1
|
El Jiar M, Eliahiai I, Chaib S, Elmorabit K, Mouatakid M, Kharmoum J, Chraibi M. The State of Telepathology in Africa in the Age of Digital Pathology Advancements: A Bibliometric Analysis and Literature Review. Cureus 2024; 16:e63835. [PMID: 39099907 PMCID: PMC11297393 DOI: 10.7759/cureus.63835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2024] [Indexed: 08/06/2024] Open
Abstract
Telepathology emerges as a vital tool, offering significant promise for enhancing pathology services in Africa, a region historically challenged by healthcare access and resource limitations. This review explores the development, adoption, and impacts of telepathology in Africa through a comprehensive bibliometric analysis and literature review. A methodical search in PubMed for publications up to 2024 revealed 119 pertinent studies, out of which 47 met the inclusion criteria for a focused review on telepathology's role in African healthcare settings. This research has charted a clear trajectory of growing interest in telepathology, as evidenced by the annual increase in related publications and robust international collaboration. It underscores the expanding utility of telepathology in diagnostics, education, and research within Africa, particularly in domains like dermatopathology, neuropathology, and, notably, oncology. The integration of artificial intelligence into telepathology presents new frontiers for enhancing diagnostic accuracy and efficiency. However, the review also identifies persistent challenges such as infrastructural inadequacies, a shortage of skilled professionals, and regulatory hurdles. The study highlights the indispensable role of international partnerships in advancing telepathology in the region. This review proposes a strategic pivot toward "leapfrogging," an approach that allows Africa to skip traditional developmental hurdles by directly adopting cutting-edge technologies and practices.
Collapse
Affiliation(s)
- Mohammed El Jiar
- Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, MAR
- Department of Pathology, University Hospital Mohammed VI of Tangier, Tangier, MAR
| | - Imane Eliahiai
- Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, MAR
- Department of Pathology, University Hospital Mohammed VI of Tangier, Tangier, MAR
| | - Sanae Chaib
- Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, MAR
- Department of Pathology, University Hospital Mohammed VI of Tangier, Tangier, MAR
| | - Khalid Elmorabit
- Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, MAR
- Department of Pathology, University Hospital Mohammed VI of Tangier, Tangier, MAR
| | - Mohamed Mouatakid
- Department of Pathology, University Hospital Mohammed VI of Tangier, Tangier, MAR
| | - Jinane Kharmoum
- Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, MAR
- Department of Pathology, University Hospital Mohammed VI of Tangier, Tangier, MAR
| | - Mariame Chraibi
- Faculty of Medicine and Pharmacy of Tangier, Abdelmalek Essaadi University, Tangier, MAR
- Department of Pathology, University Hospital Mohammed VI of Tangier, Tangier, MAR
| |
Collapse
|
2
|
Hanna MG, Ardon O. Digital pathology systems enabling quality patient care. Genes Chromosomes Cancer 2023; 62:685-697. [PMID: 37458325 PMCID: PMC11265285 DOI: 10.1002/gcc.23192] [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: 04/13/2023] [Revised: 06/27/2023] [Accepted: 07/06/2023] [Indexed: 09/20/2023] Open
Abstract
Pathology laboratories are undergoing digital transformations, adopting innovative technologies to enhance patient care. Digital pathology systems impact clinical, education, and research use cases where pathologists use digital technologies to perform tasks in lieu of using glass slides and a microscope. Pathology professional societies have established clinical validation guidelines, and the US Food and Drug Administration have also authorized digital pathology systems for primary diagnosis, including image analysis and machine learning systems. Whole slide images, or digital slides, can be viewed and navigated similar to glass slides on a microscope. These modern tools not only enable pathologists to practice their routine clinical activities, but can potentially enable digital computational discovery. Assimilation of whole slide images in pathology clinical workflow can further empower machine learning systems to support computer assisted diagnostics. The potential enrichment these systems can provide is unprecedented in the field of pathology. With appropriate integration, these clinical decision support systems will allow pathologists to increase the delivery of quality patient care. This review describes the digital pathology transformation process, applicable clinical use cases, incorporation of image analysis and machine learning systems in the clinical workflow, as well as future technologies that may further disrupt pathology modalities to deliver quality patient care.
Collapse
Affiliation(s)
- Matthew G Hanna
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Orly Ardon
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| |
Collapse
|
3
|
Movahed-Ezazi M, Nasir-Moin M, Fang C, Pizzillo I, Galbraith K, Drexler S, Krasnozhen-Ratush OA, Shroff S, Zagzag D, William C, Orringer D, Snuderl M. Clinical Validation of Stimulated Raman Histology for Rapid Intraoperative Diagnosis of Central Nervous System Tumors. Mod Pathol 2023; 36:100219. [PMID: 37201685 PMCID: PMC10527246 DOI: 10.1016/j.modpat.2023.100219] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/31/2023] [Accepted: 05/03/2023] [Indexed: 05/20/2023]
Abstract
Stimulated Raman histology (SRH) is an ex vivo optical imaging method that enables microscopic examination of fresh tissue intraoperatively. The conventional intraoperative method uses frozen section analysis, which is labor and time intensive, introduces artifacts that limit diagnostic accuracy, and consumes tissue. SRH imaging allows rapid microscopic imaging of fresh tissue, avoids tissue loss, and enables remote telepathology review. This improves access to expert neuropathology consultation in both low- and high-resource practices. We clinically validated SRH by performing a blinded, retrospective two-arm telepathology study to clinically validate SRH for telepathology at our institution. Using surgical specimens from 47 subjects, we generated a data set composed of 47 SRH images and 47 matched whole slide images (WSIs) of formalin-fixed, paraffin-embedded tissue stained with hematoxylin and eosin, with associated intraoperative clinicoradiologic information and structured diagnostic questions. We compared diagnostic concordance between WSI and SRH-rendered diagnoses. Also, we compared the 1-year median turnaround time (TAT) of intraoperative conventional neuropathology frozen sections with prospectively rendered SRH-telepathology TAT. All SRH images were of sufficient quality for diagnostic review. A review of SRH images showed high accuracy in distinguishing glial from nonglial tumors (96.5% SRH vs 98% WSIs) and predicting final diagnosis (85.9% SRH vs 93.1% WSIs). SRH-based diagnosis and WSI-permanent section diagnosis had high concordance (κ = 0.76). The median TAT for prospectively SRH-rendered diagnosis was 3.7 minutes, approximately 10-fold shorter than the median frozen section TAT (31 minutes). The SRH-imaging procedure did not affect ancillary studies. SRH generates diagnostic virtual histologic images with accuracy comparable to conventional hematoxylin and eosin-based methods in a rapid manner. Our study represents the largest and most rigorous clinical validation of SRH to date. It supports the feasibility of implementing SRH as a rapid method for intraoperative diagnosis complementary to conventional pathology laboratory methods.
Collapse
Affiliation(s)
- Misha Movahed-Ezazi
- Department of Pathology and Laboratory Medicine, NYU Langone, New York, New York
| | | | - Camila Fang
- Department of Pathology and Laboratory Medicine, NYU Langone, New York, New York
| | - Isabella Pizzillo
- Department of Pathology and Laboratory Medicine, NYU Langone, New York, New York
| | - Kristyn Galbraith
- Department of Pathology and Laboratory Medicine, NYU Langone, New York, New York
| | - Steven Drexler
- Department of Pathology and Laboratory Medicine, NYU, Mineola, New York
| | | | - Seema Shroff
- Department of Pathology and Laboratory Medicine, AdventHealth Orlando, Orlando, Florida
| | - David Zagzag
- Department of Pathology and Laboratory Medicine, NYU Langone, New York, New York; Department of Neurosurgery, NYU Langone, New York, New York
| | - Christopher William
- Department of Pathology and Laboratory Medicine, NYU Langone, New York, New York
| | | | - Matija Snuderl
- Department of Pathology and Laboratory Medicine, NYU Langone, New York, New York.
| |
Collapse
|
4
|
Manirakiza F, Niyoyita JP, Habanabakize T, Ndagijimana E, Surwumwe JB, Rugwizangoga B. The use of Vsee videoconferencing for live telepathology in Rwanda, a potential solution for resource-limited area. Digit Health 2023; 9:20552076231159184. [PMID: 36860909 PMCID: PMC9969432 DOI: 10.1177/20552076231159184] [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: 02/07/2022] [Accepted: 02/04/2023] [Indexed: 02/26/2023] Open
Abstract
Objective The shortage of pathologists is a worldwide problem that is more severe in Africa. One of the solutions is the use of telepathology (TP); however, most of the TP systems are expensive and unaffordable in many developing countries. At the University Teaching Hospital of Kigali, Rwanda, we assessed the possibility of combining commonly available laboratory tools into a system that can be used for diagnostic TP using Vsee videoconferencing. Methodology Using an Olympus microscope (with a camera) operated by a laboratory technologist, histologic images were transmitted to a computer whose screen was shared, using Vsee, with a remotely located pathologist who made the diagnoses. Sixty consecutive small biopsies (≤6 glass slides) from different tissues were examined to make a diagnosis using live Vsee-based videoconferencing TP. Vsee-based diagnoses were compared to pre-existing light microscopy-based diagnoses. Percent agreement and unweighted Cohen's kappa coefficient of the agreement were calculated. Results For agreement between conventional microscopy-based and Vsee-based diagnoses, we found an unweighted Cohen's kappa of 0.77 ± 0.07SE with a 95% CI of 0.62-0.91. The perfect percent agreement was 76.6% (46 of 60). Agreement with minor discrepancy was 15% (9 of 60). There were 2 cases of major discrepancy (3.30%). We were unable to make a diagnosis in 3 cases (5%) because of poor image quality related to the instantaneous internet connectivity problems. Conclusion This system provided promising results. However, additional studies to assess other parameters which can affect its performance are needed before this system can be considered an alternative method of providing TP services in resource-limited settings.
Collapse
Affiliation(s)
- Felix Manirakiza
- Department of Pathology, School of Medicine and Pharmacy, College of
Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda,Department of Health Informatics, School of Public Health, College
of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda,Department of Pathology, University Teaching Hospital of Kigali,
Kigali, Rwanda,Felix Manirakiza, Department of Pathology,
University Teaching Hospital of Kigali (CHUK), KN 4 Ave, P.O. Box 655 Kigali,
Rwanda.
| | - Jean Paul Niyoyita
- Department of Health Informatics, School of Public Health, College
of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Thomas Habanabakize
- Department of Pathology, School of Medicine and Pharmacy, College of
Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Emmanuel Ndagijimana
- Department of Biostatistics, School of Public Health, College of
Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda,The African Center of Excellence in Data Science, College of
Business and Economics, University of Rwanda, Kigali, Rwanda
| | - Jean Bosco Surwumwe
- Department of Pathology, University Teaching Hospital of Kigali,
Kigali, Rwanda
| | - Belson Rugwizangoga
- Department of Pathology, School of Medicine and Pharmacy, College of
Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda,Department of Pathology, University Teaching Hospital of Kigali,
Kigali, Rwanda
| |
Collapse
|
5
|
Diagnostic validation of a portable whole slide imaging scanner for lymphoma diagnosis in resource-constrained setting: A cross-sectional study. J Pathol Inform 2023; 14:100188. [PMID: 36714453 PMCID: PMC9874079 DOI: 10.1016/j.jpi.2023.100188] [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: 12/08/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
Background Telepathology utilizing high-throughput static whole slide image scanners is proposed to address the challenge of limited pathology services in resource-restricted settings. However, the prohibitive equipment costs and sophisticated technologies coupled with large amounts of space to set up the devices make it impractical for use in resource-limited settings. Herein, we aimed to address this challenge by validating a portable whole slide imaging (WSI) device against glass slide microscopy (GSM) using lymph node biopsies from suspected lymphoma cases from Sub-Saharan Africa. Material and methods This was part of a multicenter prospective case-control head-to-head comparison study of liquid biopsy against conventional pathology. For the portable WSI scanner validation, the study pathologists evaluated 105 surgical lymph node specimens initially confirmed by gold-standard pathology between February and December 2021. The tissues were processed according to standard protocols for Hematoxylin and Eosin (H&E) and Immunohistochemistry (IHC) staining by well-trained histotechnicians, then digitalized the H& E and IHC slides at each center. The digital images were anonymized and uploaded to a HIPAA-compliant server by the histotechnicians. Three study pathologists independently accessed and reviewed the images after a 6-week washout. The agreement between diagnoses established on GSM and WSI across the pathologists was described and measured using Cohens' kappa coefficient (κ). Results On GSM, 65.5% (n=84) of specimens were lymphoma; 25% were classified as benign, while 9.5% were metastatic. Morphological quality assessment on GSM and WSI established that 79.8% and 53.6% of cases were of high quality, respectively. When diagnoses by GSM were compared to WSI, the overall concordance for various diagnostic categories was 93%, 100%, and 86% for lymphoma, metastases, and benign conditions respectively. The sensitivity and specificity of WSI for the detection of lymphoma were 95.2% and 85.7%, respectively, with an overall inter-observer agreement (κ) of 0.86; 95% CI (0.70-0.95). Conclusions We demonstrate that mobile whole slide imaging (WSI) is non-inferior to conventional glass slide microscopy (GSM) for the primary diagnosis of malignant infiltration of lymph node specimens. Our results further provide proof of concept that mobile WSI can be adapted to resource-restricted settings for primary surgical pathology and would significantly improve patient outcomes.
Collapse
Key Words
- BL, Burkitt Lymphoma
- CAP, College of American Pathologists
- DLBCL, Diffuse Large B-cell Lymphoma
- GSM, Glass slide microscopy
- H&E, Hematoxylin and Eosin staining
- HL, Hodgkin’s Lymphoma
- IHC, Immunohistochemistry
- LMICs, Low-and-middle income countries
- Lymphoma diagnosis
- NPV, Negative predictive value
- PPV, Positive predictive value
- Portable whole slide imaging scanner
- Resource-limited setting
- Validation
- WSI, Whole slide imaging
Collapse
|
6
|
Stauch G, Raoufi R, Sediqi A, Dalquen P, Fritz P, Aichmüller C, Aichmüller-Ratnaparkhe M, Hubler M. [Experiences with telepathology in northern Afghanistan : A 10-year success story]. PATHOLOGIE (HEIDELBERG, GERMANY) 2022; 43:303-310. [PMID: 35238979 DOI: 10.1007/s00292-022-01060-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 06/14/2023]
Abstract
Afghanistan is in a military conflict lasting more than 20 years and according to recent political development, in a downhill spiral towards a failed society. This scenario faces the question of the usefulness of international medical aid, especially morphological diagnostics in crisis situations. On the basis of ten years of experience from a telemedicine project, need, feasibility and results in Afghanistan will be discussed. General and country-specific problems and the sustainability of an international partnership are discussed. In summary our experience is: (1) Telemedicine is possible and necessary even in countries with high conflict potential. It is integrated into routine care by local medical care taker, (2) Accompanying video conferences are a significant improvement in telemedical diagnostics, (3) "High level" consultations can bridge the gap between sophisticated western diagnostics and medicine in the partner country in selected cases and (4) Scientific work is possible on the basis of the medical data collected on site and the image material generated.
Collapse
Affiliation(s)
- Gerhard Stauch
- iPath Telemedicine Network gGmbH, 26603, Aurich, Deutschland.
- Institut für Pathologie Aurich/Westerstede, Wallinghausener Str. 8-12, 26603, Aurich, Deutschland.
| | - Rokai Raoufi
- Abu Ali Sina Hospital, Masar-e-Scharif, Afghanistan
| | - Atiq Sediqi
- Abu Ali Sina Hospital, Masar-e-Scharif, Afghanistan
| | - Peter Dalquen
- Institut für Pathologie, Universitätsspital Basel, 4031, Basel, Schweiz
| | - Peter Fritz
- Institut für Pathologie, Robert-Bosch-Krankenhaus, 70341, Stuttgart, Deutschland
| | | | | | - Monika Hubler
- Administration iPath Telemedicine Network gGmbH, 79576, Weil am Rhein, Deutschland
| |
Collapse
|
7
|
Mremi A, Bentzer NK, Mchome B, Mlay J, Blaakær J, Rasch V, Schledermann D. The role of telepathology in diagnosis of pre-malignant and malignant cervical lesions: Implementation at a tertiary hospital in Northern Tanzania. PLoS One 2022; 17:e0266649. [PMID: 35421156 PMCID: PMC9009664 DOI: 10.1371/journal.pone.0266649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/25/2022] [Indexed: 01/16/2023] Open
Abstract
Introduction Adequate and timely access to pathology services is a key to scale up cancer control, however, there is an extremely shortage of pathologists in Tanzania. Telepathology (scanned images microscopy) has the potential to increase access to pathology services and it is increasingly being employed for primary diagnosis and consultation services. However, the experience with the use of telepathology in Tanzania is limited. We aimed to investigate the feasibility of using scanned images for primary diagnosis of pre-malignant and malignant cervical lesions by assessing its equivalency to conventional (glass slide) microscopy in Tanzania. Methods In this laboratory-based study, assessment of hematoxylin and eosin stained glass slides of 175 cervical biopsies were initially performed conventionally by three pathologists independently. The slides were scanned at x 40 and one to three months later, the scanned images were reviewed by the pathologists in blinded fashion. The agreement between initial and review diagnoses across participating pathologists was described and measured using Cohen’s kappa coefficient (κ). Results The overall concordance of diagnoses established on conventional microscopy compared to scanned images across three pathologists was 87.7%; κ = 0.54; CI (0.49–0.57).The overall agreement of diagnoses established by local pathologist on conventional microscopy compared to scanned images was 87.4%; κ = 0.73; CI (0.65–0.79). The concordance of diagnoses established by senior pathologist compared to local pathologist on conventional microscopy and scanned images was 96% and 97.7% respectively. The inter-observer agreement (κ) value were 0.93, CI (0.87–1.00) and 0.94, CI (0.88–1.00) for conventional microscopy and scanned images respectively. Conclusions All κ coefficients expressed good intra- and inter-observer agreement, suggesting that telepathology is sufficiently accurate for primary diagnosis in surgical pathology. The discrepancies in interpretation of pre-malignant lesions highlights the importance of p16 immunohistochemistry in definitive diagnosis in these lesions. Sustainability factors including hardware and internet connectivity are essential components to be considered before telepathology may be deemed suitable for widely use in Tanzania.
Collapse
Affiliation(s)
- Alex Mremi
- Department of Pathology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- * E-mail:
| | | | - Bariki Mchome
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Joseph Mlay
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Jan Blaakær
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | - Vibeke Rasch
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
| | | |
Collapse
|
8
|
Hanna MG, Ardon O, Reuter VE, Sirintrapun SJ, England C, Klimstra DS, Hameed MR. Integrating digital pathology into clinical practice. Mod Pathol 2022; 35:152-164. [PMID: 34599281 DOI: 10.1038/s41379-021-00929-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/03/2021] [Accepted: 09/12/2021] [Indexed: 11/09/2022]
Abstract
The field of anatomic pathology has been evolving in the last few decades and the advancements have been largely fostered by innovative technology. Immunohistochemistry enabled a paradigm shift in discovery and diagnostic evaluation, followed by booming genomic advancements which allowed for submicroscopic pathologic characterization, and now the field of digital pathology coupled with machine learning and big data acquisition is paving the way to revolutionize the pathology medical domain. Whole slide imaging (WSI) is a disruptive technology where glass slides are digitized to produce on-screen whole slide images. Specifically, in the past decade, there have been significant advances in digital pathology systems that have allowed this technology to promote integration into clinical practice. Whole slide images (WSI), or digital slides, can be viewed and navigated comparable to glass slides on a microscope, as digital files. Whole slide imaging has increased in adoption among pathologists, pathology departments, and scientists for clinical, educational, and research initiatives. Integration of digital pathology systems requires a coordinated effort with numerous stakeholders, not only within the pathology department, but across the entire enterprise. Each pathology department has distinct needs, use cases and blueprints, however the framework components and variables for successful clinical integration can be generalized across any organization seeking to undergo a digital transformation at any scale. This article will review those components and considerations for integrating digital pathology systems into clinical practice.
Collapse
Affiliation(s)
- Matthew G Hanna
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Orly Ardon
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Victor E Reuter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Christine England
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David S Klimstra
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Meera R Hameed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|
9
|
Radich JP, Briercheck E, Chiu DT, Menon MP, Sala Torra O, Yeung CCS, Warren EH. Precision Medicine in Low- and Middle-Income Countries. ANNUAL REVIEW OF PATHOLOGY 2022; 17:387-402. [PMID: 35073168 PMCID: PMC9275191 DOI: 10.1146/annurev-pathol-042320-034052] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Most cancer cases occur in low- and middle-income countries (LMICs). The sophisticated technical and human infrastructure needed for optimal diagnosis, treatment, and monitoring of cancers is difficult enough in affluent countries; it is especially challenging in LMICs. In Western, educated, industrial, rich, democratic countries, there is a growing emphasis on and success with precision medicine, whereby targeted therapy is directed at cancers based on the specific genetic lesions in the cancer. Can such precision approaches be delivered in LMICs? We offer some examples of novel partnerships and creative solutions that suggest that precision medicine may be possible in LMICs given heavy doses of will, creativity, and persistence and a little luck.
Collapse
Affiliation(s)
- Jerald P Radich
- Global Oncology Program, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA;
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
- School of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Edward Briercheck
- Global Oncology Program, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA;
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Daniel T Chiu
- Departments of Chemistry and Bioengineering, University of Washington, Seattle, WA 98195, USA
| | - Manoj P Menon
- Global Oncology Program, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA;
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
- School of Medicine, University of Washington, Seattle, WA 98195, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Olga Sala Torra
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Cecilia C S Yeung
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
- School of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Edus H Warren
- Global Oncology Program, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA;
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
- School of Medicine, University of Washington, Seattle, WA 98195, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| |
Collapse
|
10
|
Kabukye JK, Kakungulu E, Keizer ND, Cornet R. Digital health in oncology in Africa: A scoping review and cross-sectional survey. Int J Med Inform 2021; 158:104659. [PMID: 34929545 DOI: 10.1016/j.ijmedinf.2021.104659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/09/2021] [Accepted: 12/05/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Low- and middle-income countries, especially in Africa, face a growing cancer burden. Adoption of digital health solutions has the potential to improve cancer care delivery and research in these countries. However, the extent of implementation and the impact of digital health interventions across the cancer continuum in Africa have not been studied. AIMS To describe the current landscape of digital health interventions in oncology in Africa. METHODS We conducted a scoping literature review and supplemented this with a survey. Following the PRISMA for Scoping Reviews guidelines, we searched literature in PubMed and Embase for keywords and synonyms for cancer, digital health, and African countries, and abstracted data using a structured form. For the survey, participants were delegates of the 2019 conference of the African Organization for Research and Training in Cancer. RESULTS The literature review identified 57 articles describing 40 digital health interventions or solutions from 17 African countries, while the survey included 111 respondents from 18 African countries, and these reported 25 different digital health systems. Six articles (10.5%) reported randomized controlled trials. The other 51 articles (89.5%) were descriptive or quasi-experimental studies. The interventions mostly targeted cancer prevention (28 articles, 49.1%) or diagnosis and treatment (23 articles, 40.4%). Four articles (7.0%) targeted survivorship and end of life, and the rest were cross-cutting. Cervical cancer was the most targeted cancer (25 articles, 43.9%). Regarding WHO classification of digital interventions, most were for providers (35 articles, 61.4%) or clients (13, 22.8%), while the others were for data services or cut across these categories. The interventions were mostly isolated pilots using basic technologies such as SMS and telephone calls for notifying patients of their appointments or results, or for cancer awareness; image capture apps for cervical cancer screening, and tele-conferencing for tele-pathology and mentorship. Generally positive results were reported, but evaluation focused on structure and process measures such as ease of use, infrastructure requirements, and acceptability of intervention; or general benefits e.g. supporting training and mentorship of providers, communication among providers and clients, and improving data collection and management. No studies evaluated individualized clinical outcomes, and there were no interventions in literature for health system managers although the systems identified in the survey had such functionality, e.g. inventory management. The survey also indicated that none of the digital health systems had all the functionalities for a comprehensive EHR, and major barriers for digital health were initial and ongoing costs, resistance from clinical staff, and lack of fit between the EHR and the clinical workflows. CONCLUSION Digital health interventions in oncology in Africa are at early maturity stages but promising. Barriers such as funding, fit between digital health tools and clinical workflows, and inertia towards technology, shall need to be addressed to allow for advancement of digital health solutions to support all parts of the cancer continuum. Future research should investigate the impact of digital health solutions on long-term cancer outcomes such as cancer mortality, morbidity and quality of life.
Collapse
Affiliation(s)
- Johnblack K Kabukye
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, Location AMC, Meibergdreef 15, Amsterdam, the Netherlands; Uganda Cancer Institute, Upper Mulago Hill Road, P.O. Box 3935, Kampala, Uganda.
| | - Edward Kakungulu
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, Location AMC, Meibergdreef 15, Amsterdam, the Netherlands
| | - Nicolette de Keizer
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, Location AMC, Meibergdreef 15, Amsterdam, the Netherlands
| | - Ronald Cornet
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, Location AMC, Meibergdreef 15, Amsterdam, the Netherlands
| |
Collapse
|
11
|
DeStigter K, Pool KL, Leslie A, Hussain S, Tan BS, Donoso-Bach L, Andronikou S. Optimizing integrated imaging service delivery by tier in low-resource health systems. Insights Imaging 2021; 12:129. [PMID: 34529166 PMCID: PMC8444174 DOI: 10.1186/s13244-021-01073-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/11/2021] [Indexed: 12/16/2022] Open
Abstract
Access to imaging diagnostics has been shown to result in accurate treatment, management, and optimal outcomes. Particularly in low-income and low-middle-income countries (LICs, LMICs), access is limited due to a lack of adequate resources. To achieve Sustainable Development Goal (SDG) 3, access to imaging services is critical at every tier of the health system. Optimizing imaging services in low-resource settings is best accomplished by prescriptive, integrated, and coordinated tiered service delivery that takes contextual factors into consideration. To our knowledge, this is the first recommendation for optimized, specific imaging care delivery by tier. A model for tier-based essential imaging services informs and guides policymakers as they set priorities and make budgetary decisions. In this paper, we recommend a framework for tiered imaging services essential to reduce the global burden of disease and attain universal health coverage (UHC). A lack of access to basic imaging services, even at the lowest tier of the health system, can no longer be justified by cost. Worldwide, affordable modalities of modern ultrasound and X-ray are becoming an accessible mainstay for the investigation of common conditions such as pregnancy, pneumonia, and fractures, and are safely performed and interpreted by qualified professionals. Finally, given the vast gap in access to imaging resources between LMICs and high-income countries (HICs), a scale-up of tiered imaging services in low-resource settings has the potential to reduce health disparities between, and within countries. As the access to appropriately integrated imaging services improves, UHC may be achieved.
Collapse
Affiliation(s)
- Kristen DeStigter
- Department of Radiology, Larner College of Medicine, University of Vermont, 111 Colchester Avenue Main Campus, McClure, Level 1, Burlington, VT, 05401, USA
| | - Kara-Lee Pool
- RAD-AID International, 8004 Ellingson Drive, Chevy Chase, MD, 20815, USA.
| | - Abimbola Leslie
- Department of Radiology, Larner College of Medicine, University of Vermont, 111 Colchester Avenue Main Campus, McClure, Level 1, Burlington, VT, 05401, USA
| | - Sarwat Hussain
- Department of Radiology, University of Massachusetts, 55 North Lake Ave, Worcester, MA, 01655, USA
| | - Bien Soo Tan
- Department of Vascular and Interventional Radiology, Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore
| | - Lluis Donoso-Bach
- Department of Medical Imaging, Hospital Clínic of Barcelona, University of Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Savvas Andronikou
- Department of Pediatric Radiology, The Children's Hospital of Philadelphia and the Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| |
Collapse
|
12
|
Schüffler PJ, Geneslaw L, Yarlagadda DVK, Hanna MG, Samboy J, Stamelos E, Vanderbilt C, Philip J, Jean MH, Corsale L, Manzo A, Paramasivam NHG, Ziegler JS, Gao J, Perin JC, Kim YS, Bhanot UK, Roehrl MHA, Ardon O, Chiang S, Giri DD, Sigel CS, Tan LK, Murray M, Virgo C, England C, Yagi Y, Sirintrapun SJ, Klimstra D, Hameed M, Reuter VE, Fuchs TJ. Integrated digital pathology at scale: A solution for clinical diagnostics and cancer research at a large academic medical center. J Am Med Inform Assoc 2021; 28:1874-1884. [PMID: 34260720 PMCID: PMC8344580 DOI: 10.1093/jamia/ocab085] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/25/2021] [Accepted: 05/04/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Broad adoption of digital pathology (DP) is still lacking, and examples for DP connecting diagnostic, research, and educational use cases are missing. We blueprint a holistic DP solution at a large academic medical center ubiquitously integrated into clinical workflows; researchapplications including molecular, genetic, and tissue databases; and educational processes. MATERIALS AND METHODS We built a vendor-agnostic, integrated viewer for reviewing, annotating, sharing, and quality assurance of digital slides in a clinical or research context. It is the first homegrown viewer cleared by New York State provisional approval in 2020 for primary diagnosis and remote sign-out during the COVID-19 (coronavirus disease 2019) pandemic. We further introduce an interconnected Honest Broker for BioInformatics Technology (HoBBIT) to systematically compile and share large-scale DP research datasets including anonymized images, redacted pathology reports, and clinical data of patients with consent. RESULTS The solution has been operationally used over 3 years by 926 pathologists and researchers evaluating 288 903 digital slides. A total of 51% of these were reviewed within 1 month after scanning. Seamless integration of the viewer into 4 hospital systems clearly increases the adoption of DP. HoBBIT directly impacts the translation of knowledge in pathology into effective new health measures, including artificial intelligence-driven detection models for prostate cancer, basal cell carcinoma, and breast cancer metastases, developed and validated on thousands of cases. CONCLUSIONS We highlight major challenges and lessons learned when going digital to provide orientation for other pathologists. Building interconnected solutions will not only increase adoption of DP, but also facilitate next-generation computational pathology at scale for enhanced cancer research.
Collapse
Affiliation(s)
- Peter J Schüffler
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Institute of Pathology, Technical University of Munich, Munich, Germany
| | - Luke Geneslaw
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - D Vijay K Yarlagadda
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Matthew G Hanna
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jennifer Samboy
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Evangelos Stamelos
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Chad Vanderbilt
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - John Philip
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Health Informatics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Marc-Henri Jean
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lorraine Corsale
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Allyne Manzo
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Neeraj H G Paramasivam
- Department of Information Systems, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - John S Ziegler
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jianjiong Gao
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Juan C Perin
- Department of Information Systems, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Young Suk Kim
- School of Medicine, Stanford University, Stanford, California, USA
| | - Umeshkumar K Bhanot
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Michael H A Roehrl
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Orly Ardon
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Sarah Chiang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Dilip D Giri
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Carlie S Sigel
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lee K Tan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Melissa Murray
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Christina Virgo
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Christine England
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Yukako Yagi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - S Joseph Sirintrapun
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - David Klimstra
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Meera Hameed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Victor E Reuter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Thomas J Fuchs
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
13
|
Utilization and predictors of postmastectomy radiation receipt in an Oncology Center in Zimbabwe. Breast Cancer Res Treat 2021; 189:701-709. [PMID: 34387794 DOI: 10.1007/s10549-021-06338-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 07/18/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Few sub-Saharan African studies have ascertained utilization for postmastectomy radiation (PMRT) for breast cancer, the second most common cancer among African women. We estimated PMRT utilization and identified predictors of PMRT receipt in Zimbabwe. METHODS Retrospective patient cohort included non-metastatic breast cancer patients treated from 2014 to 2019. PMRT eligibility was assigned per NCCN guidelines. Patients receiving chemotherapy for non-metastatic disease were also included. The primary endpoint was receipt of PMRT, defined as chest wall with/without regional nodal radiation. Predictors of receiving PMRT were identified using logistic regression. Model performance was evaluated using the c statistic and Hosmer-Lemeshow test for goodness-of-fit. RESULTS 201 women with localized disease and median follow-up of 11.4 months (IQR 3.3-17.9) were analyzed. PMRT was indicated in 177 women and utilized in 59(33.3%). Insurance coverage, clinical nodal involvement, higher grade, positive margins, and hormone therapy receipt were associated with higher odds of PMRT receipt. In adjusted models, no hormone therapy (aOR 0.12, 95% CI 0.043, 0.35) and missing grade (aOR 0.07, 95% CI 0.01, 0.38) were associated with lower odds of PMRT receipt. The resulting c statistic was 0.84, with Hosmer-Lemeshow p-value of 0.93 indicating good model fit. CONCLUSION PMRT was utilized in 33% of those meeting NCCN criteria. Missing grade and no endocrine therapy receipt were associated with reduced likelihood of PMRT utilization. In addition to practice adjustments such as increasing hypofractionation and increasing patient access to standard oncologic testing at diagnosis could increase postmastectomy utilization.
Collapse
|
14
|
Iyer HS, Wolf NG, Flanigan JS, Castro MC, Schroeder LF, Fleming K, Vuhahula E, Massambu C. Evaluating urban-rural access to pathology and laboratory medicine services in Tanzania. Health Policy Plan 2021; 36:1116-1128. [PMID: 34212191 PMCID: PMC8359747 DOI: 10.1093/heapol/czab078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 04/12/2021] [Accepted: 06/17/2021] [Indexed: 11/13/2022] Open
Abstract
Placement of pathology and laboratory medicine (PALM) services requires balancing efficiency (maximizing test volume) with equitable urban-rural access. We compared the association between population density (proxy for efficiency) and travel time to the closest facility (proxy for equitable access) across levels of Tanzania's public sector health system. We linked geospatial data for Tanzania from multiple sources. Data on facility locations and other geographic measures were collected from government and non-governmental databases. We classified facilities assuming increasing PALM availability by tier: (1) dispensaries, (2) health centres, (3) district hospitals and (4) regional/referral hospitals. We used the AccessMod 5 algorithm to estimate travel time to the closest facility for each tier across Tanzania with 500-m resolution. District-level average population density and travel time to the closest facility were calculated and presented using medians and interquartile ranges. Spatial correlations between these variables were estimated using the global Moran's I and bivariate Local Indicator of Spatial Autocorrelation, specifying a queen's neighbourhood matrix. Spatial analysis was restricted to 171 contiguous districts. The study included 5406 dispensaries, 675 health centres, 186 district hospitals and 37 regional/referral hospitals. District-level travel times were shortest for Tier 1 (median: [IQR]: 45.4 min [30.0-74.7]) and longest for Tier 4 facilities (160.2 min [107.3-260.0]). There was a weak spatial autocorrelation across tiers (Tier 1: -0.289, Tier 2: -0.292, Tier 3: -0.271 and Tier 4: -0.258) and few districts were classified as significant spatial outliers. Across tiers, geographic patterns of populated districts surrounded by neighbours with short travel time and sparsely populated districts surrounded by neighbours with long travel time were observed. Similar spatial correlation measures across health system levels suggest that Tanzania's health system reflects equitable urban-rural access to different PALM services. Longer travel times to hospital-based care could be ameliorated by shifting specialized diagnostics to more accessible lower tiers.
Collapse
Affiliation(s)
- Hari S Iyer
- Division of Population Sciences, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215, USA
| | - Nicholas G Wolf
- Zhu Family Center for Global Cancer Prevention, Harvard T. H. Chan School of Public Health, 651 Huntington Ave, Boston, MA 02115, USA
| | - John S Flanigan
- Zhu Family Center for Global Cancer Prevention, Harvard T. H. Chan School of Public Health, 651 Huntington Ave, Boston, MA 02115, USA
| | - Marcia C Castro
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| | - Lee F Schroeder
- Department of Pathology, University of Michigan, 1301 Catherine St, Ann Arbor, MI 48109, USA
| | - Kenneth Fleming
- Green Templeton College, Oxford University, 43 Woodstock Rd, Oxford OX2 6HG, UK
| | - Edda Vuhahula
- Department of Pathology, Muhimbili University of Health and Allied Sciences, United Nations Rd, Dar es Salaam, TZ
| | - Charles Massambu
- Department of Biomedical Sciences, College of Health Sciences, University of Dodoma, PO Box 259 Dodoma, TZ
| |
Collapse
|
15
|
Frech S, Bravo LE, Rodriguez I, Pomata A, Aung KT, Soe AN, Hornburg B, Guarner J, Brock J, Camacho R, Milner D. Strengthening Pathology Capacity to Deliver Quality Cancer Care in Cities in LMICs. JCO Glob Oncol 2021; 7:917-924. [PMID: 34129368 PMCID: PMC8457877 DOI: 10.1200/go.20.00604] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Diagnostic pathology services for oncology health systems are essential; yet, surveys, observations, and hard data from across low- and middle-income countries have revealed that these services are almost always lacking adequate quality and often missing completely. The City Cancer Challenge Foundation (C/Can), the American Society for Clinical Pathology, and C/Can partner cities undertook intense analysis of their existing pathology services as part of a year-long assessment process including the specific formation of a pathology-focused team. Internal and external expert assessments identified sustainable solutions adapted to the local context and level of resources and created specific local implementation projects. Through local leadership, capacity development, and collaboration, services were improved city-wide in three cities: Cali, Colombia; Asunción, Paraguay; and Yangon, Myanmar. Common problems identified across cities included deficiencies in personnel training, equipment, reagents, processes, quality, and coordination. Specific solutions included quality training, standard process development and regulation, implementation of new services, and public-private collaboration. As the first cities joining the C/Can initiative, Cali, Asunción, and Yangon demonstrate the success of the approach and the value of local expertise in identifying problems and solutions. The additional value of international partners' expertise created opportunities for growth through mentorship and technical support. Importantly, the power of healthcare programs with strong political support is emphasized.
Collapse
Affiliation(s)
| | - Luis Eduardo Bravo
- Registro Poblacional de Cáncer de Cali, Hospital Universitario del Valle, Universidad del Valle, Cali, Colombia
| | - Ingrid Rodriguez
- Hospital de Clínicas, Facultad de Ciencias Médicas, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Alicia Pomata
- Programa Nacional de Control del Cáncer, Instituto Nacional del Cáncer, Ministerio de Salud y Bienestar Social de Paraguay, Asunción, Paraguay
| | - Khin Thida Aung
- Department of Pathology, University of Medicine, Yangon, Myanmar
| | | | | | | | - Jane Brock
- Brigham and Women's Hospital, Boston, MA
| | | | - Dan Milner
- American Society for Clinical Pathology, Chicago, IL
| |
Collapse
|
16
|
Iyer HS, Flanigan J, Wolf NG, Schroeder LF, Horton S, Castro MC, Rebbeck TR. Geospatial evaluation of trade-offs between equity in physical access to healthcare and health systems efficiency. BMJ Glob Health 2021; 5:bmjgh-2020-003493. [PMID: 33087394 PMCID: PMC7580044 DOI: 10.1136/bmjgh-2020-003493] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/15/2020] [Accepted: 09/18/2020] [Indexed: 02/05/2023] Open
Abstract
Introduction Decisions regarding the geographical placement of healthcare services require consideration of trade-offs between equity and efficiency, but few empirical assessments are available. We applied a novel geospatial framework to study these trade-offs in four African countries. Methods Geolocation data on population density (a surrogate for efficiency), health centres and cancer referral centres in Kenya, Malawi, Tanzania and Rwanda were obtained from online databases. Travel time to the closest facility (a surrogate for equity) was estimated with 1 km resolution using the Access Mod 5 least cost distance algorithm. We studied associations between district-level average population density and travel time to closest facility for each country using Pearson’s correlation, and spatial autocorrelation using the Global Moran’s I statistic. Geographical clusters of districts with inefficient resource allocation were identified using the bivariate local indicator of spatial autocorrelation. Results Population density was inversely associated with travel time for all countries and levels of the health system (Pearson’s correlation range, health centres: −0.89 to −0.71; cancer referral centres: −0.92 to −0.43), favouring efficiency. For health centres, negative spatial autocorrelation (geographical clustering of dissimilar values of population density and travel time) was weaker in Rwanda (−0.310) and Tanzania (−0.292), countries with explicit policies supporting equitable access to rural healthcare, relative to Kenya (−0.579) and Malawi (−0.543). Stronger spatial autocorrelation was observed for cancer referral centres (Rwanda: −0.341; Tanzania: −0.259; Kenya: −0.595; Malawi: −0.666). Significant geographical clusters of sparsely populated districts with long travel times to care were identified across countries. Conclusion Negative spatial correlations suggested that the geographical distribution of health services favoured efficiency over equity, but spatial autocorrelation measures revealed more equitable geographical distribution of facilities in certain countries. These findings suggest that even when prioritising efficiency, thoughtful decisions regarding geographical allocation could increase equitable physical access to services.
Collapse
Affiliation(s)
- Hari S Iyer
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA .,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - John Flanigan
- Zhu Family Center for Global Cancer Prevention, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Nicholas G Wolf
- Zhu Family Center for Global Cancer Prevention, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | | | - Susan Horton
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Marcia C Castro
- Department of Global Health and Population, Harvard University T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Timothy R Rebbeck
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, United States.,Zhu Family Center for Global Cancer Prevention, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
17
|
Porter AB, Chukwueke UN, Mammoser AG, Friday B, Hervey-Jumper S. Delivering Equitable Care to Underserved Neuro-oncology Populations. Am Soc Clin Oncol Educ Book 2021; 41:1-9. [PMID: 33830829 DOI: 10.1200/edbk_320803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
It is widely recognized that subspecialized multidisciplinary care improves neuro-oncology outcomes. Optimizing patient outcomes relies on the expertise of the treating physicians, neuroradiology and neuropathology, and supportive services familiar with common neurologic syndromes that occur after brain tumor diagnosis and treatment. Despite an increasing number of providers, patient access to specialized multidisciplinary care and clinical trials remains limited. Barriers to equitable health care exist across the United States, with marginalized communities being impacted disproportionately. Such disparity causes increased morbidity and mortality for patients from backgrounds with various elements of diversity. Limited attention to this inequity has resulted in an incomplete understanding of the spectrum of experiences that patients with neuro-oncologic diseases encounter. Clinical trials represent the highest standard and quality of care in medicine, but inclusion of under-represented and underserved groups consistently lags behind counterpart participants from majority racial and ethnic groups. Through provider education as it pertains to issues from bias and health literacy to increasing clinical trial enrollment and offering opportunities through telemedicine, opportunities for improving access to high-quality neuro-oncologic care are explored.
Collapse
|
18
|
Rao V, Kumar R, Rajaganesan S, Rane S, Deshpande G, Yadav S, Patil A, Pai T, Menon S, Shah A, Rabade K, Ramadwar M, Panjwani P, Mittal N, Sahay A, Rekhi B, Bal M, Sakhadeo U, Gujral S, Desai S. Remote Reporting from Home for Primary Diagnosis in Surgical Pathology: A Tertiary Oncology Center Experience during the COVID-19 Pandemic. J Pathol Inform 2021; 12:3. [PMID: 34012707 PMCID: PMC8112339 DOI: 10.4103/jpi.jpi_72_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/13/2020] [Accepted: 10/28/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic accelerated the widespread adoption of digital pathology (DP) for primary diagnosis in surgical pathology. This paradigm shift is likely to influence how we function routinely in the postpandemic era. We present learnings from early adoption of DP for a live digital sign-out from home in a risk-mitigated environment. MATERIALS AND METHODS We aimed to validate DP for remote reporting from home in a real-time environment and evaluate the parameters influencing the efficiency of a digital workflow. Eighteen pathologists prospectively validated DP for remote use on 567 biopsy cases including 616 individual parts from 7 subspecialties over a duration from March 21, 2020, to June 30, 2020. The slides were digitized using Roche Ventana DP200 whole-slide scanner and reported from respective homes in a risk-mitigated environment. RESULTS Following re-review of glass slides, there was no major discordance and 1.2% (n = 7/567) minor discordance. The deferral rate was 4.5%. All pathologists reported from their respective homes from laptops with an average network speed of 20 megabits per second. CONCLUSION We successfully validated and adopted a digital workflow for remote reporting with available resources and were able to provide our patients, an undisrupted access to subspecialty expertise during these unprecedented times.
Collapse
Affiliation(s)
- Vidya Rao
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Rajiv Kumar
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | | | - Swapnil Rane
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Gauri Deshpande
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Subhash Yadav
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Asawari Patil
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Trupti Pai
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Santosh Menon
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Aekta Shah
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Katha Rabade
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Mukta Ramadwar
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Poonam Panjwani
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Neha Mittal
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Ayushi Sahay
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Bharat Rekhi
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Munita Bal
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Uma Sakhadeo
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sumeet Gujral
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sangeeta Desai
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| |
Collapse
|
19
|
Validation of a digital pathology system including remote review during the COVID-19 pandemic. Mod Pathol 2020; 33:2115-2127. [PMID: 32572154 PMCID: PMC7306935 DOI: 10.1038/s41379-020-0601-5] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 02/04/2023]
Abstract
Remote digital pathology allows healthcare systems to maintain pathology operations during public health emergencies. Existing Clinical Laboratory Improvement Amendments regulations require pathologists to electronically verify patient reports from a certified facility. During the 2019 pandemic of COVID-19 disease, caused by the SAR-CoV-2 virus, this requirement potentially exposes pathologists, their colleagues, and household members to the risk of becoming infected. Relaxation of government enforcement of this regulation allows pathologists to review and report pathology specimens from a remote, non-CLIA certified facility. The availability of digital pathology systems can facilitate remote microscopic diagnosis, although formal comprehensive (case-based) validation of remote digital diagnosis has not been reported. All glass slides representing routine clinical signout workload in surgical pathology subspecialties at Memorial Sloan Kettering Cancer Center were scanned on an Aperio GT450 at ×40 equivalent resolution (0.26 µm/pixel). Twelve pathologists from nine surgical pathology subspecialties remotely reviewed and reported complete pathology cases using a digital pathology system from a non-CLIA certified facility through a secure connection. Whole slide images were integrated to and launched within the laboratory information system to a custom vendor-agnostic, whole slide image viewer. Remote signouts utilized consumer-grade computers and monitors (monitor size, 13.3-42 in.; resolution, 1280 × 800-3840 × 2160 pixels) connecting to an institution clinical workstation via secure virtual private network. Pathologists subsequently reviewed all corresponding glass slides using a light microscope within the CLIA-certified department. Intraobserver concordance metrics included reporting elements of top-line diagnosis, margin status, lymphovascular and/or perineural invasion, pathology stage, and ancillary testing. The median whole slide image file size was 1.3 GB; scan time/slide averaged 90 s; and scanned tissue area averaged 612 mm2. Signout sessions included a total of 108 cases, comprised of 254 individual parts and 1196 slides. Major diagnostic equivalency was 100% between digital and glass slide diagnoses; and overall concordance was 98.8% (251/254). This study reports validation of primary diagnostic review and reporting of complete pathology cases from a remote site during a public health emergency. Our experience shows high (100%) intraobserver digital to glass slide major diagnostic concordance when reporting from a remote site. This randomized, prospective study successfully validated remote use of a digital pathology system including operational feasibility supporting remote review and reporting of pathology specimens, and evaluation of remote access performance and usability for remote signout.
Collapse
|
20
|
DeBoer RJ, Shyirambere C, Driscoll CD, Butera Y, Paciorek A, Ruhangaza D, Fadelu TA, Umwizerwa A, Bigirimana JB, Muhayimana C, Nguyen C, Park PH, Mpunga T, Lehmann L, Shulman LN. Treatment of Hodgkin Lymphoma With ABVD Chemotherapy in Rural Rwanda: A Model for Cancer Care Delivery Implementation. JCO Glob Oncol 2020; 6:1093-1102. [PMID: 32678711 PMCID: PMC7392734 DOI: 10.1200/go.20.00088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Hodgkin lymphoma (HL) is highly curable in high-income countries (HICs), yet many patients around the world do not have access to therapy. In 2012, cancer care was established at a rural district hospital in Rwanda through international collaboration, and a treatment protocol using doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD) without radiotherapy was implemented. METHODS We conducted a retrospective cohort study of all patients with confirmed HL seen at Butaro Hospital from 2012 to 2018 to evaluate quality indicators and clinical outcomes. RESULTS Eighty-five patients were included (median age, 16.8 years; interquartile range, 11.0-30.5 years). Ten (12%) were HIV positive. Most had B symptoms (70%) and advanced stage (56%) on examination and limited imaging. Of 21 specimens evaluated for Epstein-Barr virus, 14 (67%) were positive. Median time from biopsy to treatment was 6.0 weeks. Of 73 patients who started ABVD, 54 (74%) completed 6 cycles; the leading reasons for discontinuation were treatment abandonment and death. Median dose intensity of ABVD was 92%. Of 77 evaluable patients, 33 (43%) are in clinical remission, 27 (36%) are deceased, and 17 (22%) were lost to follow-up; 3-year survival estimate is 63% (95% CI, 50% to 74%). Poorer performance status, advanced stage, B symptoms, anemia, dose intensity < 85%, and treatment discontinuation were associated with worse survival. CONCLUSION Treating HL with standard chemotherapy in a low-resource setting is feasible. Most patients who completed treatment experienced a clinically significant remission with this approach. Late presentation, treatment abandonment, and loss to follow-up contribute to the discrepancy in survival compared with HICs. A strikingly younger age distribution in our cohort compared with HICs suggests biologic differences and warrants further investigation.
Collapse
Affiliation(s)
- Rebecca J. DeBoer
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | | | | | - Yvan Butera
- Republic of Rwanda Ministry of Health, Kigali, Rwanda
| | - Alan Paciorek
- Department of Medicine, University of California, San Francisco, San Francisco, CA
| | | | | | - Aline Umwizerwa
- Partners In Health/Inshuti Mu Buzima, Burera District, Rwanda
| | | | | | - Cam Nguyen
- Partners In Health/Inshuti Mu Buzima, Burera District, Rwanda
| | | | | | - Leslie Lehmann
- Dana-Farber/Boston Children’s Hospital Cancer Center, Boston, MA
| | | |
Collapse
|
21
|
Wagner CM, Antillón F, Uwinkindi F, Thuan TV, Luna-Fineman S, Anh PT, Huong TT, Valverde P, Eagan A, Binh PV, Quang TN, Johnson S, Binagwaho A, Torode J. Establishing Cancer Treatment Programs in Resource-Limited Settings: Lessons Learned From Guatemala, Rwanda, and Vietnam. J Glob Oncol 2019; 4:1-14. [PMID: 30085895 PMCID: PMC6223537 DOI: 10.1200/jgo.17.00082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Purpose The global burden of cancer is slated to reach 21.4 million new cases in 2030 alone, and the majority of those cases occur in under-resourced settings. Formidable changes to health care delivery systems must occur to meet this demand. Although significant policy advances have been made and documented at the international level, less is known about the efforts to create national systems to combat cancer in such settings. Methods With case reports and data from authors who are clinicians and policymakers in three financially constrained countries in different regions of the world—Guatemala, Rwanda, and Vietnam, we examined cancer care programs to identify principles that lead to robust care delivery platforms as well as challenges faced in each setting. Results The findings demonstrate that successful programs derive from equitably constructed and durable interventions focused on advancement of local clinical capacity and the prioritization of geographic and financial accessibility. In addition, a committed local response to the increasing cancer burden facilitates engagement of partners who become vital catalysts for launching treatment cascades. Also, clinical education in each setting was buttressed by international expertise, which aided both professional development and retention of staff. Conclusion All three countries demonstrate that excellent cancer care can and should be provided to all, including those who are impoverished or marginalized, without acceptance of a double standard. In this article, we call on governments and program leaders to report on successes and challenges in their own settings to allow for informed progression toward the 2025 global policy goals.
Collapse
Affiliation(s)
- Claire M Wagner
- Claire M. Wagner, Arielle Eagan, and Agnes Binagwaho, Harvard Medical School, Boston, MA; Sonali Johnson and Julie Torode, Union for International Cancer Control, Geneva, Switzerland; Federico Antillón, Unidad Nacional de Oncología Pediatrica; and Universidad Francisco Marroquín; Patricia Valverde, Unidad Nacional de Oncología Pediatrica, Guatemala City, Guatemala; François Uwinkindi and and Arielle Eagan, Rwanda Biomedical Center; Agnes Binagwaho, University of Global Health Equity, Kigali, Rwanda; Tran Van Thuan, Pham Tuan Anh, Tran Thanh Huong, Pham Van Binh, and Nguyen Tien Quang, National Cancer Hospital of Viet Nam; Tran Van Thuan and Tran Thanh Huong, National Institute for Cancer Control; Tran Thanh Huong, Hanoi Medical University, Hanoi, Viet Nam; Sandra Luna-Fineman, Children's Hospital Colorado and University of Colorado, Denver, CO; and Agnes Binagwaho and Arielle Eagan, Dartmouth College, Hanover, NH
| | - Federico Antillón
- Claire M. Wagner, Arielle Eagan, and Agnes Binagwaho, Harvard Medical School, Boston, MA; Sonali Johnson and Julie Torode, Union for International Cancer Control, Geneva, Switzerland; Federico Antillón, Unidad Nacional de Oncología Pediatrica; and Universidad Francisco Marroquín; Patricia Valverde, Unidad Nacional de Oncología Pediatrica, Guatemala City, Guatemala; François Uwinkindi and and Arielle Eagan, Rwanda Biomedical Center; Agnes Binagwaho, University of Global Health Equity, Kigali, Rwanda; Tran Van Thuan, Pham Tuan Anh, Tran Thanh Huong, Pham Van Binh, and Nguyen Tien Quang, National Cancer Hospital of Viet Nam; Tran Van Thuan and Tran Thanh Huong, National Institute for Cancer Control; Tran Thanh Huong, Hanoi Medical University, Hanoi, Viet Nam; Sandra Luna-Fineman, Children's Hospital Colorado and University of Colorado, Denver, CO; and Agnes Binagwaho and Arielle Eagan, Dartmouth College, Hanover, NH
| | - François Uwinkindi
- Claire M. Wagner, Arielle Eagan, and Agnes Binagwaho, Harvard Medical School, Boston, MA; Sonali Johnson and Julie Torode, Union for International Cancer Control, Geneva, Switzerland; Federico Antillón, Unidad Nacional de Oncología Pediatrica; and Universidad Francisco Marroquín; Patricia Valverde, Unidad Nacional de Oncología Pediatrica, Guatemala City, Guatemala; François Uwinkindi and and Arielle Eagan, Rwanda Biomedical Center; Agnes Binagwaho, University of Global Health Equity, Kigali, Rwanda; Tran Van Thuan, Pham Tuan Anh, Tran Thanh Huong, Pham Van Binh, and Nguyen Tien Quang, National Cancer Hospital of Viet Nam; Tran Van Thuan and Tran Thanh Huong, National Institute for Cancer Control; Tran Thanh Huong, Hanoi Medical University, Hanoi, Viet Nam; Sandra Luna-Fineman, Children's Hospital Colorado and University of Colorado, Denver, CO; and Agnes Binagwaho and Arielle Eagan, Dartmouth College, Hanover, NH
| | - Tran Van Thuan
- Claire M. Wagner, Arielle Eagan, and Agnes Binagwaho, Harvard Medical School, Boston, MA; Sonali Johnson and Julie Torode, Union for International Cancer Control, Geneva, Switzerland; Federico Antillón, Unidad Nacional de Oncología Pediatrica; and Universidad Francisco Marroquín; Patricia Valverde, Unidad Nacional de Oncología Pediatrica, Guatemala City, Guatemala; François Uwinkindi and and Arielle Eagan, Rwanda Biomedical Center; Agnes Binagwaho, University of Global Health Equity, Kigali, Rwanda; Tran Van Thuan, Pham Tuan Anh, Tran Thanh Huong, Pham Van Binh, and Nguyen Tien Quang, National Cancer Hospital of Viet Nam; Tran Van Thuan and Tran Thanh Huong, National Institute for Cancer Control; Tran Thanh Huong, Hanoi Medical University, Hanoi, Viet Nam; Sandra Luna-Fineman, Children's Hospital Colorado and University of Colorado, Denver, CO; and Agnes Binagwaho and Arielle Eagan, Dartmouth College, Hanover, NH
| | - Sandra Luna-Fineman
- Claire M. Wagner, Arielle Eagan, and Agnes Binagwaho, Harvard Medical School, Boston, MA; Sonali Johnson and Julie Torode, Union for International Cancer Control, Geneva, Switzerland; Federico Antillón, Unidad Nacional de Oncología Pediatrica; and Universidad Francisco Marroquín; Patricia Valverde, Unidad Nacional de Oncología Pediatrica, Guatemala City, Guatemala; François Uwinkindi and and Arielle Eagan, Rwanda Biomedical Center; Agnes Binagwaho, University of Global Health Equity, Kigali, Rwanda; Tran Van Thuan, Pham Tuan Anh, Tran Thanh Huong, Pham Van Binh, and Nguyen Tien Quang, National Cancer Hospital of Viet Nam; Tran Van Thuan and Tran Thanh Huong, National Institute for Cancer Control; Tran Thanh Huong, Hanoi Medical University, Hanoi, Viet Nam; Sandra Luna-Fineman, Children's Hospital Colorado and University of Colorado, Denver, CO; and Agnes Binagwaho and Arielle Eagan, Dartmouth College, Hanover, NH
| | - Pham Tuan Anh
- Claire M. Wagner, Arielle Eagan, and Agnes Binagwaho, Harvard Medical School, Boston, MA; Sonali Johnson and Julie Torode, Union for International Cancer Control, Geneva, Switzerland; Federico Antillón, Unidad Nacional de Oncología Pediatrica; and Universidad Francisco Marroquín; Patricia Valverde, Unidad Nacional de Oncología Pediatrica, Guatemala City, Guatemala; François Uwinkindi and and Arielle Eagan, Rwanda Biomedical Center; Agnes Binagwaho, University of Global Health Equity, Kigali, Rwanda; Tran Van Thuan, Pham Tuan Anh, Tran Thanh Huong, Pham Van Binh, and Nguyen Tien Quang, National Cancer Hospital of Viet Nam; Tran Van Thuan and Tran Thanh Huong, National Institute for Cancer Control; Tran Thanh Huong, Hanoi Medical University, Hanoi, Viet Nam; Sandra Luna-Fineman, Children's Hospital Colorado and University of Colorado, Denver, CO; and Agnes Binagwaho and Arielle Eagan, Dartmouth College, Hanover, NH
| | - Tran Thanh Huong
- Claire M. Wagner, Arielle Eagan, and Agnes Binagwaho, Harvard Medical School, Boston, MA; Sonali Johnson and Julie Torode, Union for International Cancer Control, Geneva, Switzerland; Federico Antillón, Unidad Nacional de Oncología Pediatrica; and Universidad Francisco Marroquín; Patricia Valverde, Unidad Nacional de Oncología Pediatrica, Guatemala City, Guatemala; François Uwinkindi and and Arielle Eagan, Rwanda Biomedical Center; Agnes Binagwaho, University of Global Health Equity, Kigali, Rwanda; Tran Van Thuan, Pham Tuan Anh, Tran Thanh Huong, Pham Van Binh, and Nguyen Tien Quang, National Cancer Hospital of Viet Nam; Tran Van Thuan and Tran Thanh Huong, National Institute for Cancer Control; Tran Thanh Huong, Hanoi Medical University, Hanoi, Viet Nam; Sandra Luna-Fineman, Children's Hospital Colorado and University of Colorado, Denver, CO; and Agnes Binagwaho and Arielle Eagan, Dartmouth College, Hanover, NH
| | - Patricia Valverde
- Claire M. Wagner, Arielle Eagan, and Agnes Binagwaho, Harvard Medical School, Boston, MA; Sonali Johnson and Julie Torode, Union for International Cancer Control, Geneva, Switzerland; Federico Antillón, Unidad Nacional de Oncología Pediatrica; and Universidad Francisco Marroquín; Patricia Valverde, Unidad Nacional de Oncología Pediatrica, Guatemala City, Guatemala; François Uwinkindi and and Arielle Eagan, Rwanda Biomedical Center; Agnes Binagwaho, University of Global Health Equity, Kigali, Rwanda; Tran Van Thuan, Pham Tuan Anh, Tran Thanh Huong, Pham Van Binh, and Nguyen Tien Quang, National Cancer Hospital of Viet Nam; Tran Van Thuan and Tran Thanh Huong, National Institute for Cancer Control; Tran Thanh Huong, Hanoi Medical University, Hanoi, Viet Nam; Sandra Luna-Fineman, Children's Hospital Colorado and University of Colorado, Denver, CO; and Agnes Binagwaho and Arielle Eagan, Dartmouth College, Hanover, NH
| | - Arielle Eagan
- Claire M. Wagner, Arielle Eagan, and Agnes Binagwaho, Harvard Medical School, Boston, MA; Sonali Johnson and Julie Torode, Union for International Cancer Control, Geneva, Switzerland; Federico Antillón, Unidad Nacional de Oncología Pediatrica; and Universidad Francisco Marroquín; Patricia Valverde, Unidad Nacional de Oncología Pediatrica, Guatemala City, Guatemala; François Uwinkindi and and Arielle Eagan, Rwanda Biomedical Center; Agnes Binagwaho, University of Global Health Equity, Kigali, Rwanda; Tran Van Thuan, Pham Tuan Anh, Tran Thanh Huong, Pham Van Binh, and Nguyen Tien Quang, National Cancer Hospital of Viet Nam; Tran Van Thuan and Tran Thanh Huong, National Institute for Cancer Control; Tran Thanh Huong, Hanoi Medical University, Hanoi, Viet Nam; Sandra Luna-Fineman, Children's Hospital Colorado and University of Colorado, Denver, CO; and Agnes Binagwaho and Arielle Eagan, Dartmouth College, Hanover, NH
| | - Pham Van Binh
- Claire M. Wagner, Arielle Eagan, and Agnes Binagwaho, Harvard Medical School, Boston, MA; Sonali Johnson and Julie Torode, Union for International Cancer Control, Geneva, Switzerland; Federico Antillón, Unidad Nacional de Oncología Pediatrica; and Universidad Francisco Marroquín; Patricia Valverde, Unidad Nacional de Oncología Pediatrica, Guatemala City, Guatemala; François Uwinkindi and and Arielle Eagan, Rwanda Biomedical Center; Agnes Binagwaho, University of Global Health Equity, Kigali, Rwanda; Tran Van Thuan, Pham Tuan Anh, Tran Thanh Huong, Pham Van Binh, and Nguyen Tien Quang, National Cancer Hospital of Viet Nam; Tran Van Thuan and Tran Thanh Huong, National Institute for Cancer Control; Tran Thanh Huong, Hanoi Medical University, Hanoi, Viet Nam; Sandra Luna-Fineman, Children's Hospital Colorado and University of Colorado, Denver, CO; and Agnes Binagwaho and Arielle Eagan, Dartmouth College, Hanover, NH
| | - Tien Nguyen Quang
- Claire M. Wagner, Arielle Eagan, and Agnes Binagwaho, Harvard Medical School, Boston, MA; Sonali Johnson and Julie Torode, Union for International Cancer Control, Geneva, Switzerland; Federico Antillón, Unidad Nacional de Oncología Pediatrica; and Universidad Francisco Marroquín; Patricia Valverde, Unidad Nacional de Oncología Pediatrica, Guatemala City, Guatemala; François Uwinkindi and and Arielle Eagan, Rwanda Biomedical Center; Agnes Binagwaho, University of Global Health Equity, Kigali, Rwanda; Tran Van Thuan, Pham Tuan Anh, Tran Thanh Huong, Pham Van Binh, and Nguyen Tien Quang, National Cancer Hospital of Viet Nam; Tran Van Thuan and Tran Thanh Huong, National Institute for Cancer Control; Tran Thanh Huong, Hanoi Medical University, Hanoi, Viet Nam; Sandra Luna-Fineman, Children's Hospital Colorado and University of Colorado, Denver, CO; and Agnes Binagwaho and Arielle Eagan, Dartmouth College, Hanover, NH
| | - Sonali Johnson
- Claire M. Wagner, Arielle Eagan, and Agnes Binagwaho, Harvard Medical School, Boston, MA; Sonali Johnson and Julie Torode, Union for International Cancer Control, Geneva, Switzerland; Federico Antillón, Unidad Nacional de Oncología Pediatrica; and Universidad Francisco Marroquín; Patricia Valverde, Unidad Nacional de Oncología Pediatrica, Guatemala City, Guatemala; François Uwinkindi and and Arielle Eagan, Rwanda Biomedical Center; Agnes Binagwaho, University of Global Health Equity, Kigali, Rwanda; Tran Van Thuan, Pham Tuan Anh, Tran Thanh Huong, Pham Van Binh, and Nguyen Tien Quang, National Cancer Hospital of Viet Nam; Tran Van Thuan and Tran Thanh Huong, National Institute for Cancer Control; Tran Thanh Huong, Hanoi Medical University, Hanoi, Viet Nam; Sandra Luna-Fineman, Children's Hospital Colorado and University of Colorado, Denver, CO; and Agnes Binagwaho and Arielle Eagan, Dartmouth College, Hanover, NH
| | - Agnes Binagwaho
- Claire M. Wagner, Arielle Eagan, and Agnes Binagwaho, Harvard Medical School, Boston, MA; Sonali Johnson and Julie Torode, Union for International Cancer Control, Geneva, Switzerland; Federico Antillón, Unidad Nacional de Oncología Pediatrica; and Universidad Francisco Marroquín; Patricia Valverde, Unidad Nacional de Oncología Pediatrica, Guatemala City, Guatemala; François Uwinkindi and and Arielle Eagan, Rwanda Biomedical Center; Agnes Binagwaho, University of Global Health Equity, Kigali, Rwanda; Tran Van Thuan, Pham Tuan Anh, Tran Thanh Huong, Pham Van Binh, and Nguyen Tien Quang, National Cancer Hospital of Viet Nam; Tran Van Thuan and Tran Thanh Huong, National Institute for Cancer Control; Tran Thanh Huong, Hanoi Medical University, Hanoi, Viet Nam; Sandra Luna-Fineman, Children's Hospital Colorado and University of Colorado, Denver, CO; and Agnes Binagwaho and Arielle Eagan, Dartmouth College, Hanover, NH
| | - Julie Torode
- Claire M. Wagner, Arielle Eagan, and Agnes Binagwaho, Harvard Medical School, Boston, MA; Sonali Johnson and Julie Torode, Union for International Cancer Control, Geneva, Switzerland; Federico Antillón, Unidad Nacional de Oncología Pediatrica; and Universidad Francisco Marroquín; Patricia Valverde, Unidad Nacional de Oncología Pediatrica, Guatemala City, Guatemala; François Uwinkindi and and Arielle Eagan, Rwanda Biomedical Center; Agnes Binagwaho, University of Global Health Equity, Kigali, Rwanda; Tran Van Thuan, Pham Tuan Anh, Tran Thanh Huong, Pham Van Binh, and Nguyen Tien Quang, National Cancer Hospital of Viet Nam; Tran Van Thuan and Tran Thanh Huong, National Institute for Cancer Control; Tran Thanh Huong, Hanoi Medical University, Hanoi, Viet Nam; Sandra Luna-Fineman, Children's Hospital Colorado and University of Colorado, Denver, CO; and Agnes Binagwaho and Arielle Eagan, Dartmouth College, Hanover, NH
| |
Collapse
|
22
|
Sayed S, Field A, Rajab J, Mutuiri A, Githanga J, Mungania M, Okinda N, Moloo Z, Abdillah A, Ayara B, Chesori E, Muthua J, Obosy L, Massawa T, Obiero O, Kagotho E, Shikuku PK, Gachii AK, Migide E, Muninzwa D, Dawsey SM, Muchiri L. Task Sharing and Shifting to Provide Pathology Diagnostic Services: The Kenya Fine-Needle Aspiration Biopsy Cytology and Bone Marrow Aspiration and Trephine Biopsy Training Program. J Glob Oncol 2019; 4:1-11. [PMID: 30398948 PMCID: PMC6818283 DOI: 10.1200/jgo.18.00094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Fine-needle aspiration biopsy (FNAB) cytology is a simple, inexpensive, and
accurate diagnostic test for benign, infectious, and malignant lesions of
the breast, thyroid, lymph nodes, and other organs. Similarly, bone marrow
aspiration and trephine (BMAT) biopsy procedures are relatively simple and
inexpensive techniques that are important for diagnosing and monitoring many
hematologic diseases including leukemias and lymphomas. However, the
scarcity of pathologists in Kenya limits patient access to these simple
diagnostic tests. We describe a task sharing and shifting program that
sought to improve the provision of FNABs and BMAT biopsies in tertiary
public hospitals in Kenya. Methods Between January 2016 and February 2017, we trained pathologists, pathology
residents, and technologists from the University of Nairobi and Aga Khan
University Hospital, Nairobi, in FNAB and BMAT biopsies, who in turn trained
pathologists, medical officers (MO), clinical officers (CO), and
technologists at five tertiary public hospitals. The program involved
curriculum development, training workshops, the establishment of new and
strengthening existing FNAB and BMAT biopsy clinics, interim site visits,
audits, and stakeholder workshops. Results Fifty-one medical personnel at the tertiary hospitals were trained. The FNAB
numbers increased by 41% to 1,681, with 139 malignant diagnoses (7.1%). BMAT
biopsy numbers increased by 268% to 140, with 34 malignant cases. Between
60% and 100% of the FNAB and BMAT biopsy procedures were performed by MO and
CO over the project period. One new FNAB and two new BMAT biopsy clinics
were established. Conclusion This project demonstrates a successful model of task sharing and shifting
from specialist pathologists to MO and CO that improved access to important
FNAB and BMAT biopsy services in a low-resource setting.
Collapse
Affiliation(s)
- Shahin Sayed
- Shahin Sayed, Anderson Mutuiri, Nancy Okinda, Zahir Moloo, Abubakar Abdillah, Erick Chesori, Elizabeth Kagotho, Eunida Migide, and Donstefano Muninzwa, Aga Khan University Hospital; Jamilla Rajab, Jessie Githanga, Mary Mungania, Brian Ayara, Julia Muthua, Leah Obosy, Thaddeus Massawa, Peter K. Shikuku, and Lucy Muchiri, University of Nairobi; Okoth Obiero and Andrew K. Gachii, Kenyatta National Hospital, Nairobi, Kenya; Andrew Field, Notre Dame University Medical School and St. Vincent's Hospital, Sydney, Australia; and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD
| | - Andrew Field
- Shahin Sayed, Anderson Mutuiri, Nancy Okinda, Zahir Moloo, Abubakar Abdillah, Erick Chesori, Elizabeth Kagotho, Eunida Migide, and Donstefano Muninzwa, Aga Khan University Hospital; Jamilla Rajab, Jessie Githanga, Mary Mungania, Brian Ayara, Julia Muthua, Leah Obosy, Thaddeus Massawa, Peter K. Shikuku, and Lucy Muchiri, University of Nairobi; Okoth Obiero and Andrew K. Gachii, Kenyatta National Hospital, Nairobi, Kenya; Andrew Field, Notre Dame University Medical School and St. Vincent's Hospital, Sydney, Australia; and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD
| | - Jamilla Rajab
- Shahin Sayed, Anderson Mutuiri, Nancy Okinda, Zahir Moloo, Abubakar Abdillah, Erick Chesori, Elizabeth Kagotho, Eunida Migide, and Donstefano Muninzwa, Aga Khan University Hospital; Jamilla Rajab, Jessie Githanga, Mary Mungania, Brian Ayara, Julia Muthua, Leah Obosy, Thaddeus Massawa, Peter K. Shikuku, and Lucy Muchiri, University of Nairobi; Okoth Obiero and Andrew K. Gachii, Kenyatta National Hospital, Nairobi, Kenya; Andrew Field, Notre Dame University Medical School and St. Vincent's Hospital, Sydney, Australia; and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD
| | - Anderson Mutuiri
- Shahin Sayed, Anderson Mutuiri, Nancy Okinda, Zahir Moloo, Abubakar Abdillah, Erick Chesori, Elizabeth Kagotho, Eunida Migide, and Donstefano Muninzwa, Aga Khan University Hospital; Jamilla Rajab, Jessie Githanga, Mary Mungania, Brian Ayara, Julia Muthua, Leah Obosy, Thaddeus Massawa, Peter K. Shikuku, and Lucy Muchiri, University of Nairobi; Okoth Obiero and Andrew K. Gachii, Kenyatta National Hospital, Nairobi, Kenya; Andrew Field, Notre Dame University Medical School and St. Vincent's Hospital, Sydney, Australia; and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD
| | - Jessie Githanga
- Shahin Sayed, Anderson Mutuiri, Nancy Okinda, Zahir Moloo, Abubakar Abdillah, Erick Chesori, Elizabeth Kagotho, Eunida Migide, and Donstefano Muninzwa, Aga Khan University Hospital; Jamilla Rajab, Jessie Githanga, Mary Mungania, Brian Ayara, Julia Muthua, Leah Obosy, Thaddeus Massawa, Peter K. Shikuku, and Lucy Muchiri, University of Nairobi; Okoth Obiero and Andrew K. Gachii, Kenyatta National Hospital, Nairobi, Kenya; Andrew Field, Notre Dame University Medical School and St. Vincent's Hospital, Sydney, Australia; and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD
| | - Mary Mungania
- Shahin Sayed, Anderson Mutuiri, Nancy Okinda, Zahir Moloo, Abubakar Abdillah, Erick Chesori, Elizabeth Kagotho, Eunida Migide, and Donstefano Muninzwa, Aga Khan University Hospital; Jamilla Rajab, Jessie Githanga, Mary Mungania, Brian Ayara, Julia Muthua, Leah Obosy, Thaddeus Massawa, Peter K. Shikuku, and Lucy Muchiri, University of Nairobi; Okoth Obiero and Andrew K. Gachii, Kenyatta National Hospital, Nairobi, Kenya; Andrew Field, Notre Dame University Medical School and St. Vincent's Hospital, Sydney, Australia; and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD
| | - Nancy Okinda
- Shahin Sayed, Anderson Mutuiri, Nancy Okinda, Zahir Moloo, Abubakar Abdillah, Erick Chesori, Elizabeth Kagotho, Eunida Migide, and Donstefano Muninzwa, Aga Khan University Hospital; Jamilla Rajab, Jessie Githanga, Mary Mungania, Brian Ayara, Julia Muthua, Leah Obosy, Thaddeus Massawa, Peter K. Shikuku, and Lucy Muchiri, University of Nairobi; Okoth Obiero and Andrew K. Gachii, Kenyatta National Hospital, Nairobi, Kenya; Andrew Field, Notre Dame University Medical School and St. Vincent's Hospital, Sydney, Australia; and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD
| | - Zahir Moloo
- Shahin Sayed, Anderson Mutuiri, Nancy Okinda, Zahir Moloo, Abubakar Abdillah, Erick Chesori, Elizabeth Kagotho, Eunida Migide, and Donstefano Muninzwa, Aga Khan University Hospital; Jamilla Rajab, Jessie Githanga, Mary Mungania, Brian Ayara, Julia Muthua, Leah Obosy, Thaddeus Massawa, Peter K. Shikuku, and Lucy Muchiri, University of Nairobi; Okoth Obiero and Andrew K. Gachii, Kenyatta National Hospital, Nairobi, Kenya; Andrew Field, Notre Dame University Medical School and St. Vincent's Hospital, Sydney, Australia; and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD
| | - Abubakar Abdillah
- Shahin Sayed, Anderson Mutuiri, Nancy Okinda, Zahir Moloo, Abubakar Abdillah, Erick Chesori, Elizabeth Kagotho, Eunida Migide, and Donstefano Muninzwa, Aga Khan University Hospital; Jamilla Rajab, Jessie Githanga, Mary Mungania, Brian Ayara, Julia Muthua, Leah Obosy, Thaddeus Massawa, Peter K. Shikuku, and Lucy Muchiri, University of Nairobi; Okoth Obiero and Andrew K. Gachii, Kenyatta National Hospital, Nairobi, Kenya; Andrew Field, Notre Dame University Medical School and St. Vincent's Hospital, Sydney, Australia; and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD
| | - Brian Ayara
- Shahin Sayed, Anderson Mutuiri, Nancy Okinda, Zahir Moloo, Abubakar Abdillah, Erick Chesori, Elizabeth Kagotho, Eunida Migide, and Donstefano Muninzwa, Aga Khan University Hospital; Jamilla Rajab, Jessie Githanga, Mary Mungania, Brian Ayara, Julia Muthua, Leah Obosy, Thaddeus Massawa, Peter K. Shikuku, and Lucy Muchiri, University of Nairobi; Okoth Obiero and Andrew K. Gachii, Kenyatta National Hospital, Nairobi, Kenya; Andrew Field, Notre Dame University Medical School and St. Vincent's Hospital, Sydney, Australia; and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD
| | - Erick Chesori
- Shahin Sayed, Anderson Mutuiri, Nancy Okinda, Zahir Moloo, Abubakar Abdillah, Erick Chesori, Elizabeth Kagotho, Eunida Migide, and Donstefano Muninzwa, Aga Khan University Hospital; Jamilla Rajab, Jessie Githanga, Mary Mungania, Brian Ayara, Julia Muthua, Leah Obosy, Thaddeus Massawa, Peter K. Shikuku, and Lucy Muchiri, University of Nairobi; Okoth Obiero and Andrew K. Gachii, Kenyatta National Hospital, Nairobi, Kenya; Andrew Field, Notre Dame University Medical School and St. Vincent's Hospital, Sydney, Australia; and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD
| | - Julia Muthua
- Shahin Sayed, Anderson Mutuiri, Nancy Okinda, Zahir Moloo, Abubakar Abdillah, Erick Chesori, Elizabeth Kagotho, Eunida Migide, and Donstefano Muninzwa, Aga Khan University Hospital; Jamilla Rajab, Jessie Githanga, Mary Mungania, Brian Ayara, Julia Muthua, Leah Obosy, Thaddeus Massawa, Peter K. Shikuku, and Lucy Muchiri, University of Nairobi; Okoth Obiero and Andrew K. Gachii, Kenyatta National Hospital, Nairobi, Kenya; Andrew Field, Notre Dame University Medical School and St. Vincent's Hospital, Sydney, Australia; and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD
| | - Leah Obosy
- Shahin Sayed, Anderson Mutuiri, Nancy Okinda, Zahir Moloo, Abubakar Abdillah, Erick Chesori, Elizabeth Kagotho, Eunida Migide, and Donstefano Muninzwa, Aga Khan University Hospital; Jamilla Rajab, Jessie Githanga, Mary Mungania, Brian Ayara, Julia Muthua, Leah Obosy, Thaddeus Massawa, Peter K. Shikuku, and Lucy Muchiri, University of Nairobi; Okoth Obiero and Andrew K. Gachii, Kenyatta National Hospital, Nairobi, Kenya; Andrew Field, Notre Dame University Medical School and St. Vincent's Hospital, Sydney, Australia; and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD
| | - Thaddeus Massawa
- Shahin Sayed, Anderson Mutuiri, Nancy Okinda, Zahir Moloo, Abubakar Abdillah, Erick Chesori, Elizabeth Kagotho, Eunida Migide, and Donstefano Muninzwa, Aga Khan University Hospital; Jamilla Rajab, Jessie Githanga, Mary Mungania, Brian Ayara, Julia Muthua, Leah Obosy, Thaddeus Massawa, Peter K. Shikuku, and Lucy Muchiri, University of Nairobi; Okoth Obiero and Andrew K. Gachii, Kenyatta National Hospital, Nairobi, Kenya; Andrew Field, Notre Dame University Medical School and St. Vincent's Hospital, Sydney, Australia; and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD
| | - Okoth Obiero
- Shahin Sayed, Anderson Mutuiri, Nancy Okinda, Zahir Moloo, Abubakar Abdillah, Erick Chesori, Elizabeth Kagotho, Eunida Migide, and Donstefano Muninzwa, Aga Khan University Hospital; Jamilla Rajab, Jessie Githanga, Mary Mungania, Brian Ayara, Julia Muthua, Leah Obosy, Thaddeus Massawa, Peter K. Shikuku, and Lucy Muchiri, University of Nairobi; Okoth Obiero and Andrew K. Gachii, Kenyatta National Hospital, Nairobi, Kenya; Andrew Field, Notre Dame University Medical School and St. Vincent's Hospital, Sydney, Australia; and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD
| | - Elizabeth Kagotho
- Shahin Sayed, Anderson Mutuiri, Nancy Okinda, Zahir Moloo, Abubakar Abdillah, Erick Chesori, Elizabeth Kagotho, Eunida Migide, and Donstefano Muninzwa, Aga Khan University Hospital; Jamilla Rajab, Jessie Githanga, Mary Mungania, Brian Ayara, Julia Muthua, Leah Obosy, Thaddeus Massawa, Peter K. Shikuku, and Lucy Muchiri, University of Nairobi; Okoth Obiero and Andrew K. Gachii, Kenyatta National Hospital, Nairobi, Kenya; Andrew Field, Notre Dame University Medical School and St. Vincent's Hospital, Sydney, Australia; and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD
| | - Peter K Shikuku
- Shahin Sayed, Anderson Mutuiri, Nancy Okinda, Zahir Moloo, Abubakar Abdillah, Erick Chesori, Elizabeth Kagotho, Eunida Migide, and Donstefano Muninzwa, Aga Khan University Hospital; Jamilla Rajab, Jessie Githanga, Mary Mungania, Brian Ayara, Julia Muthua, Leah Obosy, Thaddeus Massawa, Peter K. Shikuku, and Lucy Muchiri, University of Nairobi; Okoth Obiero and Andrew K. Gachii, Kenyatta National Hospital, Nairobi, Kenya; Andrew Field, Notre Dame University Medical School and St. Vincent's Hospital, Sydney, Australia; and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD
| | - Andrew K Gachii
- Shahin Sayed, Anderson Mutuiri, Nancy Okinda, Zahir Moloo, Abubakar Abdillah, Erick Chesori, Elizabeth Kagotho, Eunida Migide, and Donstefano Muninzwa, Aga Khan University Hospital; Jamilla Rajab, Jessie Githanga, Mary Mungania, Brian Ayara, Julia Muthua, Leah Obosy, Thaddeus Massawa, Peter K. Shikuku, and Lucy Muchiri, University of Nairobi; Okoth Obiero and Andrew K. Gachii, Kenyatta National Hospital, Nairobi, Kenya; Andrew Field, Notre Dame University Medical School and St. Vincent's Hospital, Sydney, Australia; and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD
| | - Eunida Migide
- Shahin Sayed, Anderson Mutuiri, Nancy Okinda, Zahir Moloo, Abubakar Abdillah, Erick Chesori, Elizabeth Kagotho, Eunida Migide, and Donstefano Muninzwa, Aga Khan University Hospital; Jamilla Rajab, Jessie Githanga, Mary Mungania, Brian Ayara, Julia Muthua, Leah Obosy, Thaddeus Massawa, Peter K. Shikuku, and Lucy Muchiri, University of Nairobi; Okoth Obiero and Andrew K. Gachii, Kenyatta National Hospital, Nairobi, Kenya; Andrew Field, Notre Dame University Medical School and St. Vincent's Hospital, Sydney, Australia; and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD
| | - Donstefano Muninzwa
- Shahin Sayed, Anderson Mutuiri, Nancy Okinda, Zahir Moloo, Abubakar Abdillah, Erick Chesori, Elizabeth Kagotho, Eunida Migide, and Donstefano Muninzwa, Aga Khan University Hospital; Jamilla Rajab, Jessie Githanga, Mary Mungania, Brian Ayara, Julia Muthua, Leah Obosy, Thaddeus Massawa, Peter K. Shikuku, and Lucy Muchiri, University of Nairobi; Okoth Obiero and Andrew K. Gachii, Kenyatta National Hospital, Nairobi, Kenya; Andrew Field, Notre Dame University Medical School and St. Vincent's Hospital, Sydney, Australia; and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD
| | - Sanford M Dawsey
- Shahin Sayed, Anderson Mutuiri, Nancy Okinda, Zahir Moloo, Abubakar Abdillah, Erick Chesori, Elizabeth Kagotho, Eunida Migide, and Donstefano Muninzwa, Aga Khan University Hospital; Jamilla Rajab, Jessie Githanga, Mary Mungania, Brian Ayara, Julia Muthua, Leah Obosy, Thaddeus Massawa, Peter K. Shikuku, and Lucy Muchiri, University of Nairobi; Okoth Obiero and Andrew K. Gachii, Kenyatta National Hospital, Nairobi, Kenya; Andrew Field, Notre Dame University Medical School and St. Vincent's Hospital, Sydney, Australia; and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD
| | - Lucy Muchiri
- Shahin Sayed, Anderson Mutuiri, Nancy Okinda, Zahir Moloo, Abubakar Abdillah, Erick Chesori, Elizabeth Kagotho, Eunida Migide, and Donstefano Muninzwa, Aga Khan University Hospital; Jamilla Rajab, Jessie Githanga, Mary Mungania, Brian Ayara, Julia Muthua, Leah Obosy, Thaddeus Massawa, Peter K. Shikuku, and Lucy Muchiri, University of Nairobi; Okoth Obiero and Andrew K. Gachii, Kenyatta National Hospital, Nairobi, Kenya; Andrew Field, Notre Dame University Medical School and St. Vincent's Hospital, Sydney, Australia; and Sanford M. Dawsey, National Cancer Institute, Bethesda, MD
| |
Collapse
|
23
|
Sayed S, Cherniak W, Lawler M, Tan SY, El Sadr W, Wolf N, Silkensen S, Brand N, Looi LM, Pai SA, Wilson ML, Milner D, Flanigan J, Fleming KA. Improving pathology and laboratory medicine in low-income and middle-income countries: roadmap to solutions. Lancet 2018; 391:1939-1952. [PMID: 29550027 DOI: 10.1016/s0140-6736(18)30459-8] [Citation(s) in RCA: 121] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 11/29/2017] [Accepted: 12/08/2017] [Indexed: 12/11/2022]
Abstract
Insufficient awareness of the centrality of pathology and laboratory medicine (PALM) to a functioning health-care system at policy and governmental level, with the resultant inadequate investment, has meant that efforts to enhance PALM in low-income and middle-income countries have been local, fragmented, and mostly unsustainable. Responding to the four major barriers in PALM service delivery that were identified in the first paper of this Series (workforce, infrastructure, education and training, and quality assurance), this second paper identifies potential solutions that can be applied in low-income and middle-income countries (LMICs). Increasing and retaining a quality PALM workforce requires access to mentorship and continuing professional development, task sharing, and the development of short-term visitor programmes. Opportunities to enhance the training of pathologists and allied PALM personnel by increasing and improving education provision must be explored and implemented. PALM infrastructure must be strengthened by addressing supply chain barriers, and ensuring laboratory information systems are in place. New technologies, including telepathology and point-of-care testing, can have a substantial role in PALM service delivery, if used appropriately. We emphasise the crucial importance of maintaining PALM quality and posit that all laboratories in LMICs should participate in quality assurance and accreditation programmes. A potential role for public-private partnerships in filling PALM services gaps should also be investigated. Finally, to deliver these solutions and ensure equitable access to essential services in LMICs, we propose a PALM package focused on these countries, integrated within a nationally tiered laboratory system, as part of an overarching national laboratory strategic plan.
Collapse
Affiliation(s)
- Shahin Sayed
- Department of Pathology, Aga Khan University Hospital Nairobi, Nairobi, Kenya.
| | - William Cherniak
- Center for Global Health, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark Lawler
- Faculty of Medicine, Health, and Life Sciences and Centre for Cancer Research and Cell Biology, Queens University, Belfast, UK
| | - Soo Yong Tan
- Department of Pathology, National University of Singapore, National University Hospital, Singapore
| | - Wafaa El Sadr
- ICAP at Columbia University, Mailman School of Public Health, New York, NY, USA
| | - Nicholas Wolf
- Center for Global Health, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Shannon Silkensen
- Center for Global Health, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nathan Brand
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Lai Meng Looi
- Department of Pathology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sanjay A Pai
- Columbia Asia Referral Hospital, Bangalore, Karnataka, India
| | - Michael L Wilson
- Department of Pathology and Laboratory Services, Denver Health, Denver, CO, USA; Department of Pathology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Danny Milner
- American Society for Clinical Pathology, Chicago, IL, USA
| | - John Flanigan
- Center for Global Health, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kenneth A Fleming
- Center for Global Health, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA; Green Templeton College, University of Oxford, Oxford, UK
| |
Collapse
|
24
|
Montgomery ND, Tomoka T, Krysiak R, Powers E, Mulenga M, Kampani C, Chimzimu F, Owino MK, Dhungel BM, Gopal S, Fedoriw Y. Practical Successes in Telepathology Experiences in Africa. Clin Lab Med 2018; 38:141-150. [PMID: 29412878 PMCID: PMC5996143 DOI: 10.1016/j.cll.2017.10.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Across much of Africa, there is a critical shortage of pathology services necessary for clinical care. Even in settings where specialty-level clinical care, such as medical oncology, is available, access to anatomic pathology services has often lagged behind. Pathology laboratories in the region are challenging to establish and maintain. This article describes the successful implementation of telepathology services in Malawi and reviews other successful programs developed to support diagnostic pathology in resource-limited settings.
Collapse
Affiliation(s)
- Nathan D Montgomery
- Department of Pathology and Laboratory Medicine, The University of North Carolina School of Medicine, CB 7525, Chapel Hill, NC 27599-7525, USA
| | - Tamiwe Tomoka
- UNC Project Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - Robert Krysiak
- UNC Project Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - Eric Powers
- Department of Pathology and Laboratory Medicine, The University of North Carolina School of Medicine, CB 7525, Chapel Hill, NC 27599-7525, USA
| | - Maurice Mulenga
- Kamuzu Central Hospital, Tidziwe Centre, PO Box 149, Lilongwe, Malawi
| | - Coxcilly Kampani
- UNC Project Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - Fred Chimzimu
- UNC Project Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - Michael K Owino
- UNC Project Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | | | - Satish Gopal
- UNC Project Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi; Lineberger Comprehensive Cancer Center, CB 7295, Chapel Hill, NC 27599-7295, USA
| | - Yuri Fedoriw
- Department of Pathology and Laboratory Medicine, The University of North Carolina School of Medicine, CB 7525, Chapel Hill, NC 27599-7525, USA; Lineberger Comprehensive Cancer Center, CB 7295, Chapel Hill, NC 27599-7295, USA.
| |
Collapse
|
25
|
Martei YM, Pace LE, Brock JE, Shulman LN. Breast Cancer in Low- and Middle-Income Countries: Why We Need Pathology Capability to Solve This Challenge. Clin Lab Med 2018; 38:161-173. [PMID: 29412880 PMCID: PMC6277976 DOI: 10.1016/j.cll.2017.10.013] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Breast cancer is the leading cause of cancer mortality among women in developing countries. Timely and accurate histopathological diagnosis of breast cancer is critical to delivering high-quality breast cancer care to patients in low- and middle-income countries (LMIC). The most important prognostic factors in breast cancer along with tumor size and nodal status are tumor grade, estrogen receptor status, as well as HER2 status in countries where specific targeted therapies are available. In addition, detailed and complete cancer registry data are needed to assess a country's disease burden and guide disease prioritization and allocation of resources for breast cancer treatment. Innovations in leapfrog technology and low-cost point-of-care tests for molecular evaluations are needed to provide accurate and timely pathology, with the ultimate goal of improving survival outcomes for patients with breast cancer in LMIC.
Collapse
Affiliation(s)
- Yehoda M Martei
- Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania, Abramson Cancer Center, 3400 Civic Center Boulevard, Philadelphia, PA 19106 USA
| | - Lydia E Pace
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Jane E Brock
- Department of Pathology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Lawrence N Shulman
- Division of Hematology-Oncology, Department of Medicine, University of Pennsylvania, Abramson Cancer Center, 3400 Civic Center Boulevard, Philadelphia, PA 19106 USA.
| |
Collapse
|
26
|
Muvugabigwi G, Nshimiyimana I, Greenberg L, Hakizimana E, Ruhangaza D, Benewe O, Bhai K, Pepoon JR, Fehr AE, Park PH, Butonzi J, Shyirambere C, Manirakiza A, Rusangwa C, Milner D, Mpunga T, Shulman LN. Decreasing Histology Turnaround Time Through Stepwise Innovation and Capacity Building in Rwanda. J Glob Oncol 2017; 4:1-6. [PMID: 30241136 PMCID: PMC6180771 DOI: 10.1200/jgo.17.00081] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose Minimal turnaround time for pathology results is crucial for highest-quality
patient care in all settings, especially in low- and middle-income
countries, where rural populations may have limited access to health
care. Methods We retrospectively determined the turnaround times (TATs) for anatomic
pathology specimens, comparing three different modes of operation that
occurred throughout the development and implementation of our pathology
laboratory at the Butaro Cancer Center of Excellence in Rwanda. Before
opening this laboratory, TAT was measured in months because of inconsistent
laboratory operations and a paucity of in-country pathologists. Results We analyzed 2,514 individual patient samples across the three modes of study.
Diagnostic mode 1 (samples sent out of the country for analysis) had the
highest median TAT, with an overall time of 30 days (interquartile range
[IQR], 22 to 43 days). For diagnostic mode 2 (static image telepathology),
the median TAT was 14 days (IQR, 7 to 27 days), and for diagnostic mode 3
(onsite expert diagnosis), it was 5 days (IQR, 2 to 9 days). Conclusion Our results demonstrate that telepathology is a significant improvement over
external expert review and can greatly assist sites in improving their TATs
until pathologists are on site.
Collapse
Affiliation(s)
- Gaspard Muvugabigwi
- Gaspard Muvugabigwi, Irenee Nshimiyimana, Emmanuel Hakizimana, Deo Ruhangaza, Origene Benewe, John Butonzi, and Tharcisse Mpunga, Butaro District Hospital, Ministry of Health, Butaro; Alexandra E. Fehr, Paul H. Park, Cyprien Shyirambere, Alexis Manirakiza, and Christian Rusangwa, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda; Lauren Greenberg and Kiran Bhai, Partners In Health; James R. Pepoon, Brigham and Women's Hospital, Boston, MA; Danny Milner, American Society for Clinical Pathology, Chicago, IL; and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Irenee Nshimiyimana
- Gaspard Muvugabigwi, Irenee Nshimiyimana, Emmanuel Hakizimana, Deo Ruhangaza, Origene Benewe, John Butonzi, and Tharcisse Mpunga, Butaro District Hospital, Ministry of Health, Butaro; Alexandra E. Fehr, Paul H. Park, Cyprien Shyirambere, Alexis Manirakiza, and Christian Rusangwa, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda; Lauren Greenberg and Kiran Bhai, Partners In Health; James R. Pepoon, Brigham and Women's Hospital, Boston, MA; Danny Milner, American Society for Clinical Pathology, Chicago, IL; and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Lauren Greenberg
- Gaspard Muvugabigwi, Irenee Nshimiyimana, Emmanuel Hakizimana, Deo Ruhangaza, Origene Benewe, John Butonzi, and Tharcisse Mpunga, Butaro District Hospital, Ministry of Health, Butaro; Alexandra E. Fehr, Paul H. Park, Cyprien Shyirambere, Alexis Manirakiza, and Christian Rusangwa, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda; Lauren Greenberg and Kiran Bhai, Partners In Health; James R. Pepoon, Brigham and Women's Hospital, Boston, MA; Danny Milner, American Society for Clinical Pathology, Chicago, IL; and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Emmanuel Hakizimana
- Gaspard Muvugabigwi, Irenee Nshimiyimana, Emmanuel Hakizimana, Deo Ruhangaza, Origene Benewe, John Butonzi, and Tharcisse Mpunga, Butaro District Hospital, Ministry of Health, Butaro; Alexandra E. Fehr, Paul H. Park, Cyprien Shyirambere, Alexis Manirakiza, and Christian Rusangwa, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda; Lauren Greenberg and Kiran Bhai, Partners In Health; James R. Pepoon, Brigham and Women's Hospital, Boston, MA; Danny Milner, American Society for Clinical Pathology, Chicago, IL; and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Deo Ruhangaza
- Gaspard Muvugabigwi, Irenee Nshimiyimana, Emmanuel Hakizimana, Deo Ruhangaza, Origene Benewe, John Butonzi, and Tharcisse Mpunga, Butaro District Hospital, Ministry of Health, Butaro; Alexandra E. Fehr, Paul H. Park, Cyprien Shyirambere, Alexis Manirakiza, and Christian Rusangwa, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda; Lauren Greenberg and Kiran Bhai, Partners In Health; James R. Pepoon, Brigham and Women's Hospital, Boston, MA; Danny Milner, American Society for Clinical Pathology, Chicago, IL; and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Origene Benewe
- Gaspard Muvugabigwi, Irenee Nshimiyimana, Emmanuel Hakizimana, Deo Ruhangaza, Origene Benewe, John Butonzi, and Tharcisse Mpunga, Butaro District Hospital, Ministry of Health, Butaro; Alexandra E. Fehr, Paul H. Park, Cyprien Shyirambere, Alexis Manirakiza, and Christian Rusangwa, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda; Lauren Greenberg and Kiran Bhai, Partners In Health; James R. Pepoon, Brigham and Women's Hospital, Boston, MA; Danny Milner, American Society for Clinical Pathology, Chicago, IL; and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Kiran Bhai
- Gaspard Muvugabigwi, Irenee Nshimiyimana, Emmanuel Hakizimana, Deo Ruhangaza, Origene Benewe, John Butonzi, and Tharcisse Mpunga, Butaro District Hospital, Ministry of Health, Butaro; Alexandra E. Fehr, Paul H. Park, Cyprien Shyirambere, Alexis Manirakiza, and Christian Rusangwa, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda; Lauren Greenberg and Kiran Bhai, Partners In Health; James R. Pepoon, Brigham and Women's Hospital, Boston, MA; Danny Milner, American Society for Clinical Pathology, Chicago, IL; and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - James R Pepoon
- Gaspard Muvugabigwi, Irenee Nshimiyimana, Emmanuel Hakizimana, Deo Ruhangaza, Origene Benewe, John Butonzi, and Tharcisse Mpunga, Butaro District Hospital, Ministry of Health, Butaro; Alexandra E. Fehr, Paul H. Park, Cyprien Shyirambere, Alexis Manirakiza, and Christian Rusangwa, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda; Lauren Greenberg and Kiran Bhai, Partners In Health; James R. Pepoon, Brigham and Women's Hospital, Boston, MA; Danny Milner, American Society for Clinical Pathology, Chicago, IL; and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Alexandra E Fehr
- Gaspard Muvugabigwi, Irenee Nshimiyimana, Emmanuel Hakizimana, Deo Ruhangaza, Origene Benewe, John Butonzi, and Tharcisse Mpunga, Butaro District Hospital, Ministry of Health, Butaro; Alexandra E. Fehr, Paul H. Park, Cyprien Shyirambere, Alexis Manirakiza, and Christian Rusangwa, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda; Lauren Greenberg and Kiran Bhai, Partners In Health; James R. Pepoon, Brigham and Women's Hospital, Boston, MA; Danny Milner, American Society for Clinical Pathology, Chicago, IL; and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Paul H Park
- Gaspard Muvugabigwi, Irenee Nshimiyimana, Emmanuel Hakizimana, Deo Ruhangaza, Origene Benewe, John Butonzi, and Tharcisse Mpunga, Butaro District Hospital, Ministry of Health, Butaro; Alexandra E. Fehr, Paul H. Park, Cyprien Shyirambere, Alexis Manirakiza, and Christian Rusangwa, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda; Lauren Greenberg and Kiran Bhai, Partners In Health; James R. Pepoon, Brigham and Women's Hospital, Boston, MA; Danny Milner, American Society for Clinical Pathology, Chicago, IL; and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - John Butonzi
- Gaspard Muvugabigwi, Irenee Nshimiyimana, Emmanuel Hakizimana, Deo Ruhangaza, Origene Benewe, John Butonzi, and Tharcisse Mpunga, Butaro District Hospital, Ministry of Health, Butaro; Alexandra E. Fehr, Paul H. Park, Cyprien Shyirambere, Alexis Manirakiza, and Christian Rusangwa, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda; Lauren Greenberg and Kiran Bhai, Partners In Health; James R. Pepoon, Brigham and Women's Hospital, Boston, MA; Danny Milner, American Society for Clinical Pathology, Chicago, IL; and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Cyprien Shyirambere
- Gaspard Muvugabigwi, Irenee Nshimiyimana, Emmanuel Hakizimana, Deo Ruhangaza, Origene Benewe, John Butonzi, and Tharcisse Mpunga, Butaro District Hospital, Ministry of Health, Butaro; Alexandra E. Fehr, Paul H. Park, Cyprien Shyirambere, Alexis Manirakiza, and Christian Rusangwa, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda; Lauren Greenberg and Kiran Bhai, Partners In Health; James R. Pepoon, Brigham and Women's Hospital, Boston, MA; Danny Milner, American Society for Clinical Pathology, Chicago, IL; and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Alexis Manirakiza
- Gaspard Muvugabigwi, Irenee Nshimiyimana, Emmanuel Hakizimana, Deo Ruhangaza, Origene Benewe, John Butonzi, and Tharcisse Mpunga, Butaro District Hospital, Ministry of Health, Butaro; Alexandra E. Fehr, Paul H. Park, Cyprien Shyirambere, Alexis Manirakiza, and Christian Rusangwa, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda; Lauren Greenberg and Kiran Bhai, Partners In Health; James R. Pepoon, Brigham and Women's Hospital, Boston, MA; Danny Milner, American Society for Clinical Pathology, Chicago, IL; and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Christian Rusangwa
- Gaspard Muvugabigwi, Irenee Nshimiyimana, Emmanuel Hakizimana, Deo Ruhangaza, Origene Benewe, John Butonzi, and Tharcisse Mpunga, Butaro District Hospital, Ministry of Health, Butaro; Alexandra E. Fehr, Paul H. Park, Cyprien Shyirambere, Alexis Manirakiza, and Christian Rusangwa, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda; Lauren Greenberg and Kiran Bhai, Partners In Health; James R. Pepoon, Brigham and Women's Hospital, Boston, MA; Danny Milner, American Society for Clinical Pathology, Chicago, IL; and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Danny Milner
- Gaspard Muvugabigwi, Irenee Nshimiyimana, Emmanuel Hakizimana, Deo Ruhangaza, Origene Benewe, John Butonzi, and Tharcisse Mpunga, Butaro District Hospital, Ministry of Health, Butaro; Alexandra E. Fehr, Paul H. Park, Cyprien Shyirambere, Alexis Manirakiza, and Christian Rusangwa, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda; Lauren Greenberg and Kiran Bhai, Partners In Health; James R. Pepoon, Brigham and Women's Hospital, Boston, MA; Danny Milner, American Society for Clinical Pathology, Chicago, IL; and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Tharcisse Mpunga
- Gaspard Muvugabigwi, Irenee Nshimiyimana, Emmanuel Hakizimana, Deo Ruhangaza, Origene Benewe, John Butonzi, and Tharcisse Mpunga, Butaro District Hospital, Ministry of Health, Butaro; Alexandra E. Fehr, Paul H. Park, Cyprien Shyirambere, Alexis Manirakiza, and Christian Rusangwa, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda; Lauren Greenberg and Kiran Bhai, Partners In Health; James R. Pepoon, Brigham and Women's Hospital, Boston, MA; Danny Milner, American Society for Clinical Pathology, Chicago, IL; and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Lawrence N Shulman
- Gaspard Muvugabigwi, Irenee Nshimiyimana, Emmanuel Hakizimana, Deo Ruhangaza, Origene Benewe, John Butonzi, and Tharcisse Mpunga, Butaro District Hospital, Ministry of Health, Butaro; Alexandra E. Fehr, Paul H. Park, Cyprien Shyirambere, Alexis Manirakiza, and Christian Rusangwa, Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda; Lauren Greenberg and Kiran Bhai, Partners In Health; James R. Pepoon, Brigham and Women's Hospital, Boston, MA; Danny Milner, American Society for Clinical Pathology, Chicago, IL; and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
27
|
Randolph-Habecker J, Stritmatter A, Cherepow L, Basemara D, Wilner Alexandre M, Gordon-Maclean C, Casper C. Opening a histopathology laboratory in Kampala Uganda – from the ground up. J Histotechnol 2017. [DOI: 10.1080/01478885.2017.1367885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | | | - Linda Cherepow
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Dianna Basemara
- Hutchinson Centre Research Institute – Uganda, Kampala, Uganda
| | | | - Cristin Gordon-Maclean
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Corey Casper
- Infectious Disease Research Institute, Seattle, WA, USA
- Departments of Medicine, Epidemiology and Global Health, University of Washington, Seattle, WA, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| |
Collapse
|
28
|
Neal C, Rusangwa C, Borg R, Tapela N, Mugunga JC, Pritchett N, Shyirambere C, Ntakirutimana E, Park PH, Shulman LN, Mpunga T. Cost of Providing Quality Cancer Care at the Butaro Cancer Center of Excellence in Rwanda. J Glob Oncol 2017; 4:1-7. [PMID: 30241219 PMCID: PMC6180748 DOI: 10.1200/jgo.17.00003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose The cost of providing cancer care in low-income countries remains largely
unknown, which creates a significant barrier to effective planning and
resource allocation. This study examines the cost of providing comprehensive
cancer care at the Butaro Cancer Center of Excellence (BCCOE) in Rwanda. Methods A retrospective costing analysis was conducted from the provider perspective
by using secondary data from the administrative systems of the BCCOE. We
identified the start-up funds necessary to begin initial implementation and
determined the fiscal year 2013-2014 operating cost of the cancer program,
including capital expenditures and fixed and variable costs. Results A total of $556,105 US dollars was assessed as necessary start-up funding to
implement the program. The annual operating cost of the cancer program was
found to be $957,203 US dollars. Radiotherapy, labor, and chemotherapy were
the most significant cost drivers. Radiotherapy services, which require
sending patients out of country because there are no radiation units in
Rwanda, comprised 25% of program costs, labor accounted for 21%, and
chemotherapy, supportive medications, and consumables accounted for 15%.
Overhead, training, computed tomography scans, surgeries, blood products,
pathology, and social services accounted for less than 10% of the total. Conclusion This study is one of the first to examine operating costs for implementing a
cancer center in a low-income country. Having a strong commitment to cancer
care, adapting clinical protocols to the local setting, shifting tasks, and
creating collaborative partnerships make it possible for BCCOE to provide
quality cancer care at a fraction of the cost seen in middle- and
high-income countries, which has saved many lives and improved survival. Not
all therapies, though, were available because of limited financial
resources.
Collapse
Affiliation(s)
- Claire Neal
- Claire Neal, University of North Carolina Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC; Christian Rusangwa, Ryan Borg, Natalie Pritchett, Cyprien Shyirambere, Elisephan Ntakirutimana, and Paul H. Park, Partners In Health/Inshuti Mu Buzima, Kigali; Tharcisse Mpunga, Ministry of Health, Butaro, Rwanda; Neo Tapela and Paul H. Park, Brigham and Women's Hospital; Jean Claude Mugunga, Partners In Health, Boston, MA; and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Christian Rusangwa
- Claire Neal, University of North Carolina Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC; Christian Rusangwa, Ryan Borg, Natalie Pritchett, Cyprien Shyirambere, Elisephan Ntakirutimana, and Paul H. Park, Partners In Health/Inshuti Mu Buzima, Kigali; Tharcisse Mpunga, Ministry of Health, Butaro, Rwanda; Neo Tapela and Paul H. Park, Brigham and Women's Hospital; Jean Claude Mugunga, Partners In Health, Boston, MA; and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Ryan Borg
- Claire Neal, University of North Carolina Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC; Christian Rusangwa, Ryan Borg, Natalie Pritchett, Cyprien Shyirambere, Elisephan Ntakirutimana, and Paul H. Park, Partners In Health/Inshuti Mu Buzima, Kigali; Tharcisse Mpunga, Ministry of Health, Butaro, Rwanda; Neo Tapela and Paul H. Park, Brigham and Women's Hospital; Jean Claude Mugunga, Partners In Health, Boston, MA; and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Neo Tapela
- Claire Neal, University of North Carolina Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC; Christian Rusangwa, Ryan Borg, Natalie Pritchett, Cyprien Shyirambere, Elisephan Ntakirutimana, and Paul H. Park, Partners In Health/Inshuti Mu Buzima, Kigali; Tharcisse Mpunga, Ministry of Health, Butaro, Rwanda; Neo Tapela and Paul H. Park, Brigham and Women's Hospital; Jean Claude Mugunga, Partners In Health, Boston, MA; and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Jean Claude Mugunga
- Claire Neal, University of North Carolina Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC; Christian Rusangwa, Ryan Borg, Natalie Pritchett, Cyprien Shyirambere, Elisephan Ntakirutimana, and Paul H. Park, Partners In Health/Inshuti Mu Buzima, Kigali; Tharcisse Mpunga, Ministry of Health, Butaro, Rwanda; Neo Tapela and Paul H. Park, Brigham and Women's Hospital; Jean Claude Mugunga, Partners In Health, Boston, MA; and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Natalie Pritchett
- Claire Neal, University of North Carolina Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC; Christian Rusangwa, Ryan Borg, Natalie Pritchett, Cyprien Shyirambere, Elisephan Ntakirutimana, and Paul H. Park, Partners In Health/Inshuti Mu Buzima, Kigali; Tharcisse Mpunga, Ministry of Health, Butaro, Rwanda; Neo Tapela and Paul H. Park, Brigham and Women's Hospital; Jean Claude Mugunga, Partners In Health, Boston, MA; and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Cyprien Shyirambere
- Claire Neal, University of North Carolina Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC; Christian Rusangwa, Ryan Borg, Natalie Pritchett, Cyprien Shyirambere, Elisephan Ntakirutimana, and Paul H. Park, Partners In Health/Inshuti Mu Buzima, Kigali; Tharcisse Mpunga, Ministry of Health, Butaro, Rwanda; Neo Tapela and Paul H. Park, Brigham and Women's Hospital; Jean Claude Mugunga, Partners In Health, Boston, MA; and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Elisephan Ntakirutimana
- Claire Neal, University of North Carolina Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC; Christian Rusangwa, Ryan Borg, Natalie Pritchett, Cyprien Shyirambere, Elisephan Ntakirutimana, and Paul H. Park, Partners In Health/Inshuti Mu Buzima, Kigali; Tharcisse Mpunga, Ministry of Health, Butaro, Rwanda; Neo Tapela and Paul H. Park, Brigham and Women's Hospital; Jean Claude Mugunga, Partners In Health, Boston, MA; and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Paul H Park
- Claire Neal, University of North Carolina Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC; Christian Rusangwa, Ryan Borg, Natalie Pritchett, Cyprien Shyirambere, Elisephan Ntakirutimana, and Paul H. Park, Partners In Health/Inshuti Mu Buzima, Kigali; Tharcisse Mpunga, Ministry of Health, Butaro, Rwanda; Neo Tapela and Paul H. Park, Brigham and Women's Hospital; Jean Claude Mugunga, Partners In Health, Boston, MA; and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Lawrence N Shulman
- Claire Neal, University of North Carolina Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC; Christian Rusangwa, Ryan Borg, Natalie Pritchett, Cyprien Shyirambere, Elisephan Ntakirutimana, and Paul H. Park, Partners In Health/Inshuti Mu Buzima, Kigali; Tharcisse Mpunga, Ministry of Health, Butaro, Rwanda; Neo Tapela and Paul H. Park, Brigham and Women's Hospital; Jean Claude Mugunga, Partners In Health, Boston, MA; and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Tharcisse Mpunga
- Claire Neal, University of North Carolina Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC; Christian Rusangwa, Ryan Borg, Natalie Pritchett, Cyprien Shyirambere, Elisephan Ntakirutimana, and Paul H. Park, Partners In Health/Inshuti Mu Buzima, Kigali; Tharcisse Mpunga, Ministry of Health, Butaro, Rwanda; Neo Tapela and Paul H. Park, Brigham and Women's Hospital; Jean Claude Mugunga, Partners In Health, Boston, MA; and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
29
|
O'Neil DS, Keating NL, Dusengimana JMV, Hategekimana V, Umwizera A, Mpunga T, Shulman LN, Pace LE. Quality of Breast Cancer Treatment at a Rural Cancer Center in Rwanda. J Glob Oncol 2017; 4:1-11. [PMID: 30241207 PMCID: PMC6180813 DOI: 10.1200/jgo.2016.008672] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE As breast cancer incidence and mortality rise in sub-Saharan Africa, it is critical to identify strategies for delivery of high-quality breast cancer care in settings with limited resources and few oncology specialists. We investigated the quality of treatments received by a cohort of patients with breast cancer at Butaro Cancer Center of Excellence (BCCOE), Rwanda's first public cancer center. PATIENTS AND METHODS We reviewed medical records of all female patients diagnosed with invasive breast cancer at BCCOE between July 2012 and December 2013. We evaluated the provision of chemotherapy, endocrine therapy, surgery, and chemotherapy dose densities. We also applied modified international quality metrics and estimated overall survival using interval-censored analysis. RESULTS Among 150 patients, 28 presented with early-stage, 64 with locally advanced, and 53 with metastatic disease. Among potentially curable patients (ie, those with early-stage or locally advanced disease), 74% received at least four cycles of chemotherapy and 63% received surgery. Among hormone receptor-positive patients, 83% received endocrine therapy within 1 year of diagnosis. Fifty-seven percent of potentially curable patients completed surgery and chemotherapy and initiated endocrine therapy if indicated within 1 year of biopsy. Radiotherapy was not available. At the end of follow-up, 62% of potentially curable patients were alive, 24% were dead, and 14% were lost to follow-up. CONCLUSION Appropriate delivery of chemotherapy and endocrine therapy for breast cancer is possible in rural sub-Saharan African even without oncologists based on site. Performing timely surgery and ensuring treatment completion were key challenges after the opening of BCCOE. Further investigation should examine persistent quality gaps and the relationship between treatment quality and survival.
Collapse
Affiliation(s)
- Daniel S O'Neil
- Daniel S. O'Neil, Columbia University Medical Center, New York, NY; Nancy L. Keating and Lydia E. Pace, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Jean Marie V. Dusengimana, Partners in Health/Inshuti Mu Buzima, Rwinkwavu; Vedaste Hategekimana, Aline Umwizera, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Nancy L Keating
- Daniel S. O'Neil, Columbia University Medical Center, New York, NY; Nancy L. Keating and Lydia E. Pace, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Jean Marie V. Dusengimana, Partners in Health/Inshuti Mu Buzima, Rwinkwavu; Vedaste Hategekimana, Aline Umwizera, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Jean Marie V Dusengimana
- Daniel S. O'Neil, Columbia University Medical Center, New York, NY; Nancy L. Keating and Lydia E. Pace, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Jean Marie V. Dusengimana, Partners in Health/Inshuti Mu Buzima, Rwinkwavu; Vedaste Hategekimana, Aline Umwizera, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Vedaste Hategekimana
- Daniel S. O'Neil, Columbia University Medical Center, New York, NY; Nancy L. Keating and Lydia E. Pace, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Jean Marie V. Dusengimana, Partners in Health/Inshuti Mu Buzima, Rwinkwavu; Vedaste Hategekimana, Aline Umwizera, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Aline Umwizera
- Daniel S. O'Neil, Columbia University Medical Center, New York, NY; Nancy L. Keating and Lydia E. Pace, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Jean Marie V. Dusengimana, Partners in Health/Inshuti Mu Buzima, Rwinkwavu; Vedaste Hategekimana, Aline Umwizera, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Tharcisse Mpunga
- Daniel S. O'Neil, Columbia University Medical Center, New York, NY; Nancy L. Keating and Lydia E. Pace, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Jean Marie V. Dusengimana, Partners in Health/Inshuti Mu Buzima, Rwinkwavu; Vedaste Hategekimana, Aline Umwizera, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Lawrence N Shulman
- Daniel S. O'Neil, Columbia University Medical Center, New York, NY; Nancy L. Keating and Lydia E. Pace, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Jean Marie V. Dusengimana, Partners in Health/Inshuti Mu Buzima, Rwinkwavu; Vedaste Hategekimana, Aline Umwizera, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Lydia E Pace
- Daniel S. O'Neil, Columbia University Medical Center, New York, NY; Nancy L. Keating and Lydia E. Pace, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Jean Marie V. Dusengimana, Partners in Health/Inshuti Mu Buzima, Rwinkwavu; Vedaste Hategekimana, Aline Umwizera, and Tharcisse Mpunga, Ministry of Health, Kigali, Rwanda; Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|