Global Cancer by Kari Leung
European J Cancer, 2023
The number of systemic anticancer therapy (SACT) regimens has expanded rapidly over the last deca... more The number of systemic anticancer therapy (SACT) regimens has expanded rapidly over the last decade. There is a need to ensure quality of SACT delivery across cancer services and systems in different resource settings to reduce morbidity, mortality, and detrimental economic impact at individual and systems level. Existing literature on SACT focuses on treatment efficacy with few studies on quality or how SACT is delivered within routine care in comparison to radiation and surgical oncology. Methods: Systematic review was conducted following PRISMA guidelines. EMBASE and MEDLINE were searched and handsearching was undertaken to identify literature on existing quality indicators (QIs) that detect meaningful variations in the quality of SACT delivery across different healthcare facilities, regions, or countries. Data extraction was undertaken by two independent reviewers. Results: This review identified 63 distinct QIs from 15 papers. The majority were process QIs (n = 55, 87.3%) relating to appropriateness of treatment and guideline adherence (n = 28, 44.4%). There were few outcome QIs (n = 7, 11.1%) and only one structural QI (n = 1, 1.6%). Included studies solely focused on breast, colorectal, lung, and skin cancer. All but one studies were conducted in high-income countries. Conclusions: The results of this review highlight a significant lack of research on SACT QIs particularly those appropriate for resource-constrained settings in low-and middle-income countries. This review should form the basis for future work in transforming performance measurement of SACT provision, through context-specific QI SACT development, validation, and implementation.
Papers by Kari Leung
Crystal Growth & Design, 2014
ABSTRACT The existence of a cocrystal between curcumin (CUR) and phloroglucinol (PHL) was suspect... more ABSTRACT The existence of a cocrystal between curcumin (CUR) and phloroglucinol (PHL) was suspected but could not be demonstrated in a recent systematic effort to synthesize novel curcumin cocrystals. We hypothesize that the elusive CURPHL cocrystal is a kinetically stable form that can be prepared by trapping it using a fast solvent removal crystallization process. The polarity of crystallization solvent and relative solubility of cocrystal formers in the solvent appear to be critical parameters governing the phase purity of the resulting cocrystal. Organic solvents of higher polarity and in which the cocrystal formers exhibited congruent solubility tended to afford a purer cocrystal phase. Essentially phase-pure CURPHL cocrystals were successfully obtained from acetone, and their 1:1 stoichiometry was confirmed by differential scanning calorimetry and solid state nuclear magnetic resonance spectroscopy. Compared with the individual component phases, the cocrystal displayed reduced hygroscopicity and improved tabletability. However, the intrinsic dissolution rate of the cocrystal showed no significant improvement compared with the pure CUR crystal due to the instantaneous conversion of the cocrystal to CUR at its surface upon contact with the dissolution medium.
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Global Cancer by Kari Leung
Papers by Kari Leung