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Trapani D, Murthy SS, Hammad N, Casolino R, Moreira DC, Roitberg F, Blay JY, Curigliano G, Ilbawi AM. Policy strategies for capacity building and scale up of the workforce for comprehensive cancer care: a systematic review. ESMO Open 2024; 9:102946. [PMID: 38507895 PMCID: PMC10966170 DOI: 10.1016/j.esmoop.2024.102946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Patients with cancer in low- and middle-income countries experience worse outcomes as a result of the limited capacity of health systems to deliver comprehensive cancer care. The health workforce is a key component of health systems; however, deep gaps exist in the availability and accessibility of cancer care providers. MATERIALS AND METHODS We carried out a systematic review of the literature evaluating the strategies for capacity building of the cancer workforce. We studied how the policy strategies addressed the availability, accessibility, acceptability, and quality (AAAQ) of the workforce. We used a strategic planning framework (SWOT: strengths, weaknesses, opportunities, threats) to identify actionable areas of capacity building. We contextualized our findings based on the WHO 2030 Global Strategy on Human Resources for Health, evaluating how they can ultimately be framed in a labour market approach and inform strategies to improve the capacity of the workforce (PROSPERO: CRD42020109377). RESULTS The systematic review of the literature yielded 9617 records, and we selected 45 eligible papers for data extraction. The workforce interventions identified were delivered mostly in the African and American Regions, and in two-thirds of cases, in high-income countries. Many strategies have been shown to increase the number of competent oncology providers. Optimization of the existing workforce through role delegation and digital health interventions was reported as a short- to mid-term solution to optimize cancer care, through quality-oriented, efficiency-improving, and acceptability-enforcing workforce strategies. The increased workload alone was potentially detrimental. The literature on retaining the workforce and reducing brain drain or attrition in underserved areas was commonly limited. CONCLUSIONS Workforce capacity building is not only a quantitative problem but can also be addressed through quality-oriented, organizational, and managerial solutions of human resources. The delivery of comprehensive, acceptable, and impact-oriented cancer care requires an available, accessible, and competent workforce for comprehensive cancer care. Efficiency-improving strategies may be instrumental for capacity building in resource-constrained settings.
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Affiliation(s)
- D Trapani
- Department of Oncology and Hemato-Oncology, University of Milano, Milano; European Institute of Oncology, IRCCS, Milan, Italy.
| | - S S Murthy
- Global Cancer Disparities Initiative, Division of Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - N Hammad
- Michael's Hospital, University of Toronto, Toronto, Canada
| | - R Casolino
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - D C Moreira
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, USA
| | - F Roitberg
- Hospital Sírio-Libanês, São Paulo, Brazil
| | - J-Y Blay
- Department of Medical Oncology, Centre Leon Berard, Lyon, France
| | - G Curigliano
- Department of Oncology and Hemato-Oncology, University of Milano, Milano; European Institute of Oncology, IRCCS, Milan, Italy
| | - A M Ilbawi
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
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Torbenson M, Desmet V, Denk H, Callea F, Burt AD, Hübscher SG, Terracciano L, Dienes HP, Goodman ZD, Bedossa P, Wanless IR, Roberts EA, Brunt EM, Clouston AD, Gouw ASH, Kleiner D, Schirmacher P, Tiniakos D. Fifty years of impact on liver pathology: a history of the Gnomes. Virchows Arch 2020; 478:191-200. [PMID: 32607686 PMCID: PMC7969554 DOI: 10.1007/s00428-020-02879-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/14/2020] [Accepted: 06/17/2020] [Indexed: 12/01/2022]
Abstract
Professional societies play a major role in medicine and science. The societies tend to be large with well-developed administrative structures. An additional model, however, is based on small groups of experts who meet regularly in an egalitarian model in order to discuss disease-specific scientific and medical problems. In order to illustrate the effectiveness of this model, the history and practices are examined of a long-standing successful example, the International Liver Pathology Group, better known as the Gnomes. The history shows that groups such as the Gnomes offer a number of important benefits not available in larger societies and nurturing such groups advances science and medicine in meaningful ways. The success of the Gnomes' approach provides a road map for future small scientific groups.
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Affiliation(s)
- Michael Torbenson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Valeer Desmet
- Histology and Pathology, Faculty of Medicine, K.U. Leuven, Leuven, Belgium
| | - Helmut Denk
- Institute of Pathology, Medical University of Graz, Graz, Austria
| | | | - Alastair D Burt
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.,Faculty of Health and Medical Sciences, University of Adelaide School of Medicine, Adelaide, South Australia, 5005, Australia
| | - Stefan G Hübscher
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.,Department of Cellular Pathology, Queen Elizabeth Hospital Birmingham, Birmingham, B15 2WB, UK
| | - Luigi Terracciano
- Institute of Pathology, University of Basel, 4003, Basel, Switzerland
| | - Hans-Peter Dienes
- Institute of Pathology, Meduniwien, Medical University of Vienna, 1090, Wien, Austria
| | - Zachary D Goodman
- Center for Liver Diseases, Inova Fairfax Hospital, Falls Church, VA, 22042, USA
| | - Pierre Bedossa
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK.,LiverPat, Paris, France
| | - Ian R Wanless
- Department of Pathology, Dalhousie University, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, B3H 1V8, Canada
| | - Eve A Roberts
- Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, Toronto, Ontario, M5G1X8, Canada
| | - Elizabeth M Brunt
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Andrew D Clouston
- Centre for Liver Disease Research, School of Medicine (Southern), University of Queensland, Princess Alexandra Hospital, Ipswich Rd, Woolloongabba, 4109, Australia
| | - Annette S H Gouw
- Department of Pathology and Medical Biology, University Medical Center Groningen, 9700 RB, Groningen, The Netherlands
| | | | - Peter Schirmacher
- Heidelberg University, Im Neuenheimer Feld 224, 69120, Heidelberg, Germany
| | - Dina Tiniakos
- Translational & Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4HH, UK. .,Department of Pathology, Aretaieion Hospital, Medical School, National & Kapodistrian University of Athens, Athens, Greece.
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Serra P, Katabalo DM, Masalu N, Amadori D, Bugingo S, Foca F, Bravaccini S, Donati C, Bucchi L, Masini C. Evaluating the appropriateness of chemotherapy in a low-resource cancer centre in sub-Saharan Africa. Cancer Med 2019; 9:133-140. [PMID: 31721474 PMCID: PMC6943087 DOI: 10.1002/cam4.2672] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 10/16/2019] [Accepted: 10/18/2019] [Indexed: 01/08/2023] Open
Abstract
Background To evaluate the appropriateness of chemotherapy use at the Oncology Department of the Bugando Medical Centre of Mwanza, Tanzania. Methods The study was an observational prevalence‐based study designed to evaluate a single‐chemotherapy cycle during a defined time period for a cross‐section of patients at varying stages of their clinical history. The sample included 103 consecutive subjects who were treated during January‐March 2017 and had at least one previous cycle. Chemotherapy treatment omissions, cycle delays, and dose reductions and their causes were recorded using a standard form that included demographic, anthropometric, and clinical items. The data were analyzed descriptively. Results There were 59 males (57.3%) and 44 females (42.7%). Ninety‐four patients were aged ≥18 years. Considering cancer type/site, there were 23 distinct groups of patients. The recorded number of drugs in the chemotherapy regimens varied between one and five. The median cycle number was three (range: 2‐11). Sixty‐eight (66.0%) patients were treated in a standard fashion. For the remaining, cycle delay and dose reduction were the most common cause for nonstandard treatment. Hematologic toxicity was responsible for the greater part of cycle delays, whereas dose reductions were accounted for by a larger spectrum of causes. Overall, toxicity explained 21/35 (60.0%) patients receiving nonstandard treatment. The distribution of toxic events was skewed toward grade 1 and grade 2. Conclusions The observed level of appropriateness of chemotherapy was encouraging. The proportion of patients experiencing severe toxic effects was lower than expected.
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Affiliation(s)
- Patrizia Serra
- Biostatistics and Clinical Trials Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | | | - Nestory Masalu
- Oncology Department, Bugando Medical Centre, Mwanza, Tanzania
| | | | | | - Flavia Foca
- Biostatistics and Clinical Trials Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Sara Bravaccini
- Gerobiomics Unit, Bioscience Laboratory, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Caterina Donati
- Oncology Pharmacy Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Lauro Bucchi
- Romagna Cancer Registry, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Carla Masini
- Oncology Pharmacy Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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Ng DL, Vuhahula E, Zhang L, Waterhouse EG, White KL, Mushi BP, Nyeriga MS, Philipo GS, Mmbaga EJ, Sheth S, Van Loon K, Lee AY, Balassanian R. Efficacy of an Intensive, Ultrasound-Guided Fine-Needle Aspiration Biopsy Training Workshop in Tanzania. J Glob Oncol 2019; 4:1-9. [PMID: 30372401 PMCID: PMC7010453 DOI: 10.1200/jgo.18.00134] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Fine-needle aspiration biopsy (FNAB) is a minimally invasive, cost-effective diagnostic tool that can be used in low-resource settings. However, adequacy and accuracy of FNAB is highly dependent on the skills of the operator and requires specialized training. Poor technique can preclude definitive diagnoses because of insufficient quality or quantity of FNAB samples. We evaluated the efficacy of an intensive training experience in Tanzania on improving ultrasound-guided FNAB techniques. Methods A 2-day workshop offered didactic lectures, demonstrations, and hands-on practicum on fundamentals of ultrasound imaging and FNAB technique. A prospective interventional study design was used with pre- and postintervention surveys and assessments to measure the effect of the workshop on specific skills related to slide smearing and ultrasound-guidance among participants. Results Twenty-six pathologists and radiologists, including trainees in each specialty, participated in the workshop. Pre- and postworkshop assessments demonstrated that most participants improved significantly in nearly all technical skills for slide smearing and ultrasound-guided FNAB. After the workshop, most participants demonstrated substantial improvements in ability to prepare the ultrasound equipment, measure the lesion in three dimensions by ultrasound, target lesions in one pass using both parallel and perpendicular approaches, and prepare high-quality aspirate smears. Conclusion An in-country 2-day workshop in Tanzania was efficacious in transferring basic skills in FNAB smear preparation and ultrasound-guided FNAB, resulting in skills enhancement among participating pathologists and radiologists. Although mastery of skills was not the goal of this short workshop, participants demonstrated proficiency in most technical elements after workshop completion, and the workshop generated interest among select participants to pursue additional intensive training in cytopathology.
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Affiliation(s)
- Dianna L Ng
- Dianna L. Ng, Li Zhang, Emily G. Waterhouse, Kristie L. White, Sujay Sheth, Katherine Van Loon, Amie Y. Lee, and Ronald Balassanian, University of California, San Francisco, San Francisco, CA; Edda Vuhahula, Beatrice Paul Mushi, Msiba Selekwa Nyeriga, Godfrey Sama Philipo, and Elia J. Mmbaga, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Edda Vuhahula
- Dianna L. Ng, Li Zhang, Emily G. Waterhouse, Kristie L. White, Sujay Sheth, Katherine Van Loon, Amie Y. Lee, and Ronald Balassanian, University of California, San Francisco, San Francisco, CA; Edda Vuhahula, Beatrice Paul Mushi, Msiba Selekwa Nyeriga, Godfrey Sama Philipo, and Elia J. Mmbaga, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Li Zhang
- Dianna L. Ng, Li Zhang, Emily G. Waterhouse, Kristie L. White, Sujay Sheth, Katherine Van Loon, Amie Y. Lee, and Ronald Balassanian, University of California, San Francisco, San Francisco, CA; Edda Vuhahula, Beatrice Paul Mushi, Msiba Selekwa Nyeriga, Godfrey Sama Philipo, and Elia J. Mmbaga, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Emily G Waterhouse
- Dianna L. Ng, Li Zhang, Emily G. Waterhouse, Kristie L. White, Sujay Sheth, Katherine Van Loon, Amie Y. Lee, and Ronald Balassanian, University of California, San Francisco, San Francisco, CA; Edda Vuhahula, Beatrice Paul Mushi, Msiba Selekwa Nyeriga, Godfrey Sama Philipo, and Elia J. Mmbaga, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Kristie L White
- Dianna L. Ng, Li Zhang, Emily G. Waterhouse, Kristie L. White, Sujay Sheth, Katherine Van Loon, Amie Y. Lee, and Ronald Balassanian, University of California, San Francisco, San Francisco, CA; Edda Vuhahula, Beatrice Paul Mushi, Msiba Selekwa Nyeriga, Godfrey Sama Philipo, and Elia J. Mmbaga, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Beatrice Paul Mushi
- Dianna L. Ng, Li Zhang, Emily G. Waterhouse, Kristie L. White, Sujay Sheth, Katherine Van Loon, Amie Y. Lee, and Ronald Balassanian, University of California, San Francisco, San Francisco, CA; Edda Vuhahula, Beatrice Paul Mushi, Msiba Selekwa Nyeriga, Godfrey Sama Philipo, and Elia J. Mmbaga, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Msiba Selekwa Nyeriga
- Dianna L. Ng, Li Zhang, Emily G. Waterhouse, Kristie L. White, Sujay Sheth, Katherine Van Loon, Amie Y. Lee, and Ronald Balassanian, University of California, San Francisco, San Francisco, CA; Edda Vuhahula, Beatrice Paul Mushi, Msiba Selekwa Nyeriga, Godfrey Sama Philipo, and Elia J. Mmbaga, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Godfrey Sama Philipo
- Dianna L. Ng, Li Zhang, Emily G. Waterhouse, Kristie L. White, Sujay Sheth, Katherine Van Loon, Amie Y. Lee, and Ronald Balassanian, University of California, San Francisco, San Francisco, CA; Edda Vuhahula, Beatrice Paul Mushi, Msiba Selekwa Nyeriga, Godfrey Sama Philipo, and Elia J. Mmbaga, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Elia J Mmbaga
- Dianna L. Ng, Li Zhang, Emily G. Waterhouse, Kristie L. White, Sujay Sheth, Katherine Van Loon, Amie Y. Lee, and Ronald Balassanian, University of California, San Francisco, San Francisco, CA; Edda Vuhahula, Beatrice Paul Mushi, Msiba Selekwa Nyeriga, Godfrey Sama Philipo, and Elia J. Mmbaga, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sujay Sheth
- Dianna L. Ng, Li Zhang, Emily G. Waterhouse, Kristie L. White, Sujay Sheth, Katherine Van Loon, Amie Y. Lee, and Ronald Balassanian, University of California, San Francisco, San Francisco, CA; Edda Vuhahula, Beatrice Paul Mushi, Msiba Selekwa Nyeriga, Godfrey Sama Philipo, and Elia J. Mmbaga, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Katherine Van Loon
- Dianna L. Ng, Li Zhang, Emily G. Waterhouse, Kristie L. White, Sujay Sheth, Katherine Van Loon, Amie Y. Lee, and Ronald Balassanian, University of California, San Francisco, San Francisco, CA; Edda Vuhahula, Beatrice Paul Mushi, Msiba Selekwa Nyeriga, Godfrey Sama Philipo, and Elia J. Mmbaga, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Amie Y Lee
- Dianna L. Ng, Li Zhang, Emily G. Waterhouse, Kristie L. White, Sujay Sheth, Katherine Van Loon, Amie Y. Lee, and Ronald Balassanian, University of California, San Francisco, San Francisco, CA; Edda Vuhahula, Beatrice Paul Mushi, Msiba Selekwa Nyeriga, Godfrey Sama Philipo, and Elia J. Mmbaga, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ronald Balassanian
- Dianna L. Ng, Li Zhang, Emily G. Waterhouse, Kristie L. White, Sujay Sheth, Katherine Van Loon, Amie Y. Lee, and Ronald Balassanian, University of California, San Francisco, San Francisco, CA; Edda Vuhahula, Beatrice Paul Mushi, Msiba Selekwa Nyeriga, Godfrey Sama Philipo, and Elia J. Mmbaga, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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