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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Cancer Care in Low-Resource Areas: Cancer Treatment, Palliative Care, and Survivorship Care: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24743.
×

Cancer Care in Low-Resource Areas

CANCER TREATMENT, PALLIATIVE CARE, AND
SURVIVORSHIP CARE

PROCEEDINGS OF A WORKSHOP

Erin Balogh, Margie Patlak, and Sharyl J. Nass, Rapporteurs

National Cancer Policy Forum

Board on Health Care Services

Health and Medicine Division

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THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Cancer Care in Low-Resource Areas: Cancer Treatment, Palliative Care, and Survivorship Care: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24743.
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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This project was supported by Contract No. 200-2011-38807 (Task Order No. 0051) and Contract No. HHSN263201200074I (Task Order No. HHSN26300052) with the Centers for Disease Control and Prevention and the National Cancer Institute/National Institutes of Health, respectively, and by the American Association for Cancer Research, American Cancer Society, American College of Radiology, American Society for Radiation Oncology, American Society of Clinical Oncology, American Society of Hematology, Association of American Cancer Institutes, AstraZeneca, Bristol-Myers Squibb, Cancer Support Community, CEO Roundtable on Cancer, Helsinn Therapeutics (U.S.), Inc., LIVESTRONG Foundation, National Comprehensive Cancer Network, Novartis Oncology, Oncology Nursing Society, and Pfizer Inc. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-45799-6
International Standard Book Number-10: 0-309-45799-8
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2017. Cancer care in low-resource areas: Cancer treatment, palliative care, and survivorship care: Proceedings of a workshop. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/24743.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Cancer Care in Low-Resource Areas: Cancer Treatment, Palliative Care, and Survivorship Care: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24743.
×

images

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.

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The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.

The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.

Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Cancer Care in Low-Resource Areas: Cancer Treatment, Palliative Care, and Survivorship Care: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24743.
×

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Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task.

Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies.

For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Cancer Care in Low-Resource Areas: Cancer Treatment, Palliative Care, and Survivorship Care: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24743.
×

WORKSHOP PLANNING COMMITTEE1

ROBERT W. CARLSON (Co-Chair), Chief Executive Officer, National Comprehensive Cancer Network

RICHARD A. LARSON (Co-Chair), Professor of Medicine and Director, Hematologic Malignancies Clinical Research Program, The University of Chicago

WENDY DEMARK-WAHNEFRIED, Professor and Webb Endowed Chair of Nutrition Sciences, Associate Director for Cancer Prevention and Control, University of Alabama at Birmingham Comprehensive Cancer Center

SAMIR N. KHLEIF, Professor of Medicine, Biochemistry, Molecular Biology, and Graduate Studies, Augusta University

MARK LAZENBY, Associate Professor of Nursing, Yale School of Nursing

GRETA MASSETTI, Associate Director for Science, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention

WORTA MCCASKILL-STEVENS, Chief, Community Oncology and Prevention Trials Research Group, National Cancer Institute

LOYCE PACE, Executive Director, Global Health Council

KATHLEEN SCHMELER, Associate Professor, Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center

YA-CHEN TINA SHIH, Professor of Health Economics, Chief, Section of Cancer Economics and Policy, Department of Health Services Research, The University of Texas MD Anderson Cancer Center

LAWRENCE N. SHULMAN, Professor of Medicine, Deputy Director for Clinical Services, and Director, Center for Global Cancer Medicine, Abramson Cancer Center, University of Pennsylvania

BHADRASAIN VIKRAM, Branch Chief, Clinical Radiation Oncology Branch, National Cancer Institute

___________________

1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Cancer Care in Low-Resource Areas: Cancer Treatment, Palliative Care, and Survivorship Care: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24743.
×

Project Staff

ERIN BALOGH, Senior Program Officer

CYNDI TRANG, Research Assistant

SYLARA MARIE CRUZ, Senior Program Assistant

SHARYL J. NASS, Director, National Cancer Policy Forum

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Cancer Care in Low-Resource Areas: Cancer Treatment, Palliative Care, and Survivorship Care: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24743.
×

NATIONAL CANCER POLICY FORUM1

EDWARD J. BENZ, JR. (Chair), President and Chief Executive Officer Emeritus, Dana-Farber Cancer Institute; Richard and Susan Smith Distinguished Professor of Medicine, Genetics and Pediatrics, Harvard Medical School

KALD A. ABDALLAH, Oncology External Alliances Leader, U.S. Medical Affairs, AstraZeneca

AMY P. ABERNETHY, Chief Medical Officer, Chief Scientific Officer, and Senior Vice President, Oncology, Flatiron Health

LUCILE L. ADAMS-CAMPBELL, Professor of Oncology, Associate Director for Minority Health and Health Disparities Research, Georgetown University Lombardi Cancer Center

GARNET L. ANDERSON, Senior Vice President and Director, Public Health Sciences Division, Fred Hutchinson Cancer Research Center; Affiliate Professor, Department of Biostatistics, University of Washington

KENNETH ANDERSON, Kraft Family Professor of Medicine, American Cancer Society Clinical Research Director, Jerome Lipper Multiple Myeloma Center, Harvard Medical School, Dana-Farber Cancer Institute

KAREN BASEN-ENGQUIST, Annie Laurie Howard Research Distinguished Professor, Professor of Behavioral Science, and Director, Center for Energy Balance in Cancer Prevention and Survivorship, The University of Texas MD Anderson Cancer Center

CATHY J. BRADLEY, Associate Director, Cancer Prevention and Control, University of Colorado Cancer Center

OTIS W. BRAWLEY, Chief Medical Officer, American Cancer Society

ROBERT W. CARLSON, Chief Executive Officer, National Comprehensive Cancer Network

CHRISTOPHER R. COGLE, Professor of Medicine, Pierre Chagnon Professor of Stem Cell Biology and Bone Marrow Transplant, University of Florida; Scholar in Clinical Research, Leukemia & Lymphoma Society

___________________

1 The National Academies of Sciences, Engineering, and Medicine’s forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.

Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Cancer Care in Low-Resource Areas: Cancer Treatment, Palliative Care, and Survivorship Care: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24743.
×

ROGER D. DANSEY, Senior Vice President, Clinical Research–Late Stage Development, Merck

NANCY E. DAVIDSON, President and Executive Director, Seattle Cancer Care Alliance; Senior Vice President, Director, and Full Member, Clinical Research Division, Fred Hutchinson Cancer Research Center; Head, Department of Medicine, Division of Medical Oncology, University of Washington

GEORGE D. DEMETRI, Professor of Medicine and Director, Ludwig Center, Harvard Medical School; Senior Vice President for Experimental Therapeutics, Dana-Farber Cancer Institute; Associate Director for Clinical Sciences, Dana-Farber/Harvard Cancer Center

JAMES H. DOROSHOW, Deputy Director for Clinical and Translational Research, National Cancer Institute

KOJO S. J. ELENITOBA-JOHNSON, Professor, Perelman School of Medicine, Founding Director, Center for Personalized Diagnostics and Division of Precision and Computational Diagnostics, University of Pennsylvania

STANTON L. GERSON, President, Association of American Cancer Institutes; Director, Case Comprehensive Cancer Center; Professor of Hematological Oncology, Case Western Reserve University; Director, University Hospitals Seidman Cancer Center

LORI HOFFMAN HŌGG, Veterans Health Administration National Oncology Clinical Advisor and Program Manager, Prevention Policy, Department of Veterans Affairs

LINDA HOUSE, President, Cancer Support Community

HEDVIG HRICAK, Chair, Department of Radiology, Memorial Sloan Kettering Cancer Center

LISA KENNEDY SHELDON, Chief Clinical Officer, Oncology Nursing Society; Editor, Clinical Journal of Oncology Nursing

SAMIR N. KHLEIF, Professor of Medicine, Biochemistry, Molecular Biology, and Graduate Studies, Augusta University

RONALD M. KLINE, Medical Officer, Patient Care Models Group, Center for Medicare & Medicaid Innovation, Centers for Medicare & Medicaid Services

LEE M. KRUG, Disease Area Head, Lung and Head & Neck Cancer, Immuno-Oncology, Bristol-Myers Squibb

FRANCOIS LAFLEUR, U.S. Head and Vice President, Medical Affairs, Helsinn Therapeutics (U.S.), Inc.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Cancer Care in Low-Resource Areas: Cancer Treatment, Palliative Care, and Survivorship Care: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24743.
×

MICHELLE M. LE BEAU, Arthur and Marian Edelstein Professor of Medicine and Director, The University of Chicago Comprehensive Cancer Center

MIA LEVY, Director of Cancer Health Informatics and Strategy, Ingram Associate Professor of Cancer Research, Associate Professor of Biomedical Informatics and Medicine, Vanderbilt-Ingram Cancer Center

GRETA MASSETTI, Associate Director for Science, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention

MARTIN J. MURPHY, Chief Executive Officer, CEO Roundtable on Cancer

RICHARD PAZDUR, Director, Oncology Center of Excellence; Acting Director, Office of Hematology and Oncology Products, Food and Drug Administration

MACE L. ROTHENBERG, Chief Development Officer, Oncology, Pfizer Global Product Development, Pfizer Inc.

RICHARD L. SCHILSKY, Senior Vice President and Chief Medical Officer, American Society of Clinical Oncology

DEBORAH SCHRAG, Chief, Division of Population Sciences, Professor of Medicine, Department of Medical Oncology, Harvard Medical School, Dana-Farber Cancer Institute

LAWRENCE N. SHULMAN, Professor of Medicine, Deputy Director for Clinical Services, and Director, Center for Global Cancer Medicine, Abramson Cancer Center, University of Pennsylvania

DAN THEODORESCU, Paul A. Bunn, Jr. Endowed Chair in Cancer Research, Professor of Surgery and Pharmacology, and Director, University of Colorado Cancer Center

GEORGE J. WEINER, C.E. Block Chair of Cancer Research, Professor of Internal Medicine, and Director, Holden Comprehensive Cancer Center, University of Iowa

ROBERT A. WINN, Associate Vice Chancellor for Community-Based Practice; Professor of Medicine, Division of Pulmonary and Critical Care Medicine, University of Illinois College of Medicine at Chicago; Director, University of Illinois Health Cancer Center

RICHARD C. WOODMAN, Senior Vice President and Head, North America Oncology Clinical Development & Medical Affairs, Novartis Pharmaceuticals Corporation

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Cancer Care in Low-Resource Areas: Cancer Treatment, Palliative Care, and Survivorship Care: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24743.
×

WENDY A. WOODWARD, Associate Professor and Service Chief, Breast Cancer Radiation Oncology, Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center

National Cancer Policy Forum Staff

SHARYL J. NASS, Forum Director and Director, Board on Health Care Services

ERIN BALOGH, Senior Program Officer

CYNDI TRANG, Research Assistant

SYLARA MARIE CRUZ, Senior Program Assistant (until June 2017)

NATALIE LUBIN, Senior Program Assistant (from June 2017)

PATRICK BURKE, Financial Officer

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Cancer Care in Low-Resource Areas: Cancer Treatment, Palliative Care, and Survivorship Care: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24743.
×

Reviewers

This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.

We thank the following individuals for their review of this proceedings:

ELLEN BAKER, The University of Texas MD Anderson Cancer Center

MURRAY F. BRENNAN, Memorial Sloan Kettering Cancer Center

JAMES F. CLEARY, University of Wisconsin Carbone Cancer Center

GWEN DARIEN, National Patient Advocate Foundation

MARY K. GOSPODAROWICZ, Princess Margaret Cancer Centre

EDWARD L. TRIMBLE, National Cancer Institute

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Cancer Care in Low-Resource Areas: Cancer Treatment, Palliative Care, and Survivorship Care: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24743.
×

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by RUTH MCCORKLE, Yale School of Nursing. She was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.

Page xiii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Cancer Care in Low-Resource Areas: Cancer Treatment, Palliative Care, and Survivorship Care: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24743.
×

Acknowledgments

Support from the many annual sponsors of the National Academies of Sciences, Engineering, and Medicine’s National Cancer Policy Forum is crucial to the work of the Forum. Federal sponsors include the Centers for Disease Control and Prevention and the National Cancer Institute/National Institutes of Health. Non-federal sponsors include the American Association for Cancer Research, American Cancer Society, American College of Radiology, American Society for Radiation Oncology, American Society of Clinical Oncology, American Society of Hematology, Association of American Cancer Institutes, AstraZeneca, Bristol-Myers Squibb, Cancer Support Community, CEO Roundtable on Cancer, Flatiron Health, Helsinn Therapeutics (U.S.), Inc., LIVESTRONG Foundation, Merck, National Comprehensive Cancer Network, Novartis Oncology, Oncology Nursing Society, and Pfizer Inc.

The Forum wishes to express its gratitude to the expert speakers whose presentations helped examine policy issues pertaining to the cancer care continuum in low-resource areas, both domestically and internationally. The Forum also wishes to thank the members of the planning committee for their work in developing an excellent workshop agenda.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Cancer Care in Low-Resource Areas: Cancer Treatment, Palliative Care, and Survivorship Care: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24743.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Cancer Care in Low-Resource Areas: Cancer Treatment, Palliative Care, and Survivorship Care: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24743.
×
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Cancer Care in Low-Resource Areas: Cancer Treatment, Palliative Care, and Survivorship Care: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24743.
×

Acronyms and Abbreviations

ASCO

American Society of Clinical Oncology

ASCP

American Society for Clinical Pathology

CDC

Centers for Disease Control and Prevention

CIRB

central institutional review board

CML

chronic myeloid leukemia

CMS

Centers for Medicare & Medicaid Services

DoD

Department of Defense

ER

estrogen receptor

GloBAM

Global Breast Health Analytics Map

HER2

human epidermal growth factor receptor 2

HIV/AIDS

human immunodeficiency virus/acquired immunodeficiency syndrome

HRSA

Health Resources and Services Administration

IRB

institutional review board

IT

information technology

IV

intravenous

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Cancer Care in Low-Resource Areas: Cancer Treatment, Palliative Care, and Survivorship Care: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24743.
×
LSU

Louisiana State University

NCCN

National Comprehensive Cancer Network

NCI

National Cancer Institute

NCORP

NCI Community Oncology Research Program

PEPFAR

U.S. President’s Emergency Plan for AIDS Relief

PIH

Partners In Health

Project ECHO

Project Extension for Community Healthcare Outcomes

Project ENABLE

Project Educate, Nurture, Advise Before Life Ends

TB

tuberculosis

UICC

Union for International Cancer Control

UN

United Nations

UNAIDS

Joint United Nations Programme on HIV/AIDS

UNODC

United Nations Office on Drugs and Crime

WHO

World Health Organization

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Cancer Care in Low-Resource Areas: Cancer Treatment, Palliative Care, and Survivorship Care: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24743.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Cancer Care in Low-Resource Areas: Cancer Treatment, Palliative Care, and Survivorship Care: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24743.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Cancer Care in Low-Resource Areas: Cancer Treatment, Palliative Care, and Survivorship Care: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24743.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Cancer Care in Low-Resource Areas: Cancer Treatment, Palliative Care, and Survivorship Care: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24743.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Cancer Care in Low-Resource Areas: Cancer Treatment, Palliative Care, and Survivorship Care: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/24743.
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Though cancer was once considered to be a problem primarily in wealthy nations, low- and middle-income countries now bear a majority share of the global cancer burden, and cancer often surpasses the burden of infectious diseases in these countries. Effective low-cost cancer control options are available for some malignancies, with the World Health Organization estimating that these interventions could facilitate the prevention of approximately one-third of cancer deaths worldwide. Effective cancer treatment approaches are also available and can reduce the morbidity and mortality due to cancer in low-resource areas. But these interventions remain inaccessible for many people in the world, especially those residing in low-resource communities that are characterized by a lack of funds—on an individual or a societal basis—to cover health infrastructure and care costs. As a result, worse outcomes for patients with cancer are more common in low- and middle-income countries compared with high-income countries.

Few guidelines and strategies for cancer control consider the appropriateness and feasibility of interventions in low-resource settings, and this may undermine the effectiveness of care. Recognizing the challenges of providing cancer care in resource constrained settings, the National Academies of Sciences, Engineering, and Medicine developed a two- workshop series examining cancer care in low-resource communities, building on prior work of the National Academies. The first workshop, held in October 2015, focused on cancer prevention and early detection. The second workshop was held in November 2016, and focused on cancer treatment, palliative care, and survivorship care in low-resource areas. This publication summarizes the presentations and discussions of this workshop.

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