Cancers
Developing a Conceptual Framework: Integrating Tumour, Macroenvironment and Resource (TMR) as a Composite Determinant of Ovarian Cancer Outcome in Diverse Resource Settings
By Asima Mukhopadhyay, Adam Ruddock, Mohamed Elsebaei and 3 others.
Abstract
Background
Ovarian cancer (OC) poses an escalating global health burden, with marked disparities in incidence, mortality, and survivorship. Social, psychological, and structural determinants, including deprivation, stigma, and access to specialist care, may influence outcomes but are not well-represented in existing models of cancer care. We introduce the Tumour, Macroenvironment and Resource (TMR) framework, a novel conceptual model exploring interactions among tumour biology, social determinants, and healthcare resources in OC survivorship and care.
Methods
Framework development occurred in three phases. First, a narrative review identified factors influencing OC outcomes across tumour, macroenvironmental, and healthcare resource domains. Second, multi-criteria decision analysis (MCDA) was used to structure these factors within a preliminary framework and assign indicative domain weightings. Third, two cross-sectional expert opinion surveys were conducted to refine and validate the concept of the framework. The final model was then evaluated in a retrospective pilot cohort to assess the feasibility of collecting predefined TMR variables from routinely available clinical data.