 52·4% (95% CI 42·8–61·9) in Cali, Colombia, to 91·6% (89·5–93·6) in the German registries, and for AML ranged from 33·3% (18·9–47·7) in Bulgaria to 78·2% (72·0–84·3) in German registries. Survival from precursor-cell ALL was very close to that of all lymphoid leukaemias combined, with similar variation. In most countries, survival from AML improved more than survival from ALL between 2000–04 and 2005–09. Survival for each type of leukaemia varied markedly with age: survival was highest for children aged 1–4 and 5–9 years, and lowest for infants (younger than 1 year). There was no systematic difference in survival between boys and girls.InterpretationGlobal inequalities in survival from childhood leukaemia have narrowed with time but remain very wide for both ALL and AML. These results provide useful information for health policy makers on the effectiveness of health-care systems and for cancer policy makers to reduce inequalities in childhood cancer survival.FundingCanadian Partnership Against Cancer, Cancer Focus Northern Ireland, Cancer In...

The distribution of ovarian cancer histology varies widely worldwide. Type I epithelial, germ cell and sex cord-stromal tumours are generally associated with higher survival than type II tumours, so the proportion of these tumours may influence survival estimates for all ovarian cancers combined. The distribution of histological groups should be considered when comparing survival between countries and regions.

Objective: Epstein-Barr virus (EBV)-associated gastric cancer (GC) has been proposed to be a distinct GC molecular subtype. The prognostic significance of EBV infection in GC remains unclear and needs further investigation. Our study aimed to analyze EBV-positive and EBV negative GC patients regarding their personal and tumor-related characteristics, and compare their overall survival.Methods: GC patients consecutively treated at the Riga East University Hospital during 2009-2016 were identified retrospectively. Tumor EBV status was determined by in situ hybridization

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Covid-19 pandemic has caused unprecedented challenges for teachers and the resources of teachers have been critically exhausted causing fatigue and burn-out. Self-care actualization and practice is one way to strengthen teachers' emotional health and resilience. Self-care is understood as engagement in activities to preserve or improve one’s own health and well-being, in particular during periods of stress. Supervision is one of the activities where teachers can receive professional support, minimize negative emotions and develop stress resilience. The aim of this study was to investigate teachers' self-care strategies and experts’ views on actualization of self-care strategies and supervision as a self-care activity within supervision. The research was executed in two stages - quantitative data analysis and qualitative interviews. In the quantitative part the participants of the research were 245 teachers in Latvia. Self-Care Strategies Questionnaire was used to collect answers and the 14 strategies were measured on a 4-point Likert scale. Self-care strategies were assessed on what is considered important and is attainable. The results showed that there are statistically significant differences between importance and attainability in all 14 self-care strategies. All strategies were assessed higher on importance than the attainability. Experts indicated that supervision should take place during working hours, be publicly funded, regular and carried out as long-term support.

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Objectives: Since 2011, seven innovative drugs were commercialized for the treatment of metastatic melanoma (MM), significantly improving patient survival and cost in 1st line of treatment. With 52% of patients reaching a second line of treatment, the optimal sequence in patients with BRAF-mutated MM remains unclear. To inform policy makers about the value of these sequences, we performed a costeffectiveness analysis comparing sequences for BRAF-mutated MM in real life in France. Methods: Five sequences were compared: Anti-PD1-Bi-targeted therapies (BI-TT), BI-TT-Anti-PD1, Ipilimumab+Nivolumab-BI-TT, Mono-targeted therapies (MONO-TT)-BI-TT and MONO-TT-Anti-PD1. Clinical (efficacy and utility) and economic data were extracted from the prospective MelBase cohort, collecting individual data in 1,435 MM patients from 26 French hospitals, from MM diagnosis until death. To adjust for confounding effects and differences in patient characteristics among groups, the inverse probability of sequence weighted with a propensity score (PS) for multiple treatments was used. The PS was estimated using generalized boosted modeling. Costs were calculated from the health insurance perspective using French tariffs. Survival and costs were extrapolated using a multistate model, describing the 10-year course of the disease. Results: Among the 1435 patients, effectiveness was assessed on the 608 B-RAF mutated patients that were included between 2013 and 2019. As compared to the MONO-TT-BI-TT sequence (the less expensive), three sequences were excluded from the efficiency frontier as they were more expensive and less efficacy. Remains the Anti-PD1-BI-TT sequence, which was associated with additional costs of 66,343V and 0.7 additional quality-adjusted life years (QALYs), giving an incremental cost-effectiveness ratio of 94,776V/QALY. Considering the acceptability curve, at a threshold of 150,000V, Mono-TT-Anti-PD1 has nearly 100% chance of being efficient, and at 300,000V Anti-PD1-Bi-TT has a 60% chance of being efficient. Conclusions: For patients with BRAF-mutated MM, Anti-PD1-BI-TT and MONO-TT-Anti-PD1 seem to be most cost-effective sequences, in France based on observational data.