Cancer care capacity in sub-Saharan Africa (SSA) is constrained by late diagnosis and limited treatment access. Few funding mechanisms support innovative, locally led programs to address these challenges. A collaborative initiative was developed to strengthen oncology care through quality improvement (QI) projects. The program was developed by Global Bridges Oncology (GBO) at Mayo Clinic, Pfizer Global Medical Grants, and the African Organisation for Research and Training in Cancer. A committee composed primarily of African oncology experts guided the process. An RFP was disseminated across SSA in English, French, and Portuguese, inviting applications to improve diagnostic and therapeutic cancer care. Applications underwent a structured, two-stage review, with GBO providing technical support, expert guidance, and training resources. The RFP generated 218 applications reflecting strong demand for oncology QI funding in SSA. After review, 17 projects representing 10 African countries were selected and awarded $1.1 million USD. Funded initiatives reflected four themes: oncology training and clinical practice improvements, early detection and accurate diagnostics, pediatric cancer care, and oncology nursing and palliative medicine. As of March 2026, 11 (65%) of 17 projects are complete, with 4,565 health care professionals engaged through direct training, conference dissemination, system adoption, and sensitization activities, and program-supported services were delivered to more than 47,300 patients. This initiative demonstrates the feasibility of a competitive, regionally guided grant program to strengthen cancer care capacity. Early implementation outcomes, including measurable improvements in diagnostic delay, treatment adherence, and care network expansion, confirm that locally led QI initiatives can generate meaningful results across diverse institutional settings. By centering African leadership and supporting diverse QI projects, it advances equitable access to funding, capacity building, and sustainability planning.
The impending increase in cancer incidence around the world remains one of the most pressing health challenges of the 21st century. Triangular partnerships, which include at least one institution from the Global North and two or more from the Global South (North-South-South partnerships), present promising avenues to address inequities in oncology care by uniting actors in similarly resourced health care settings around a central goal. Despite this, triangular partnership remains rare in the field of oncology. Here, we present the Kenya-Nepal Oncology Network (KeNON), a novel triangular partnership for the provision of breast and cervical cancer care between institutions in Kenya, Nepal, Canada, and the United States centered around the Academic Model Providing Access to Healthcare. KeNON aims to build upon existing oncology services through its four-partite model: clinical care, composed of screening and treatment services; community, designed to facilitate communication and collaboration; education, aiming to build an oncology workforce and thus sustainable systems of care; and research, evaluating optimal implementation of screening techniques and care delivery. By generating discourse among collaborators on three different continents and from varied health care settings, KeNON can address the unique challenges of providing oncology care to underserved populations through an iterative process of dialogue and improvement known as reciprocal innovation. Overall, KeNON provides a unique model of partnership for the provision of oncology care, allowing it to leverage the strengths of institutions around the world to improve breast and cervical cancer outcomes for the most vulnerable.
Speaker roles at major international oncology meetings mark academic visibility and leadership, yet representation of Latin America and Caribbean (LAC)-affiliated investigators remains poorly characterized. We evaluated LAC-affiliated faculty appearances at the ASCO Genitourinary Cancers Symposium (ASCO GU) from 2021 to 2025. We systematically reviewed ASCO GU programs (2021-2025). Eligible sessions included General Session, Oral Abstract Session, and Rapid Oral Abstract Session. Affiliation was determined by institutional listing. We recorded total faculty appearances and stratified faculty appearances into invited educational, abstract-linked, and leadership roles. We additionally examined discussant and moderator appearances separately and identified the assigned speaker for each Oral or Rapid Oral presentation with at least one LAC-affiliated author. Among 84 eligible sessions comprising 540 faculty speakers, only six LAC-affiliated faculty appearances were identified, representing only 1% of the total faculty. No LAC-affiliated faculty appeared in 2021 or 2022, with minimal representation in subsequent years (2023: n = 1; 2024: n = 2; 2025: n = 3). By contrast, LAC-affiliated investigators were identified in 53 appearances as authors or coauthors in Oral or Rapid Oral sessions, predominantly affiliated with institutions in Brazil, Argentina, Chile, Mexico, and Colombia. Three of six LAC-affiliated faculty were linked to specific clinical trial presentations rather than independent educational lectures. LAC-affiliated investigators remain markedly under-represented among ASCO GU faculty despite robust scientific contributions, highlighting potential structural inequities and the need for deliberate initiatives to support equitable participation in international scientific discourse.
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In low- and middle-income countries (LMICs), access to traditional oncology education through conferences, journals, and in-person mentorship is often restricted. Social media has emerged as a potential tool to bridge this gap; however, its educational and clinical influence on oncology professionals remains underexplored. We conducted a cross-sectional, anonymized, web-based survey of 202 oncology professionals from 13 countries. A 30-item questionnaire was used for the survey. Data were analyzed using descriptive statistics and chi-square tests. Among the respondents, 93% practiced in India, with 61% identifying Twitter (X) as their primary oncology information source. Daily engagement was reported by 53% of the respondents. The most valued benefits were early access to emerging research (30%) and trial updates (29%). Social media discussions atleast moderately influenced clinical decision making in 75% of respondents, with 29% reporting a substantial impact, which was a subjective assessment of the participants. Virtual tumor boards engaged 58% of the participants and prompted practice changes in 21%. Sixty-eight percent credited social media, with expanding their professional networks, and 25% initiated research collaborations through these platforms. Structured digital literacy training and tools, such as automated fact-checking and professional credential verification, were supported by over two thirds of the participants. Social media has become an essential educational and collaborative platform for oncology professionals, particularly in LMICs. By enabling timely access to research and supporting peer learning, it complements the traditional modes of oncology education. The formal integration of digital literacy training and content-verification mechanisms may enhance its safe and equitable use.
Sub-Saharan Africa (SSA) remains significantly underrepresented in global cancer clinical trials, despite having the largest population of individuals of African descent, an essential demographic for ensuring diversity in clinical research. This study, developed from the 2024 African Organization for Research and Training in Cancer (AORTIC)-ASCO stakeholder meeting, addresses the critical need to involve SSA in cancer trials to improve global trial diversity and patient outcomes. Although globalization of trials has shifted research sites to regions like Eastern Europe and Asia, <1% occur in Africa. This report highlights emerging solutions such as regional alliances, decentralized trial models, capacity-building initiatives, and public-private partnerships. The role of AORTIC and its Clinical Trial Special Interest Group in advancing training, infrastructure development, and international collaboration is discussed, with notable clinical trial networks, such as HypoAfrica, ARETTA, African Research Group for Oncology, and regional consortia, illustrating growing momentum and capability. This study advocates for a coordinated strategy to integrate SSA into global trials, ensuring more inclusive, effective, and equitable cancer treatment outcomes.
Clinical trial availability often varies between countries, independent of the local burden of disease. We aimed to evaluate the current global availability of prostate cancer clinical trials and the factors affecting it. We searched for clinical trials involving prostate cancer between June 2019 and June 2024 through Clinicaltrials.gov. Noninterventional trials were excluded. Countries were classified according to the World Bank Ranking (WBR) as high-, upper-middle-, lower-middle-, and low-income countries (HICs, UMICs, LMICs, and LICs). Multivariable negative binomial regression was used to evaluate the association between the number of trials and country's characteristics. Multivariable logistic regression was used to evaluate the association between trial availability and country's characteristics. In addition, we collected data on sponsorship, funding, intervention, intervention intent, end point selection, trial phase, and cancer stage. Of the 1,531 trials identified, 1,413 met the eligibility criteria. Most trials were conducted exclusively in HICs (80.4%), included patients with metastatic disease (55.4%), and were sponsored by academia (68.8%). Pharma-funded trials had a higher number of participating countries (mean 2.7 v 1.0, P < .001) and were more likely to include metastatic disease (72.0% v 32.3%, P < .001) and to investigate systemic therapy (76.3% v 29.4%, P < .001). In the multivariable analysis, WBR, gross national income (GNI), and annual health expenditure were all associated with the presence of at least one trial (P < .001). Only GNI was independently associated with the number of trials within a country (P < .001). Prostate cancer trials are disproportionately concentrated in HICs despite a lower burden of disease. Intentional efforts are needed to ensure global representation and long-term benefits for populations historically excluded from research.
Gender inequality shapes women's cancer outcomes through social, economic, and health system factors. This study disaggregated the Gender Inequality Index (GII) to identify which dimensions-reproductive health, educational attainment, workforce participation, and political empowerment-independently influence global female cancer outcomes. We conducted an ecologic, cross-national analysis using data from 185 countries. Age-standardized female cancer mortality-to-incidence ratios (MIRs) were derived from GLOBOCAN 2022. Independent variables included the composite GII and its five components: maternal mortality ratio, adolescent birth rate, female secondary education, labor force participation, and parliamentary representation. Univariable (Bonferroni-corrected significance threshold α = .01) and multivariable (α = .05) linear regressions assessed associations between these indicators and MIR, adjusting for health system variables including universal health coverage (UHC) index, gross domestic product (GDP) per capita, workforce availability, health spending, and radiotherapy access. Univariable analyses showed that GII and all components associated with higher MIR (P < .001 for all except labor participation, P = .026). Upon examining GII components in a multivariable model, higher adolescent birth rate (β = .0014, P < .001), lower female secondary education (β = -.0020, P < .001), and lower women's parliamentary representation (β = -.0022, P < .001) were independently associated with higher female MIR (N = 168, R2 = 0.70). In fully adjusted models accounting for national wealth and system capacity (N = 124, R2 = 0.88), higher UHC index (P < .001) and GDP per capita (P = .007) predicted lower MIR, while adolescent birth rate may be positively associated (P = .084). Structural gender inequalities, particularly those related to reproductive burden, education, and political representation, are linked to poorer female cancer outcomes. Advancing gender equity through reproductive health access, girls' education, and women's leadership is integral to improving cancer outcomes globally.
Advanced head and neck squamous cell carcinoma (HNSCC) carries a poor prognosis, particularly in resource-limited settings with restricted access to targeted or immune therapies. We evaluated whether adding triple oral metronomic chemotherapy (OMCT; erlotinib, celecoxib, methotrexate) to paclitaxel-carboplatin (PC) improves overall survival (OS) in patients with platinum-sensitive, unresectable advanced HNSCC. This was a single-center, investigator-initiated, prospective, randomized, open-label, phase III superiority trial conducted at a tertiary cancer center in North India. A total of 238 adults with histologically confirmed, unresectable advanced HNSCC eligible for palliative platinum-based chemotherapy were randomly assigned 1:1 after stratification by tumor site and Eastern Cooperative Oncology Group (ECOG) performance status. Arm A received PC plus OMCT; Arm B received PC alone. The primary end point was OS. Secondary end points included progression-free survival (PFS), quality of life (QoL; European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 and Functional Assessment of Cancer Therapy-Head & Neck), and safety. Among 238 patients (119 per arm), the median age was 47 years; 97.8% were male, and 78% had ECOG performance status (PS) 0-1. The median OS was 10 months (95% CI, 8.3 to 11.7) with PC + OMCT versus 5 months (95% CI, 3.9 to 6.1) with PC alone (hazard ratio [HR], 0.54 [95% CI, 0.41 to 0.72]; P < .001). The median PFS was 6 months versus 2 months, respectively (HR, 0.38 [95% CI, 0.28 to 0.50]; P < .001). QoL analyses demonstrated clinically meaningful preservation across multiple domains in the PC + OMCT arm. Grade ≥3 toxicities did not increase with the addition of OMCT. In platinum-sensitive advanced HNSCC, the addition of triple OMCT to PC significantly improved OS and PFS with acceptable toxicity. PC + OMCT represents a feasible and cost-conscious first-line option in resource-constrained settings.
The global need for training in clinical research is substantial, particularly in resource-limited settings. We describe an international collaboration to build capacity in clinical research skills through a semi-personalized curriculum. Five sequential workshops (2020-2025) combined online modules with on-site, project-based learning. The curriculum across workshops included research project planning, proposal writing, and manuscript publishing. Topics included fundamentals of clinical study design, data registries, statistical considerations, research ethics, and scientific writing. At registration, applicants submitted an abstract for further development. An average of 35 applicants per workshop were selected. Participants' experiences were evaluated through postworkshop surveys. Participants across the workshops presented from 17 countries and seven disciplines, with the majority being physicians (66%) and nurses (16%). During each 2.5-day workshop, participants refined their abstracts with structured guidance and shared their work in a 10-minute presentation. Workshop 1 used a group-based model where each group developed one common abstract. Workshop 2 focused on quality improvement research; each group worked on preselected mock concepts through a structured learning exercise. Workshops 3 and 4 involved individualized learning, with each participant developing their own abstract into a study proposal. Workshop 5 focused on scientific writing, guiding participants to develop their abstracts into a manuscript outline. Surveys after each workshop consistently demonstrated a high level of satisfaction and perceived gain in knowledge and skill. These workshops effectively engaged trainees with various levels of clinical research training and imparted skills for research planning and manuscript writing. Future iterations will include thematic workshops including advanced statistical methods. Combining asynchronous learning modules with on-site, project-based training can be implemented across other regions and specialties in context-relevant settings.
Lung cancer remains one of the leading causes of cancer-related mortality in Africa, with survival rates starkly lagging behind global benchmarks because of systemic inequities in prevention, diagnosis, and treatment access. Despite representing only 6% of global smokers, the continent faces a disproportionate burden driven by environmental and occupational carcinogens, aggressive tobacco marketing, and fragmented health care infrastructure. Key challenges include prohibitive delays in accessing targeted therapies like epidermal growth factor receptor inhibitors and immunotherapies, a dire shortage of radiotherapy infrastructure-0.12 megavoltage units per million people versus the International Atomic Energy Agency's recommended five megavoltage units per million, and a dearth of thoracic surgeons (0.03 thoracic surgeons per 100,000 people). These barriers contribute to over 90% of patients presenting with advanced-stage disease and 5-year survival rates below 10%. Multifaceted strategies are essential to bridge these gaps: regional pooled procurement and compulsory licensing to lower drug costs, telemedicine platforms like the African Radiation Oncology Network to expand radiotherapy access, and task-shifting surgical training programs through institutions such as The College of Surgeons of East, Central, and Southern Africa, which graduates 15 cardiothoracic specialists annually and partnerships such as that between the West African College of Surgeons and Global Oncology Group at Queens University, Canada. Investments in critical care infrastructure, exemplified by dedicated thoracic intensive care units in Ghana and Kenya, alongside harmonized guidelines from the African Cancer Coalition, are pivotal. The Lancet Oncology Commission underscores the urgency of political commitment and sustainable investment in diagnostics, workforce training, and technology transfer to align Africa's cancer care with global standards. Addressing these inequities is a clinical imperative and a moral obligation to ensure life-saving innovations benefit all populations equitably.
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To assess willingness of patients with cancer to participate in observational studies (OBS) and clinical trials (CT) and to examine the factors influencing their decision to join CT. A cross-sectional study using a systematic sampling strategy was conducted from December 2023 to June 2024. Data were collected directly from patients and their medical charts. Logistic regression was performed to identify significant predictors of patients' willingness to participate in CT. A total of 367 patients participated, 58.9% were females, and 59.8% had stage IV disease. Most participants (81%) had a performance status (PS) of 0-1, with only 1.9% having prior experience with a CT and 9% with OBS. Willingness to join OBS was higher than willingness to join CT (64% v 31.6%, P < .001). Key barriers included fear of side effects (61.6%), lack of information (46.3%), and concerns about the investigational product (41.6%). Motivators were having their treating physician as the principal investigator (42.5%) and prior human testing of the product (40.6%). Patients who underwent surgery or believed that their physical or psychological condition is unsuitable for trials were less likely to participate (P < .05, odds ratio [OR], 0.30, 0.38, 0.37, respectively). Patients with a friend or relative who had joined a trial were more willing to participate (P < .05, OR, 3.48). The results highlight a low level of willingness to participate in CT. Some barriers could be avoided during the study design phase. Discrepancies between patients' self-assessed PS and physicians' evaluations may lower the enrollment rates. Encouraging patients who have participated in CTs to share their experiences with the family and friends could significantly improve the community's willingness to join CT.
The integration of novel systemic therapies including antibody-drug conjugates (ADCs), immune checkpoint inhibitors (ICIs), and cyclin-dependent kinases 4 and 6 (CDK4/6) inhibitors with radiotherapy (RT) presents new opportunities in breast cancer (BC) management. However, clinical guidance on concurrent administration remains limited, particularly for advanced techniques. A multidisciplinary panel of radiation and medical oncologists from AROME and the Moroccan Medical Oncology Association conducted a literature review and established expert consensus recommendations during the fourth Moroccan Congress of Medical Oncology Private Practice. An evidence-informed, structured consensus process was used to achieve agreement on safety profiles across six RT modalities. Trastuzumab deruxtecan has shown a favorable safety profile with whole-breast irradiation and palliative RT, while trastuzumab emtansine combined with stereotactic radiosurgery shows elevated radionecrosis risk. ICIs are generally feasible with most RT modalities and toxicity monitoring applied; however, risk is context dependent, and evidence supporting stereotactic body radiotherapy-ICI benefit in oligometastatic BC remains limited. The use of CDK4/6 inhibitors concurrently with conventional and stereotactic RT seems feasible, although caution is advised for visceral metastases. These experts' agreements are supported by retrospective data and preclinical evidence, highlighting the need for prospective validation. This expert consensus statement provides pragmatic, modality-specific guidance on combining contemporary RT techniques with selected novel systemic agents in BC, complementing existing European Society for Medical Oncology /European Society for Radiotherapy and Oncology‑oriented frameworks and highlighting areas where prospective data are still needed. The findings underscore the importance of toxicity monitoring, particularly for ADCs in CNS-directed therapies, and call for biomarker-driven studies to optimize combination strategies. These recommendations aim to guide safe integration of novel agents with RT across resource-variable settings, including low- and middle-income countries.
There are now six anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors (TKIs) approved for first-line ALK-positive non-small cell lung cancer (NSCLC) therapy, improving survival and quality of life. However, real-world data on treatment outcomes, predictors of discontinuation, and sequencing strategies remain scarce, while direct comparisons between second- and third-generation TKIs are limited. This global longitudinal observational study evaluated patients with ALK-positive NSCLC, with data collected via online surveys from September 2022 to April 2025. Treatment patterns, outcomes, and factors associated with time to discontinuation (TTD) were assessed using descriptive statistics and univariable regression. Overall, 1,111 patients from 71 countries were included (64% female; median age at diagnosis 53 years; 28% with a smoking history). Crizotinib was predominantly the first TKI administered, although prescribing patterns shifted over time (crizotinib before 2016, alectinib between 2017 and 2022, and lorlatinib thereafter). After the follow-up period (median of 20.7 months), 60% of patients remained on their initial TKI, with TTD varying significantly across agents. Factors associated with prolonged TTDs included radiotherapy, prior chemotherapy, delayed therapy initiation, and treatment in India (crizotinib) and retirement, prior chemotherapy, and treatment in the United Kingdom (alectinib). Gastroesophageal reflux disease, thyroid disease, TP53 mutations, and ALK V3a/b fusions were associated with a short TTD. Globally, alectinib to lorlatinib was the most common treatment sequence. Discontinuations because of toxicity were the highest with crizotinib and ceritinib and the lowest with lorlatinib and alectinib. This multinational registry-based analysis highlights evolving global treatment patterns, supports newer TKIs' effectiveness, and identifies clinical and molecular factors associated with treatment duration.
Childhood cancer is an under-recognized public health priority in low- and middle-income countries. India bears a substantial share of the global burden, yet survival outcomes are poorly documented. This scoping review synthesizes survival outcomes across childhood cancers in India, assesses geographic disparities, and benchmarks against international standards to inform national policy and system strengthening. We searched PubMed, Scopus, Web of Science, and Embase (January 1994 to December 2023) for studies reporting survival outcomes among childhood cancers (0-18 years) in India. Two reviewers independently screened records, extracted data, and conducted descriptive synthesis by cancer type excluding case reports and registry summaries. Exploratory forest plots were created where ≥3 studies reported comparable end points. The protocol was prospectively registered on Open Science Framework. Of 6,505 records screened, 182 studies (22,886 children) were included. Most were retrospective (78%) and single-center (94%), concentrated in four tertiary hospitals. Exploratory pooled estimates derived from descriptive analyses showed that the 5-year overall (OS) and event-free survival were 67.1% (95% CI, 56.9 to 77.2) and 59.2% (95% CI, 48.0 to 70.3) for ALL and 93.1% (95% CI, 91.7 to 94.4) and 85.3% (95% CI, 81.3 to 89.3) for Hodgkin lymphoma (HL). The pooled median OS for AML and Ewing sarcoma was 25.4 months (95% CI, 16.8 to 33.9) and 21.2 months (95% CI, 14.6 to 27.7), respectively, whereas the 3-year OS for neuroblastoma was 56.9% (95% CI, 45.7 to 68.0). Reporting was inconsistent, with frequent omission of CIs and heterogeneity across regions. Childhood cancer survival in India remains variable, with HL nearing global benchmarks, but leukemias and solid tumors show inferior outcomes. Strengthening national cancer registries, research infrastructure, and political commitment is critical for achieving equity in childhood cancer care.
Colorectal cancer (CRC) is the second leading cause of cancer mortality globally. We estimate where and how much progress has been made in the reduction of CRC mortality across 48 countries with varying background risks, epidemiologic risk factors, and screening practices. We used age-specific population counts and CRC mortality rates from 1950 to 2019 from 48 countries from the WHO's Global Cancer Observatory web-based platform and standardized mortality to the WHO (2000-2025) Standard Population. The expected number of CRC deaths following the peak mortality years was estimated using the peak-year age-specific mortality rates and population counts for the index year. Avoided deaths were estimated as the difference between the expected and observed number of CRC deaths. There has been a notable reduction (standardized mortality ratio < 0.70) in CRC deaths in 7 of 41 (17.1%) countries for males and only 2 of 41 (4.9%) countries for females. In countries where screening is widely used, notable reductions have been observed. In many countries, CRC peak mortality has not been reached. Across these 48 countries, there have been 2.87 million avoided CRC deaths, with the greatest reductions observed in the United States, the United Kingdom, and Germany. This study shows the diverging trends in CRC mortality across 48 countries. In countries where CRC screening has been implemented, considerable numbers of CRC cancer deaths have been avoided since mortality rates peaked. The reduction in CRC mortality has not been observed equally for males and females. For many countries, CRC peak mortality has not been reached, highlighting the importance of primary and secondary prevention in addition to treatment advances.
GI cancers contribute substantially to global cancer morbidity and mortality. China experiences a high burden of GI cancers, yet the burden, epidemiologic trends, and attributable risk factors of early-onset GI cancers in China have not been systematically investigated. We conducted a population-based ecologic study with data from the Global Burden of Disease 2023. Early-onset GI cancers were defined with the diagnosis during age 20-49 years. Temporal trends were evaluated using Joinpoint regression and age-period-cohort models. Risk-attributable mortality was assessed using the comparative risk assessment framework. Exponential smoothing models were applied to project incidence rates through 2035. In 2023, early-onset colorectal cancer had the highest incidence rate (7.31 [95% CI, 5.73 to 9.58] per 100,000), whereas stomach cancer had the highest mortality rate (3.30 [95% CI, 2.45 to 4.47] per 100,000). From 2000 to 2023, both incidence and mortality rates generally declined across early-onset GI cancers (average annual percent change range: -0.85 to -4.21 for incidence; -0.97 to -4.86 for mortality). However, all GI cancer sites showed increasing trends during 2020-2022. Risk-attributable patterns varied by sex, age group, and cancer type, with tobacco and alcohol contributing more prominently to mortality among males. Forecasts suggested largely stable trends for most sites through 2035, with persistent sex disparities. Early-onset GI cancers in China showed overall declines over the past two decades but a concerning rebound since 2020, alongside substantial heterogeneity in attributable risks by sex and age. These findings support longitudinal monitoring, alongside strengthened risk-stratified screening and targeted, integrated prevention strategies in alignment with the Healthy China 2030 agenda.
Supportive cancer care focuses on the prevention and management of the adverse effects of cancer and its treatment, with the aim of preserving quality of life, physical functioning, social and vocational well-being, treatment adherence, and survival. As cancer survival rates improve and poor-quality survivorship has become increasingly recognized, supportive care has become more important than ever, forming the basis of compassionate care that places the person, not their cancer, at the center of their treatment. Despite its proven benefits, supportive care remains undervalued, inconsistently delivered, and poorly integrated into routine oncology practices. The Multinational Association for Supportive Care in Cancer (MASCC) brings together global leaders in this field. In this commentary, MASCC leaders seek to clarify the purpose of supportive care, challenge common myths and barriers, and highlight how it can and should be embedded in modern cancer care. This remains essential in the era of novel therapies, where treatment-related toxicities are not eliminated, but instead differ in their etiology and clinical presentation, reinforcing the ongoing need for innovation in the design and delivery of supportive care.