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Razzano D, Puranam K, Tomoka T, Fedoriw Y. The role of telepathology in improving cancer diagnostic and research capacity in sub-Saharan Africa. Front Med (Lausanne) 2022; 9:978245. [PMID: 36325383 PMCID: PMC9618672 DOI: 10.3389/fmed.2022.978245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 09/05/2022] [Indexed: 11/17/2022] Open
Abstract
Non-communicable disease (NCD), including cancer, disproportionately affect Low- and Middle-Income Countries (LMICs). This inequity is in part due to limitations of pathology services, both human and infrastructural. While significant improvements have been made to address these gaps, creative approaches that are mindful of regional priorities, cultural differences, and unique local challenges are needed. In this perspective, we will describe the implementation of telepathology services in sub-Saharan Africa (SSA) that serve as cornerstones for direct patient care, multi-disciplinary care coordination, research programs, and building human capacity through training. Models and challenges of system implementation, sustainability, and pathologist engagement will be discussed. Using disease and site-specific examples, we will suggest metrics for quality control and improvement initiatives that are critical for providing high-quality cancer registry data and necessary for future implementation of therapeutic and interventional clinical trials.
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Affiliation(s)
- Dana Razzano
- Department of Pathology, Stanford University, Stanford, CA, United States
| | - Kaushik Puranam
- School of Medicine, Georgetown University, Washington, DC, United States
| | - Tamiwe Tomoka
- Department of Pathology, UNC Project Malawi Cancer Program, Lilongwe, Malawi
| | - Yuri Fedoriw
- Department of Pathology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- *Correspondence: Yuri Fedoriw
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2
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Glynn EH, Amukele T, Vian T. Corruption: An Impediment to Delivering Pathology and Laboratory Services in Resource-Limited Settings. Am J Clin Pathol 2021; 156:958-968. [PMID: 34219146 DOI: 10.1093/ajcp/aqab046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Corruption is a widely acknowledged problem in the health sector of low- and middle-income countries (LMICs). Yet, little is known about the types of corruption that affect the delivery of pathology and laboratory medicine (PALM) services. This review is a first step at examining corruption risks in PALM. METHODS We performed a critical review of medical literature focused on health sector corruption in LMICs. To provide context, we categorized cases of laboratory-related fraud and abuse in the United States. RESULTS Forms of corruption in LMICs that may affect the provision of PALM services include informal payments, absenteeism, theft and diversion, kickbacks, self-referral, and fraudulent billing. CONCLUSIONS Corruption represents a functional reality in many LMICs and hinders the delivery of services and distribution of resources to which individuals and entities are legally entitled. Further study is needed to estimate the extent of corruption in PALM and develop appropriate anticorruption strategies.
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Affiliation(s)
- Emily H Glynn
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA, USA
| | - Timothy Amukele
- Department of Pathology and Laboratory Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Taryn Vian
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA, USA
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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.
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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
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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.
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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
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Mumba JM, Kasonka L, Owiti OB, Andrew J, Lubeya MK, Lukama L, Kasempa C, Msadabwe SC, Kalinda C. Cervical cancer diagnosis and treatment delays in the developing world: Evidence from a hospital-based study in Zambia. Gynecol Oncol Rep 2021; 37:100784. [PMID: 34095422 PMCID: PMC8165546 DOI: 10.1016/j.gore.2021.100784] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/18/2021] [Accepted: 04/30/2021] [Indexed: 01/07/2023] Open
Abstract
Expedited diagnostic processes for all suspected cervical cancer cases remain essential in the effort to improve clinical outcomes of the disease. However, in some developing countries like Zambia, there is paucity of data that assesses factors influencing diagnostic and treatment turnaround time (TAT) and other metrics vital for quality cancer care. We conducted a retrospective hospital-based study at the Cancer Diseases Hospital (CDH) for cervical cancer cases presenting to the facility between January 2014 and December 2018. Descriptive statistics were used to summarize demographic characteristics while a generalized linear model of the negative binomial was used to assess determinants of overall TAT. Our study included 2121 patient case files. The median age was 49 years (IQR: ±17) and most patients (n = 634, 31%) were aged between 41 and 50 years. The International Federation of Gynaecology and Obstetrics (FIGO) Cancer stage II (n = 941, 48%) was the most prevalent while stage IV (n = 103, 5.2%) was the least. The average diagnostic TAT in public laboratories was 1.48 (95%CI: 1.21-1.81) times longer than in private laboratories. Furthermore, referral delay was 55 days (IQR: 24-152) and the overall TAT (oTAT) was 110 days (IQR: 62-204). The age of the patient, HIV status, stage of cancer and histological subtype did not influence oTAT while marital status influenced oTAT. The observed longer oTAT may increase irreversible adverse health outcomes among cervical cancer patients. There is a need to improve cancer care in Zambia through improved health expenditure especially in public health facilities.
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Affiliation(s)
- Jane Mwamba Mumba
- The University of Zambia, School of Medicine, Department of Obstetrics and Gynaecology, Nationalist Road, P/Box RWX1 50110, Ridgeway, Lusaka, Zambia
- Ndola Teaching Hospital, Department of Obstetrics and Gynaecology, Broadway Road, Postal Agency Ndola, Ndola, Zambia
| | - Lackson Kasonka
- The University of Zambia, School of Medicine, Department of Obstetrics and Gynaecology, Nationalist Road, P/Box RWX1 50110, Ridgeway, Lusaka, Zambia
- Women and Newborn Hospital-University Teaching Hospitals, Nationalist Road, P/Bag RWX1 Ridgeway, Lusaka, Zambia
| | - Okola Basil Owiti
- Hasselt University, Faculty of Science, Campus Diepenbeek, Agoralaan Building D, 3590 Diepenbeek, Belgium
| | - John Andrew
- Hasselt University, Faculty of Science, Campus Diepenbeek, Agoralaan Building D, 3590 Diepenbeek, Belgium
| | - Mwansa Ketty Lubeya
- The University of Zambia, School of Medicine, Department of Obstetrics and Gynaecology, Nationalist Road, P/Box RWX1 50110, Ridgeway, Lusaka, Zambia
- Women and Newborn Hospital-University Teaching Hospitals, Nationalist Road, P/Bag RWX1 Ridgeway, Lusaka, Zambia
| | - Lufunda Lukama
- Ndola Teaching Hospital, Department of Otorhinolaryngology, Head and Neck Surgery, Broadway Road, Postal Agency Ndola, Ndola, Zambia
- University of KwaZulu-Natal, College of Health Sciences., Nelson R Mandela School of Medicine, Durban 4001, South Africa
| | - Charlotte Kasempa
- Cancer Diseases Hospital, Nationalist Road, Nationalist Road, P/Box RWX1 50110 Ridgeway, Lusaka, Zambia
| | - Susan C. Msadabwe
- Cancer Diseases Hospital, Nationalist Road, Nationalist Road, P/Box RWX1 50110 Ridgeway, Lusaka, Zambia
- Zambia College of Medicine and Surgery, Levy Mwanawasa Medical University, Great East Campus, Box 33991, Lusaka, Lusaka
| | - Chester Kalinda
- University of Namibia, Faculty of Agriculture, Engineering and Science, School of Science, Katima Mulilo Campus, Winele Road, Private Bag 1096, Ngweze, Katima Mulilo, Namibia
- University of KwaZulu-Natal, Howard College Campus, College of Health Sciences, School of Public Health and Nursing, Desmond Clarence Building, Durban 4001, South Africa
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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.
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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
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7
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Biracyaza E, Habimana S, Rusengamihigo D. Psychometric Properties of the Beck Depression Inventory (BDI-II) in Cancer Patients: Cancer Patients from Butaro Ambulatory Cancer Center, Rwanda. Psychol Res Behav Manag 2021; 14:665-674. [PMID: 34104012 PMCID: PMC8180290 DOI: 10.2147/prbm.s306530] [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: 02/24/2021] [Accepted: 05/14/2021] [Indexed: 11/23/2022] Open
Abstract
Background The prevalence of depressive disorders remains high in patients with cancer and their diagnosis and treatment remain an epidemiologic concern. Without proper screening and diagnosis, the necessary care and follow-up would not be possible for these patients who need potential support to increase their quality of mental health. Hence, the screening tools for depression are prominent in diagnosing this mental health disorder; however, there are few studies conducted for assessing psychometric properties of Beck Depression Inventory (BDI-II) amongst the cancer patients from developing countries. We, therefore, determined psychometric properties of the BDI-II among cancer patients from Butaro Ambulatory Cancer Center (BACC). Methods Cross-sectional study design was conducted among 425 cancer patients from the BACC, Rwanda. Confirmatory and exploratory factor (CFA) analyses were performed to compare the fit indices of three-factor and two-factor models of the BDI-II. The eligible participants were administered the BDI-II instrument. Results Average scores of depression was 16.3 (SD=9.8). Results showed an adequate consistency (Cronbach’s α=0.904) and high correlations with the subscales of this instrument. Our findings showed that the area under the curve of the receiver operating characteristics analysis of BDI-II was 0.805. Our CFA results revealed that three-factor model (χ2=1699.921, p<0.001) represented a better model fit than the two-factor model of BDI-II (χ2=2115.397, p<0.001). In addition, the goodness of fit indices were tested and showed that the Beck’s three-factor model had a better performance than the two-factor model. Kaiser–Meyer–Olin (KMO) measure of 0.916 demonstrated that the factor structure or sampling was adequate for analysis and the Bartlett’s test of sphericity was highly significant (χ2=3780, p<0.001) and this revealed that the items of BDI-II were significantly correlated and sufficiently large. Conclusion BDI-II presented a good reliability and validity that represent adequate psychometric properties. Its sensitivity and specificity were suitable. This psychometric measure is important in diagnosing and treating depression in cancer patients.
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Affiliation(s)
- Emmanuel Biracyaza
- Department of Community Health, School of Public Health, University of Rwanda, Kigali, Rwanda.,Rwanda Resilience and Grounding Organization (RRGO), Kigali, Rwanda.,Programme of Sociotherapy, Prison Fellowship Rwanda (PFR), Kigali, Rwanda
| | - Samuel Habimana
- Department of Community Health, School of Public Health, University of Rwanda, Kigali, Rwanda.,Rwanda Resilience and Grounding Organization (RRGO), Kigali, Rwanda
| | - Donat Rusengamihigo
- Department of Clinical Psychology, University of Picardy Jules Verne, Amiens, France
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Emmanuel I, Abaniwo S, Nzekwe P, Richard SK, Abobarin O, Longwap A, Joseph A. Laboratory Turnaround Time of Surgical Biopsies at a Histopathology Service in Nigeria. Niger Med J 2020; 61:180-183. [PMID: 33284886 PMCID: PMC7688028 DOI: 10.4103/nmj.nmj_173_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/25/2020] [Accepted: 07/10/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction Laboratory turnaround time is defined as the time between the receipt of a sample in the laboratory and when the report is ready for collection/dispatch. It is a critical component of the quality assurance of a laboratory and has been identified as a key performance indicator of laboratory performance. This study is aimed at evaluating the turnround time in the histopathology unit of our center and comparing the findings with that of similar studies. Methodology This was a prospective descriptive study of the first 500 consecutive samples of surgical biopsies submitted for analyses at the Histopathology Department of the Jos University Teaching Hospital. The samples were tracked from the reception desk, where they are submitted to the dispatch point where the results are collected by clients. The grossing time (T1), processing time (T2), reporting time (T3), and the transcription time (T4) were recorded for each sample. The data obtained were analyzed using SPSS software and presented as simple frequencies and percentages. Results The mean laboratory turnaround time was 7.5 + 9.7 days with a range of 3-18 days. As much as 20.8% of reports were ready for dispatch by day 3 and 100% by day 18. Overall, the grossing time (T1), processing time (T2), reporting time (T3), and transcription (T4) time consumed 17.5%, 35.5%, 27.7%, and 19.3% of the total time spent, respectively. Conclusion We recommend the development of practicable targets for the histopathology laboratories as regards timeliness. This should be regularly evaluated to ensure compliance and improvement of service quality in this regard.
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Affiliation(s)
- Innocent Emmanuel
- Department of Histopathology, University of Jos, Jos, Nigeria.,Department of Histopathology, Jos University Teaching Hospital, Jos, Nigeria
| | - Samuel Abaniwo
- Department of Histopathology, Jos University Teaching Hospital, Jos, Nigeria
| | - Patrick Nzekwe
- Department of Histopathology, Jos University Teaching Hospital, Jos, Nigeria
| | | | - Olufunmilayo Abobarin
- Department of Anatomical Pathology, Bingham University Teaching Hospital, Jos, Nigeria
| | - Abdulazis Longwap
- Department of Chemical Pathology, Bingham University Teaching Hospital, Jos, Nigeria
| | - Alhamdu Joseph
- Department of Academy and Cadets Matters, Nigerian Defence Academy, Kaduna, Nigeria
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Qu LG, Brand NR, Chao A, Ilbawi AM. Interventions Addressing Barriers to Delayed Cancer Diagnosis in Low- and Middle-Income Countries: A Systematic Review. Oncologist 2020; 25:e1382-e1395. [PMID: 32125732 DOI: 10.1634/theoncologist.2019-0804] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 01/21/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Delays to cancer diagnosis exist, resulting in worse survival outcomes for many cancers. Interventions targeting delays and barriers to cancer diagnosis and treatment have been investigated, but mostly in high-income countries. We conducted a systematic literature review to identify and characterize the interventions studied across cancers, within low- and middle-income countries (LMICs). METHODS This systematic review forms part two of a wider study examining solutions to delays and barriers in cancer early diagnosis in LMICs. A comprehensive literature search was conducted on November 27, 2017, encompassing published studies from the preceding 15 years. We extracted study design, population, and intervention, and reported outcome measures from each study. Results were presented by target of interventions (general vs. health care professionals). A narrative synthesis was used to summarize intervention efficacy. RESULTS Of 10,193 abstracts returned, 25 were included, consisting of studies across World Health Organization geographical regions, examining breast, cervix, childhood, prostate, head and neck, and gastric cancers. Altogether, 11 intervention studies targeted the general population, 12 targeted health care professionals, and 2 targeted both. The majority (17/25) of studies reported interventions focusing on patient and diagnosis-related barriers early in the cancer care pathway. Most studies reported knowledge score as primary outcome measure (17/25); few (6/25) reported on clinically relevant measures such as reducing disease stage at presentation or diagnostic time interval. Effectiveness of interventions was demonstrated for some cancers only. CONCLUSION More interventions reporting clinically relevant measures and using standardized methods and outcomes are required to improve our ability to effectively improve cancer early diagnosis in LMICs. IMPLICATIONS FOR PRACTICE Prior to this study, the extent of intervention literature in cancer early diagnosis in low- and middle-income countries had not been characterized. This study aimed to outline and characterize interventions across all cancer types and across all countries. This systematic review demonstrated that interventions have been investigated targeting both the general population and health care professionals. Furthermore, this review demonstrates that the majority of studies report knowledge as an outcome measure, rather than clinically significant measures that improve cancer-related outcomes, such as delay intervals or downstaging of disease. Future interventions should address clinically relevant measures to better assess efficacy of interventions.
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Affiliation(s)
- Liang G Qu
- Faculty of Medicine, Nursing, and Health Sciences, Monash University, Victoria, Australia
| | - Nathan R Brand
- Department of Surgery, University of California San Francisco, San Francisco, California, USA
- Vagelos College of Physicians and Surgeons at Columbia University, New York, New York, USA
| | - Ann Chao
- Center for Global Health, National Cancer Institute, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland, USA
| | - André M Ilbawi
- Management of Noncommunicable Diseases Unit, Department for Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland
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10
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Yesufe AA, Assefa M, Bekele A, Ergete W, Aynalem A, Wondemagegnehu T, Tausjø J, Assefa Tessema G, Kantelhardt EJ, Gansler T, Jemal A. Adequacy of Pathologic Reports of Invasive Breast Cancer From Mastectomy Specimens at Tikur Anbessa Specialized Hospital Oncology Center in Ethiopia. J Glob Oncol 2019; 4:1-12. [PMID: 30084708 PMCID: PMC6223529 DOI: 10.1200/jgo.17.00198] [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: 01/04/2023] Open
Abstract
Purpose Although information from pathology reports is essential to the care of individuals with cancer and to population-level cancer control, no systematic evidence exists regarding the adequacy of breast pathology reporting in Ethiopia. This study audited pathology reports of mastectomy specimens from patients evaluated at the Tikur Anbessa Specialized Hospital Oncology Center in Addis Ababa, Ethiopia. Methods Mastectomy pathology reports from February 2014 through January 2016 were assessed for gross and microscopic information considered by the Breast Cancer Initiative 2.5 (BCI 2.5; formerly the Breast Health Global Initiative) guideline to be necessary for care of patients with breast cancer stratified according to basic, limited, and enhanced resource settings. Results Fewer than two thirds (61.6%) of the 417 reports we reviewed included all four of the BCI 2.5 basic pathology data elements we could evaluate with available data (tumor category, lymph node category, histologic type, and histologic grade). Only 1.0% of reports included all three pathology data elements recommended for limited resource settings (estrogen receptor status, margin status, and lymphovascular invasion). Several elements were significantly more likely to be noted in reports from nonpublic hospitals than from public hospitals. Although only three of 417 reports included checklists or templates, all three of these reports included all of the basic pathology information, and they all included at least two of the three limited pathology elements not already on the basic list. Conclusion More than one third (38.4%) of mastectomy pathology reports did not meet BCI 2.5 standards for basic resource settings. Quality measurement and improvement programs and capacity-building interventions by national pathology and oncology organizations, collaboration with medical and public health organizations in neighboring countries, adoption of synoptic reporting templates, use of electronic pathology reporting, and histotechnology and histopathology training collaborations with laboratories in high-resource regions are recommended.
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Affiliation(s)
- Abdu A Yesufe
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Mathewos Assefa
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Abebe Bekele
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Wondwossen Ergete
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Abreha Aynalem
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Tigeneh Wondemagegnehu
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Johan Tausjø
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Gizachew Assefa Tessema
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Eva Johanna Kantelhardt
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Ted Gansler
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Ahmedin Jemal
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
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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.
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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
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Saleh M, Naik G, Mwirigi A, Shaikh AJ, Sayani S, Ghesani M, Asaria S, Sohani AR, Sayed S, Moloo Z, Budhwani KI, Talib Z. Bridging the Gap in Training and Clinical Practice in Sub-Saharan Africa. CURRENT BREAST CANCER REPORTS 2019. [DOI: 10.1007/s12609-019-00322-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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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.
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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
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Park PH, Davey S, Fehr AE, Butonzi J, Shyirambere C, Hategekimana V, Bigirimana JB, Borg R, Uwizeye R, Tapela N, Shulman LN, Randall T, Mpanumusingo E, Mpunga T. Patient Characteristics, Early Outcomes, and Implementation Lessons of Cervical Cancer Treatment Services in Rural Rwanda. J Glob Oncol 2019; 4:1-11. [PMID: 30582433 PMCID: PMC7010450 DOI: 10.1200/jgo.18.00120] [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: 12/23/2022] Open
Abstract
PURPOSE Low- and middle-income countries account for 86% of all cervical cancer cases and 88% of cervical cancer mortality globally. Successful management of cervical cancer requires resources that are scarce in sub-Saharan Africa, especially in rural settings. Here, we describe the early clinical outcomes and implementation lessons learned from the Rwanda Ministry of Health's first national cancer referral center, the Butaro Cancer Center of Excellence (BCCOE). We hypothesize that those patients presenting at earlier stage and receiving treatment will have higher rates of being alive. METHODS The implementation of cervical cancer services included developing partnerships, clinical protocols, pathology services, and tools for monitoring and evaluation. We conducted a retrospective study of patients with cervical cancer who presented at BCCOE between July 1, 2012, and June 30, 2015. Data were collected from the electronic medical record system and by manually reviewing medical records. Descriptive, bivariable and multivariable statistical analyses were conducted to describe patient demographics, disease profiles, treatment, and clinical outcomes. RESULTS In all, 373 patients met the study inclusion criteria. The median age was 53 years (interquartile rage, 45 to 60 years), and 98% were residents of Rwanda. Eighty-nine percent of patients had a documented disease stage: 3% were stage I, 48% were stage II, 29% were stage III, and 8% were stage IV at presentation. Fifty percent of patients were planned to be treated with a curative intent, and 54% were referred to chemoradiotherapy in Uganda. Forty percent of patients who received chemoradiotherapy were in remission. Overall, 25% were lost to follow-up. CONCLUSION BCCOE illustrates the feasibility and challenges of implementing effective cervical cancer treatment services in a rural setting in a low-income country.
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Affiliation(s)
- Paul H Park
- Paul H. Park, Alexandra E. Fehr, Cyprien Shyirambere, Jean Bosco Bigirimana, Ryan Borg, Regis Uwizeye, and Egide Mpanumusingo, Partners In Health/Inshuti Mu Buzima, Rwinkwavu; John Butonzi, Vedaste Hategekimana, and Tharcisse Mpunga, Butaro District Hospital, Rwanda Ministry of Health, Butaro, Rwanda; Sonya Davey and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Paul H. Park and Neo Tapela, Brigham and Women's Hospital; Paul H. Park, Harvard Medical School; Thomas Randall, Harvard Medical School, and Massachusetts General Hospital, Boston, MA; and Neo Tapela, Oxford University, Oxford, United Kingdom
| | - Sonya Davey
- Paul H. Park, Alexandra E. Fehr, Cyprien Shyirambere, Jean Bosco Bigirimana, Ryan Borg, Regis Uwizeye, and Egide Mpanumusingo, Partners In Health/Inshuti Mu Buzima, Rwinkwavu; John Butonzi, Vedaste Hategekimana, and Tharcisse Mpunga, Butaro District Hospital, Rwanda Ministry of Health, Butaro, Rwanda; Sonya Davey and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Paul H. Park and Neo Tapela, Brigham and Women's Hospital; Paul H. Park, Harvard Medical School; Thomas Randall, Harvard Medical School, and Massachusetts General Hospital, Boston, MA; and Neo Tapela, Oxford University, Oxford, United Kingdom
| | - Alexandra E Fehr
- Paul H. Park, Alexandra E. Fehr, Cyprien Shyirambere, Jean Bosco Bigirimana, Ryan Borg, Regis Uwizeye, and Egide Mpanumusingo, Partners In Health/Inshuti Mu Buzima, Rwinkwavu; John Butonzi, Vedaste Hategekimana, and Tharcisse Mpunga, Butaro District Hospital, Rwanda Ministry of Health, Butaro, Rwanda; Sonya Davey and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Paul H. Park and Neo Tapela, Brigham and Women's Hospital; Paul H. Park, Harvard Medical School; Thomas Randall, Harvard Medical School, and Massachusetts General Hospital, Boston, MA; and Neo Tapela, Oxford University, Oxford, United Kingdom
| | - John Butonzi
- Paul H. Park, Alexandra E. Fehr, Cyprien Shyirambere, Jean Bosco Bigirimana, Ryan Borg, Regis Uwizeye, and Egide Mpanumusingo, Partners In Health/Inshuti Mu Buzima, Rwinkwavu; John Butonzi, Vedaste Hategekimana, and Tharcisse Mpunga, Butaro District Hospital, Rwanda Ministry of Health, Butaro, Rwanda; Sonya Davey and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Paul H. Park and Neo Tapela, Brigham and Women's Hospital; Paul H. Park, Harvard Medical School; Thomas Randall, Harvard Medical School, and Massachusetts General Hospital, Boston, MA; and Neo Tapela, Oxford University, Oxford, United Kingdom
| | - Cyprien Shyirambere
- Paul H. Park, Alexandra E. Fehr, Cyprien Shyirambere, Jean Bosco Bigirimana, Ryan Borg, Regis Uwizeye, and Egide Mpanumusingo, Partners In Health/Inshuti Mu Buzima, Rwinkwavu; John Butonzi, Vedaste Hategekimana, and Tharcisse Mpunga, Butaro District Hospital, Rwanda Ministry of Health, Butaro, Rwanda; Sonya Davey and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Paul H. Park and Neo Tapela, Brigham and Women's Hospital; Paul H. Park, Harvard Medical School; Thomas Randall, Harvard Medical School, and Massachusetts General Hospital, Boston, MA; and Neo Tapela, Oxford University, Oxford, United Kingdom
| | - Vedaste Hategekimana
- Paul H. Park, Alexandra E. Fehr, Cyprien Shyirambere, Jean Bosco Bigirimana, Ryan Borg, Regis Uwizeye, and Egide Mpanumusingo, Partners In Health/Inshuti Mu Buzima, Rwinkwavu; John Butonzi, Vedaste Hategekimana, and Tharcisse Mpunga, Butaro District Hospital, Rwanda Ministry of Health, Butaro, Rwanda; Sonya Davey and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Paul H. Park and Neo Tapela, Brigham and Women's Hospital; Paul H. Park, Harvard Medical School; Thomas Randall, Harvard Medical School, and Massachusetts General Hospital, Boston, MA; and Neo Tapela, Oxford University, Oxford, United Kingdom
| | - Jean Bosco Bigirimana
- Paul H. Park, Alexandra E. Fehr, Cyprien Shyirambere, Jean Bosco Bigirimana, Ryan Borg, Regis Uwizeye, and Egide Mpanumusingo, Partners In Health/Inshuti Mu Buzima, Rwinkwavu; John Butonzi, Vedaste Hategekimana, and Tharcisse Mpunga, Butaro District Hospital, Rwanda Ministry of Health, Butaro, Rwanda; Sonya Davey and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Paul H. Park and Neo Tapela, Brigham and Women's Hospital; Paul H. Park, Harvard Medical School; Thomas Randall, Harvard Medical School, and Massachusetts General Hospital, Boston, MA; and Neo Tapela, Oxford University, Oxford, United Kingdom
| | - Ryan Borg
- Paul H. Park, Alexandra E. Fehr, Cyprien Shyirambere, Jean Bosco Bigirimana, Ryan Borg, Regis Uwizeye, and Egide Mpanumusingo, Partners In Health/Inshuti Mu Buzima, Rwinkwavu; John Butonzi, Vedaste Hategekimana, and Tharcisse Mpunga, Butaro District Hospital, Rwanda Ministry of Health, Butaro, Rwanda; Sonya Davey and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Paul H. Park and Neo Tapela, Brigham and Women's Hospital; Paul H. Park, Harvard Medical School; Thomas Randall, Harvard Medical School, and Massachusetts General Hospital, Boston, MA; and Neo Tapela, Oxford University, Oxford, United Kingdom
| | - Regis Uwizeye
- Paul H. Park, Alexandra E. Fehr, Cyprien Shyirambere, Jean Bosco Bigirimana, Ryan Borg, Regis Uwizeye, and Egide Mpanumusingo, Partners In Health/Inshuti Mu Buzima, Rwinkwavu; John Butonzi, Vedaste Hategekimana, and Tharcisse Mpunga, Butaro District Hospital, Rwanda Ministry of Health, Butaro, Rwanda; Sonya Davey and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Paul H. Park and Neo Tapela, Brigham and Women's Hospital; Paul H. Park, Harvard Medical School; Thomas Randall, Harvard Medical School, and Massachusetts General Hospital, Boston, MA; and Neo Tapela, Oxford University, Oxford, United Kingdom
| | - Neo Tapela
- Paul H. Park, Alexandra E. Fehr, Cyprien Shyirambere, Jean Bosco Bigirimana, Ryan Borg, Regis Uwizeye, and Egide Mpanumusingo, Partners In Health/Inshuti Mu Buzima, Rwinkwavu; John Butonzi, Vedaste Hategekimana, and Tharcisse Mpunga, Butaro District Hospital, Rwanda Ministry of Health, Butaro, Rwanda; Sonya Davey and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Paul H. Park and Neo Tapela, Brigham and Women's Hospital; Paul H. Park, Harvard Medical School; Thomas Randall, Harvard Medical School, and Massachusetts General Hospital, Boston, MA; and Neo Tapela, Oxford University, Oxford, United Kingdom
| | - Lawrence N Shulman
- Paul H. Park, Alexandra E. Fehr, Cyprien Shyirambere, Jean Bosco Bigirimana, Ryan Borg, Regis Uwizeye, and Egide Mpanumusingo, Partners In Health/Inshuti Mu Buzima, Rwinkwavu; John Butonzi, Vedaste Hategekimana, and Tharcisse Mpunga, Butaro District Hospital, Rwanda Ministry of Health, Butaro, Rwanda; Sonya Davey and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Paul H. Park and Neo Tapela, Brigham and Women's Hospital; Paul H. Park, Harvard Medical School; Thomas Randall, Harvard Medical School, and Massachusetts General Hospital, Boston, MA; and Neo Tapela, Oxford University, Oxford, United Kingdom
| | - Thomas Randall
- Paul H. Park, Alexandra E. Fehr, Cyprien Shyirambere, Jean Bosco Bigirimana, Ryan Borg, Regis Uwizeye, and Egide Mpanumusingo, Partners In Health/Inshuti Mu Buzima, Rwinkwavu; John Butonzi, Vedaste Hategekimana, and Tharcisse Mpunga, Butaro District Hospital, Rwanda Ministry of Health, Butaro, Rwanda; Sonya Davey and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Paul H. Park and Neo Tapela, Brigham and Women's Hospital; Paul H. Park, Harvard Medical School; Thomas Randall, Harvard Medical School, and Massachusetts General Hospital, Boston, MA; and Neo Tapela, Oxford University, Oxford, United Kingdom
| | - Egide Mpanumusingo
- Paul H. Park, Alexandra E. Fehr, Cyprien Shyirambere, Jean Bosco Bigirimana, Ryan Borg, Regis Uwizeye, and Egide Mpanumusingo, Partners In Health/Inshuti Mu Buzima, Rwinkwavu; John Butonzi, Vedaste Hategekimana, and Tharcisse Mpunga, Butaro District Hospital, Rwanda Ministry of Health, Butaro, Rwanda; Sonya Davey and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Paul H. Park and Neo Tapela, Brigham and Women's Hospital; Paul H. Park, Harvard Medical School; Thomas Randall, Harvard Medical School, and Massachusetts General Hospital, Boston, MA; and Neo Tapela, Oxford University, Oxford, United Kingdom
| | - Tharcisse Mpunga
- Paul H. Park, Alexandra E. Fehr, Cyprien Shyirambere, Jean Bosco Bigirimana, Ryan Borg, Regis Uwizeye, and Egide Mpanumusingo, Partners In Health/Inshuti Mu Buzima, Rwinkwavu; John Butonzi, Vedaste Hategekimana, and Tharcisse Mpunga, Butaro District Hospital, Rwanda Ministry of Health, Butaro, Rwanda; Sonya Davey and Lawrence N. Shulman, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA; Paul H. Park and Neo Tapela, Brigham and Women's Hospital; Paul H. Park, Harvard Medical School; Thomas Randall, Harvard Medical School, and Massachusetts General Hospital, Boston, MA; and Neo Tapela, Oxford University, Oxford, United Kingdom
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Morgan GW, Foster K, Healy B, Opie C, Huynh V. Improving Health and Cancer Services in Low-Resource Countries to Attain the Sustainable Development Goals Target 3.4 for Noncommunicable Diseases. J Glob Oncol 2018; 4:1-11. [PMID: 30582432 PMCID: PMC7010423 DOI: 10.1200/jgo.18.00185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The United Nations Sustainable Development Goals 2015 to 2030 includes a specific goal for health (Sustainable Development Goal [SDG] 3) with 13 targets, including SDG3.4 for the control and treatment of noncommunicable diseases (NCDs), namely, cardiovascular diseases, cancer, diabetes, and chronic lung disease. There is considerable concern that SDG3.4 may not be achieved. The WHO Best Buys for NCDs has emphasized prevention, and although crucial, it alone will not achieve the 30% reduction in NCDs by 2030. Likewise, a strengthened health system is required as all NCDs are likely to require hospital facilities and community services for optimal management. This is a major problem for low-resource countries (LRCs) -that is, low-income countries and lower-middle-income countries-as most currently have a poorly developed health system, including cancer services, in need of upgrading. This is a result of the extreme poverty of LRCs, where 40% to 80% of the population live on less than USD $1.25 per day, with the average health spending by governments in low-income countries at $110 per person per year. In this article, we outline a comprehensive national cancer services plan for LRCs. Surgery, radiotherapy, and chemotherapy for cancer treatment also require input from other specialties, such as anesthesia, pathology, laboratory medicine, a blood bank, and diagnostic radiology. This will provide a focus for adding additional specialties, including cardiology, respiratory medicine, and psychiatry, to support the management of all NCDs and to contribute to the overall strengthening of the health system. The national cancer services plan for LRCs will require significant funding and input from both in-country and overseas experts in health, cancer, and finance working collaboratively. Success will depend on thoughtful strategic planning and providing the right balance of overseas support and guidance, but ensuring that there is in-country ownership and control of the program is essential.
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Affiliation(s)
- Graeme W Morgan
- Graeme W. Morgan, Kirsty Foster, and Vu Huynh, The University of Sydney; Craig Opie, Royal North Shore Hospital, Sydney, New South Wales; and Brendan Healy, Icon Cancer Group, Brisbane, Queensland, Australia
| | - Kirsty Foster
- Graeme W. Morgan, Kirsty Foster, and Vu Huynh, The University of Sydney; Craig Opie, Royal North Shore Hospital, Sydney, New South Wales; and Brendan Healy, Icon Cancer Group, Brisbane, Queensland, Australia
| | - Brendan Healy
- Graeme W. Morgan, Kirsty Foster, and Vu Huynh, The University of Sydney; Craig Opie, Royal North Shore Hospital, Sydney, New South Wales; and Brendan Healy, Icon Cancer Group, Brisbane, Queensland, Australia
| | - Craig Opie
- Graeme W. Morgan, Kirsty Foster, and Vu Huynh, The University of Sydney; Craig Opie, Royal North Shore Hospital, Sydney, New South Wales; and Brendan Healy, Icon Cancer Group, Brisbane, Queensland, Australia
| | - Vu Huynh
- Graeme W. Morgan, Kirsty Foster, and Vu Huynh, The University of Sydney; Craig Opie, Royal North Shore Hospital, Sydney, New South Wales; and Brendan Healy, Icon Cancer Group, Brisbane, Queensland, Australia
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16
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Martin AN, Silverstein A, Ssebuufu R, Lule J, Mugenzi P, Fehr A, Mpunga T, Shulman LN, Park PH, Costas-Chavarri A. Impact of delayed care on surgical management of patients with gastric cancer in a low-resource setting. J Surg Oncol 2018; 118:1237-1242. [PMID: 30380140 DOI: 10.1002/jso.25286] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/11/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Gastric cancer is the fifth most common cancer in Eastern Africa. Diagnostic delays in low-resource countries result in advanced disease presentation. We describe perioperative management of gastric cancer in Rwanda. METHODS A retrospective review of records at three hospitals was performed to identify gastric adenocarcinoma cases from January 2012 to June 2016. Multiple perioperative and tumor-related variables were collected. Descriptive and bivariate analyses were performed. RESULTS The final analysis included 229 patients with gastric cancer. Median age was 58 years (interquartile range [IQR] 49-65) and 49.6% were female (n = 114). Patients reported symptoms (ie, weight loss, epigastric pain) for a median time of 12 months (IQR 7.5-24). On presentation, 18.8% ( n = 43) had gastric outlet obstruction; 13.5% ( n = 31) had a palpable mass. Fifty-one percent ( n = 117) underwent an operation; of these, 74% ( n = 86) received gastrojejunostomy or were inoperable; and 29% ( n = 34) underwent curative resection. Palliative care referrals were made for 9% ( n = 20). Pathology reports were available for 190 patients (83.0%). Only 11.3% ( n = 26) had Helicobacter pylori ( H. pylori) testing of which 65.4% tested positive ( n = 17). CONCLUSIONS A majority of patients presented with advanced disease. Very few patients had a curative resection. Significant advances in diagnosis and treatment are needed to improve the care of gastric cancer patients in Rwanda.
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Affiliation(s)
- Allison N Martin
- Department of Surgery, University of Virginia, Charlottesville, Virginia
| | - Allison Silverstein
- Department of Plastic Surgery, Boston Children's Hospital, Boston, Massachusetts.,Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts.,Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Robinson Ssebuufu
- Department of Surgery, Centre Hospitalier Universitaire de Butare, Butare, Rwanda
| | - Joseph Lule
- Department of Surgery, Rwanda Military Hospital, Kigali, Rwanda
| | | | | | | | - Lawrence N Shulman
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennyslavia
| | - Paul H Park
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts.,Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda.,Department of Global Health and Social Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ainhoa Costas-Chavarri
- Department of Plastic Surgery, Boston Children's Hospital, Boston, Massachusetts.,Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts.,Department of Surgery, Rwanda Military Hospital, Kigali, Rwanda
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17
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Tapela NM, Peluso MJ, Kohler RE, Setlhako II, Botebele K, Gabegwe K, Nkele I, Narasimhamurthy M, Mmalane M, Grover S, Barak T, Shulman LN, Lockman S, Dryden-Peterson S. A Step Toward Timely Referral and Early Diagnosis of Cancer: Implementation and Impact on Knowledge of a Primary Care-Based Training Program in Botswana. Front Oncol 2018; 8:187. [PMID: 29896450 PMCID: PMC5986942 DOI: 10.3389/fonc.2018.00187] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/11/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction Health system delays in diagnosis of cancer contribute to the glaring disparities in cancer mortality between high-income countries and low- and middle-income countries. In Botswana, approximately 70% of cancers are diagnosed at late stage and median time from first health facility visit for cancer-related symptoms to specialty cancer care was 160 days (IQR 59-653). We describe the implementation and early outcomes of training targeting primary care providers, which is a part of a multi-component implementation study in Kweneng-East district aiming to enhance timely diagnosis of cancers. Methods Health-care providers from all public facilities within the district were invited to participate in an 8-h intensive short-course program developed by a multidisciplinary team and adapted to the Botswana health system context. Participants' performance was assessed using a 25-multiple choice question tool, with pre- and post-assessments paired by anonymous identifier. Statistical analysis with Wilcoxon signed-rank test to compare performance at the two time points across eight sub-domains (pathophysiology, epidemiology, social context, symptoms, evaluation, treatment, documentation, follow-up). Linear regression and negative binomial modeling were used to determine change in performance. Participants' satisfaction with the program was measured on a separate survey using a 5-point Likert scale. Results 176 participants attended the training over 5 days in April 2016. Pooled linear regression controlling for test version showed an overall performance increase of 16.8% after participation (95% CI 15.2-18.4). Statistically significant improvement was observed for seven out of eight subdomains on test A and all eight subdomains on test B. Overall, 71 (40.3%) trainees achieved a score greater than 70% on the pretest, and 161 (91.5%) did so on the posttest. Participants reported a high degree of satisfaction with the training program's content and its relevance to their daily work. Conclusion We describe a successfully implemented primary health care provider-focused training component of an innovative intervention aiming to reduce health systems delays in cancer diagnosis in sub-Saharan Africa. The training achieved district-wide participation, and improvement in the knowledge of primary health-care providers in this setting. Clinical Trial Registration www.ClinicalTrials.gov, identifier NCT02752061.
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Affiliation(s)
- Neo M Tapela
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States
| | - Michael J Peluso
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States.,Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Racquel E Kohler
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Irene I Setlhako
- Princess Marina Hospital, Ministry of Health and Wellness, Gaborone, Botswana
| | | | - Kemiso Gabegwe
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Isaac Nkele
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Mohan Narasimhamurthy
- Department of Pathology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Mompati Mmalane
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Surbhi Grover
- University of Pennsylvania, Philadelphia, PA, United States.,Botswana Upenn Partnership, Gaborone, Botswana
| | - Tomer Barak
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Lawrence N Shulman
- Center for Global Cancer Medicine, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, United States
| | - Shahin Lockman
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Harvard TH Chan School of Public Health, Boston, MA, United States.,Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, United States
| | - Scott Dryden-Peterson
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Harvard TH Chan School of Public Health, Boston, MA, United States.,Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, United States
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18
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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.
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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
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19
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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: 47] [Impact Index Per Article: 7.8] [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.
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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.
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20
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Tomoka T, Montgomery ND, Powers E, Dhungel BM, Morgan EA, Mulenga M, Gopal S, Fedoriw Y. Lymphoma and Pathology in Sub-Saharan Africa: Current Approaches and Future Directions. Clin Lab Med 2018; 38:91-100. [PMID: 29412887 PMCID: PMC5999328 DOI: 10.1016/j.cll.2017.10.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The care of patients with lymphoma relies heavily on accurate tissue diagnosis and classification. In sub-Saharan Africa, where lymphoma burden is increasing because of population growth, aging, and continued epidemic levels of human immunodeficiency virus infection, diagnostic pathology services are limited. This article summarizes lymphoma epidemiology, current diagnostic capacity, and obstacles and opportunities for improving practice in the region.
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Affiliation(s)
- Tamiwe Tomoka
- UNC Project Malawi, Tidziwe Centre, Private Bag A-104, Lilongwe, Malawi
| | - 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
| | - Eric Powers
- Department of Pathology and Laboratory Medicine, The University of North Carolina School of Medicine, CB 7525, Chapel Hill, NC 27599-7525, USA
| | | | - Elizabeth A Morgan
- Brigham and Women's Hospital, 75 Francis Street, Amory Building, Boston, MA 02115, USA
| | | | - 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.
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21
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Building Laboratory Capacity to Strengthen Health Systems: The Partners In Health Experience. Clin Lab Med 2017; 38:101-117. [PMID: 29412874 DOI: 10.1016/j.cll.2017.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The diagnostic laboratory is essential to patient care and to the achievement of health equity. Through the development of quality laboratories in settings burdened by poverty and weak health systems, Partners In Health has demonstrated the critical contributions of clinical laboratories to the care of patients with HIV, tuberculosis, and cancer, among other conditions. The lessons learned through the organization's experience include the importance of well-trained and well-supported staff; reliable access to supplies, reagents, and diagnostic equipment; adequate facilities to provide diagnostic services; the integration of laboratories into networks of care; and accompaniment of the public health sector.
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22
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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.
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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
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23
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Martei YM, Narasimhamurthy M, Prabhakar P, Hutson J, Setlhako DI, Chiyapo S, Ramogola-Masire D, Makozhombwe I, Feldman M, Kayembe MKA, Grover S. Breast Cancer Pathology Turnaround Time in Botswana. J Glob Oncol 2017; 4:1-7. [PMID: 30241141 PMCID: PMC6180776 DOI: 10.1200/jgo.17.00090] [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: 01/04/2023] Open
Abstract
Purpose Quality pathology is critical for timely diagnosis and management of breast
cancer. Few studies have analyzed pathology turnaround time (TAT) in
sub-Saharan Africa. The purpose of this study was to quantify TAT for breast
cancer specimens processed by the National Health Laboratory and Diagnofirm
Laboratory in Gaborone, Botswana, and additionally compare TAT before and
after 2012 to evaluate the effect of pathology scale-up interventions by the
Ministry of Health and Wellness. Methods Retrospective analyses of TAT were performed for breast specimens submitted
to the two laboratories from 2011 to 2015. TAT was calculated as the time
from specimen collection and receipt in the laboratory to the date of final
report sign-out. Descriptive statistics and rank sum test were used to
compare temporal trends in TAT before and after 2012. Results A total of 158 breast biopsy, 219 surgical, and 218 immunohistochemistry
(IHC) specimens were analyzed. The median TAT in 2015 was 6 and 7 days for
biopsy and IHC specimens, respectively, and 57.5 days for surgical
specimens. There was a significant decrease in median TAT for biopsy
specimens from 21.5 days in 2011 to 2012 compared with 8 days in 2013 to
2015 (P < .001). There was also a significant
decrease in median TAT for IHC specimens during the same period
(P < .001). However, there was no significant
decline in median TAT for surgical specimens. Conclusion The scale-up of pathology personnel and infrastructure by the Ministry of
Health and Wellness significantly reduced median TAT for biopsy and IHC
specimens. TAT for surgical specimens remains suboptimal. Efforts are
currently under way to decrease TAT for surgical specimens to 7 days.
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Affiliation(s)
- Yehoda M Martei
- Yehoda M. Martei, Jeré Hutson, Doreen Ramogola-Masire, Michael Feldman, and Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Mohan Narasimhamurthy, Doreen Ramogola-Masire, and Mukendi K.A. Kayembe, University of Botswana; Dipho I. Setlhako and Surbhi Grover, Princess Marina Hospital; Sebathu Chiyapo, Gaborone Private Hospital; Doreen Ramogola-Masire and Surbhi Grover, Botswana University of Pennsylvania Partnership; Ignetious Makozhombwe, Diagnofirm Medical Laboratories; Mukendi K.A. Kayembe, National Health Laboratory, Gaborone, Botswana; and Pooja Prabhakar, University of Texas Southwestern Medical Center, Dallas, TX
| | - Mohan Narasimhamurthy
- Yehoda M. Martei, Jeré Hutson, Doreen Ramogola-Masire, Michael Feldman, and Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Mohan Narasimhamurthy, Doreen Ramogola-Masire, and Mukendi K.A. Kayembe, University of Botswana; Dipho I. Setlhako and Surbhi Grover, Princess Marina Hospital; Sebathu Chiyapo, Gaborone Private Hospital; Doreen Ramogola-Masire and Surbhi Grover, Botswana University of Pennsylvania Partnership; Ignetious Makozhombwe, Diagnofirm Medical Laboratories; Mukendi K.A. Kayembe, National Health Laboratory, Gaborone, Botswana; and Pooja Prabhakar, University of Texas Southwestern Medical Center, Dallas, TX
| | - Pooja Prabhakar
- Yehoda M. Martei, Jeré Hutson, Doreen Ramogola-Masire, Michael Feldman, and Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Mohan Narasimhamurthy, Doreen Ramogola-Masire, and Mukendi K.A. Kayembe, University of Botswana; Dipho I. Setlhako and Surbhi Grover, Princess Marina Hospital; Sebathu Chiyapo, Gaborone Private Hospital; Doreen Ramogola-Masire and Surbhi Grover, Botswana University of Pennsylvania Partnership; Ignetious Makozhombwe, Diagnofirm Medical Laboratories; Mukendi K.A. Kayembe, National Health Laboratory, Gaborone, Botswana; and Pooja Prabhakar, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jeré Hutson
- Yehoda M. Martei, Jeré Hutson, Doreen Ramogola-Masire, Michael Feldman, and Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Mohan Narasimhamurthy, Doreen Ramogola-Masire, and Mukendi K.A. Kayembe, University of Botswana; Dipho I. Setlhako and Surbhi Grover, Princess Marina Hospital; Sebathu Chiyapo, Gaborone Private Hospital; Doreen Ramogola-Masire and Surbhi Grover, Botswana University of Pennsylvania Partnership; Ignetious Makozhombwe, Diagnofirm Medical Laboratories; Mukendi K.A. Kayembe, National Health Laboratory, Gaborone, Botswana; and Pooja Prabhakar, University of Texas Southwestern Medical Center, Dallas, TX
| | - Dipho I Setlhako
- Yehoda M. Martei, Jeré Hutson, Doreen Ramogola-Masire, Michael Feldman, and Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Mohan Narasimhamurthy, Doreen Ramogola-Masire, and Mukendi K.A. Kayembe, University of Botswana; Dipho I. Setlhako and Surbhi Grover, Princess Marina Hospital; Sebathu Chiyapo, Gaborone Private Hospital; Doreen Ramogola-Masire and Surbhi Grover, Botswana University of Pennsylvania Partnership; Ignetious Makozhombwe, Diagnofirm Medical Laboratories; Mukendi K.A. Kayembe, National Health Laboratory, Gaborone, Botswana; and Pooja Prabhakar, University of Texas Southwestern Medical Center, Dallas, TX
| | - Sebathu Chiyapo
- Yehoda M. Martei, Jeré Hutson, Doreen Ramogola-Masire, Michael Feldman, and Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Mohan Narasimhamurthy, Doreen Ramogola-Masire, and Mukendi K.A. Kayembe, University of Botswana; Dipho I. Setlhako and Surbhi Grover, Princess Marina Hospital; Sebathu Chiyapo, Gaborone Private Hospital; Doreen Ramogola-Masire and Surbhi Grover, Botswana University of Pennsylvania Partnership; Ignetious Makozhombwe, Diagnofirm Medical Laboratories; Mukendi K.A. Kayembe, National Health Laboratory, Gaborone, Botswana; and Pooja Prabhakar, University of Texas Southwestern Medical Center, Dallas, TX
| | - Doreen Ramogola-Masire
- Yehoda M. Martei, Jeré Hutson, Doreen Ramogola-Masire, Michael Feldman, and Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Mohan Narasimhamurthy, Doreen Ramogola-Masire, and Mukendi K.A. Kayembe, University of Botswana; Dipho I. Setlhako and Surbhi Grover, Princess Marina Hospital; Sebathu Chiyapo, Gaborone Private Hospital; Doreen Ramogola-Masire and Surbhi Grover, Botswana University of Pennsylvania Partnership; Ignetious Makozhombwe, Diagnofirm Medical Laboratories; Mukendi K.A. Kayembe, National Health Laboratory, Gaborone, Botswana; and Pooja Prabhakar, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ignetious Makozhombwe
- Yehoda M. Martei, Jeré Hutson, Doreen Ramogola-Masire, Michael Feldman, and Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Mohan Narasimhamurthy, Doreen Ramogola-Masire, and Mukendi K.A. Kayembe, University of Botswana; Dipho I. Setlhako and Surbhi Grover, Princess Marina Hospital; Sebathu Chiyapo, Gaborone Private Hospital; Doreen Ramogola-Masire and Surbhi Grover, Botswana University of Pennsylvania Partnership; Ignetious Makozhombwe, Diagnofirm Medical Laboratories; Mukendi K.A. Kayembe, National Health Laboratory, Gaborone, Botswana; and Pooja Prabhakar, University of Texas Southwestern Medical Center, Dallas, TX
| | - Michael Feldman
- Yehoda M. Martei, Jeré Hutson, Doreen Ramogola-Masire, Michael Feldman, and Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Mohan Narasimhamurthy, Doreen Ramogola-Masire, and Mukendi K.A. Kayembe, University of Botswana; Dipho I. Setlhako and Surbhi Grover, Princess Marina Hospital; Sebathu Chiyapo, Gaborone Private Hospital; Doreen Ramogola-Masire and Surbhi Grover, Botswana University of Pennsylvania Partnership; Ignetious Makozhombwe, Diagnofirm Medical Laboratories; Mukendi K.A. Kayembe, National Health Laboratory, Gaborone, Botswana; and Pooja Prabhakar, University of Texas Southwestern Medical Center, Dallas, TX
| | - Mukendi K A Kayembe
- Yehoda M. Martei, Jeré Hutson, Doreen Ramogola-Masire, Michael Feldman, and Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Mohan Narasimhamurthy, Doreen Ramogola-Masire, and Mukendi K.A. Kayembe, University of Botswana; Dipho I. Setlhako and Surbhi Grover, Princess Marina Hospital; Sebathu Chiyapo, Gaborone Private Hospital; Doreen Ramogola-Masire and Surbhi Grover, Botswana University of Pennsylvania Partnership; Ignetious Makozhombwe, Diagnofirm Medical Laboratories; Mukendi K.A. Kayembe, National Health Laboratory, Gaborone, Botswana; and Pooja Prabhakar, University of Texas Southwestern Medical Center, Dallas, TX
| | - Surbhi Grover
- Yehoda M. Martei, Jeré Hutson, Doreen Ramogola-Masire, Michael Feldman, and Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Mohan Narasimhamurthy, Doreen Ramogola-Masire, and Mukendi K.A. Kayembe, University of Botswana; Dipho I. Setlhako and Surbhi Grover, Princess Marina Hospital; Sebathu Chiyapo, Gaborone Private Hospital; Doreen Ramogola-Masire and Surbhi Grover, Botswana University of Pennsylvania Partnership; Ignetious Makozhombwe, Diagnofirm Medical Laboratories; Mukendi K.A. Kayembe, National Health Laboratory, Gaborone, Botswana; and Pooja Prabhakar, University of Texas Southwestern Medical Center, Dallas, TX
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Stalsberg H, Adjei EK, Owusu-Afriyie O, Isaksen V. Sustainable Development of Pathology in Sub-Saharan Africa: An Example From Ghana. Arch Pathol Lab Med 2017; 141:1533-1539. [DOI: 10.5858/arpa.2016-0498-oa] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Pathology services are poorly developed in Sub-Saharan Africa. Komfo Anokye Teaching Hospital in Kumasi, Ghana, asked for help from the pathology department of the University Hospital of North Norway, Tromsø.
Objective.—
To reestablish surgical pathology and cytology in an African pathology department in which these functions had ceased completely, and to develop the department into a self-supporting unit of good international standard and with the capacity to train new pathologists.
Design.—
Medical technologists from Kumasi were trained in histotechnology in Norway, they were returned to Kumasi, and they produced histologic slides that were temporarily sent to Norway for diagnosis. Two Ghanaian doctors received pathology training for 4 years in Norway. Mutual visits by pathologists and technologists from the 2 hospitals were arranged for the introduction of immunohistochemistry and cytology. Pathologists from Norway visited Kumasi for 1 month each year during 2007–2010. Microscopes and immunohistochemistry equipment were provided from Norway. Other laboratory equipment and a new building were provided by the Ghanaian hospital.
Results.—
The Ghanaian hospital had a surgical pathology service from the first project year. At 11 years after the start of the project, the services included autopsy, surgical pathology, cytopathology, frozen sections, and limited use of immunohistochemistry, and the department had 10 residents at different levels of training.
Conclusions.—
A Ghanaian pathology department that performed autopsies only was developed into a self-supported department with surgical pathology, cytology, immunohistochemistry, and frozen section service, with an active residency program and the capacity for further development that is independent from assistance abroad.
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Affiliation(s)
- Helge Stalsberg
- From the Department of Pathology, University of Tromsø (Dr Stalsberg), and the Department of Pathology, University Hospital of North Norway (Drs Stalsberg and Isaksen), Tromsø, Norway; and the Department of Pathology, Komfo Anokye Teaching Hospital, Kumasi, Ghana (Drs Adjei and Owusu-Afriyie)
| | - Ernest Kwasi Adjei
- From the Department of Pathology, University of Tromsø (Dr Stalsberg), and the Department of Pathology, University Hospital of North Norway (Drs Stalsberg and Isaksen), Tromsø, Norway; and the Department of Pathology, Komfo Anokye Teaching Hospital, Kumasi, Ghana (Drs Adjei and Owusu-Afriyie)
| | - Osei Owusu-Afriyie
- From the Department of Pathology, University of Tromsø (Dr Stalsberg), and the Department of Pathology, University Hospital of North Norway (Drs Stalsberg and Isaksen), Tromsø, Norway; and the Department of Pathology, Komfo Anokye Teaching Hospital, Kumasi, Ghana (Drs Adjei and Owusu-Afriyie)
| | - Vidar Isaksen
- From the Department of Pathology, University of Tromsø (Dr Stalsberg), and the Department of Pathology, University Hospital of North Norway (Drs Stalsberg and Isaksen), Tromsø, Norway; and the Department of Pathology, Komfo Anokye Teaching Hospital, Kumasi, Ghana (Drs Adjei and Owusu-Afriyie)
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25
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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
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26
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Randall TC, Chuang L, Orang'o E, Rosen B, Uwinkindi F, Rebbeck T, Trimble EL. Strengthening care and research for women's cancers in Sub-Saharan Africa. Gynecol Oncol Rep 2017; 21:109-113. [PMID: 28819635 PMCID: PMC5548333 DOI: 10.1016/j.gore.2017.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/26/2017] [Accepted: 06/02/2017] [Indexed: 11/29/2022] Open
Abstract
•The burden of gynecologic cancers in low resource settings is overwhelming.•Areas with the highest needs have few human resources and limited infrastructure.•Cancer specialists can best help by leveraging ongoing work to assist local leaders.
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Affiliation(s)
- Thomas C. Randall
- Division of Gynecologic Oncology, The Massachusetts General Hospital, Boston, MA, United States
- The National Cancer Institute, Center for Global Health, Rockville, MD, United States
| | - Linus Chuang
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Mount Sinai Medical Center, New York, NY, United States
| | - ElkanahOmenge Orang'o
- Department of Reproductive Health, Moi University School of Medicine, Eldoret, Kenya
| | - Barry Rosen
- Gynecologic Oncology, Beaumont Hospital, Grosse Point, MI, United States
| | | | - Timothy Rebbeck
- Epidemiology, Harvard T.H. Chan School of Public Health, Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Edward L. Trimble
- The National Cancer Institute, Center for Global Health, Rockville, MD, United States
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27
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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.
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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
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Masamba LPL, Mtonga PE, Kalilani Phiri L, Bychkovsky BL. Cancer Pathology Turnaround Time at Queen Elizabeth Central Hospital, the Largest Referral Center in Malawi for Oncology Patients. J Glob Oncol 2017; 3:734-739. [PMID: 29244984 PMCID: PMC5735957 DOI: 10.1200/jgo.2015.000257] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Purpose In all settings, a need exists for expedited pathology processing for patients with a suspected cancer diagnosis. In low- and middle-income countries (LMICs) with limited resources, processing pathology samples is particularly challenging, so the measurement of turnaround times (TATs) for pathology results is an important quality metric. We explored the pathology TAT for suspected cancer patients at Queen Elizabeth Central Hospital in Malawi to determine whether a difference exists when patients paid an out-of-pocket fee (paid for [PF] v nonpaid for [NPF]) to facilitate sample processing. Methods and Population This retrospective descriptive study included all patients with suspected cancer (N = 544) who underwent incisional and excisional biopsy in 2010 at Queen Elizabeth Central Hospital, a teaching hospital in Malawi. Data were abstracted from patient charts and administrative forms to build a database and determine the TAT for PF and NPF samples. Results The median TAT for the 544 patients was 71 days (interquartile range [IQR], 31 to 118 days). The median pathology processing time was 31 days (IQR, 15 to 52 days) and was shorter for PF versus NPF samples. The median TAT was 43 days for PF samples (IQR, 27 to 69 days) versus 101 days for NPF samples (IQR, 31 to 118 days), which was significantly different by the Wilcoxon rank sum test (P < .01). Conclusion The TAT for pathology samples among patients with suspected cancer was longer than reported for other African countries during the study period, was longer than considered acceptable in high-income countries, and differed between PF and NPF samples.
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Affiliation(s)
- Leo P L Masamba
- Leo P.L. Masamba and Petani E. Mtonga, Queen Elizabeth Central Hospital; Linda Kalilani Phiri, University of Malawi College of Medicine, Blantyre, Malawi; Brittany L. Bychkovsky, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Petani E Mtonga
- Leo P.L. Masamba and Petani E. Mtonga, Queen Elizabeth Central Hospital; Linda Kalilani Phiri, University of Malawi College of Medicine, Blantyre, Malawi; Brittany L. Bychkovsky, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Linda Kalilani Phiri
- Leo P.L. Masamba and Petani E. Mtonga, Queen Elizabeth Central Hospital; Linda Kalilani Phiri, University of Malawi College of Medicine, Blantyre, Malawi; Brittany L. Bychkovsky, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Brittany L Bychkovsky
- Leo P.L. Masamba and Petani E. Mtonga, Queen Elizabeth Central Hospital; Linda Kalilani Phiri, University of Malawi College of Medicine, Blantyre, Malawi; Brittany L. Bychkovsky, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
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Bashshur RL, Krupinski EA, Weinstein RS, Dunn MR, Bashshur N. The Empirical Foundations of Telepathology: Evidence of Feasibility and Intermediate Effects. Telemed J E Health 2017; 23:155-191. [PMID: 28170313 DOI: 10.1089/tmj.2016.0278] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Telepathology evolved from video microscopy (i.e., "television microscopy") research in the early 1950s to video microscopy used in basic research in the biological sciences to a basic diagnostic tool in telemedicine clinical applications. Its genesis can be traced to pioneering feasibility studies regarding the importance of color and other image-based parameters for rendering diagnoses and a series of studies assessing concordance of virtual slide and light microscopy diagnoses. This article documents the empirical foundations of telepathology. METHODS A selective review of the research literature during the past decade (2005-2016) was conducted using robust research design and adequate sample size as criteria for inclusion. CONCLUSIONS The evidence regarding feasibility/acceptance of telepathology and related information technology applications has been well documented for several decades. The majority of evidentiary studies focused on intermediate outcomes, as indicated by comparability between telepathology and conventional light microscopy. A consistent trend of concordance between the two modalities was observed in terms of diagnostic accuracy and reliability. Additional benefits include use of telepathology and whole slide imaging for teaching, research, and outreach to resource-limited countries. Challenges still exist, however, in terms of use of telepathology as an effective diagnostic modality in clinical practice.
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Affiliation(s)
- Rashid L Bashshur
- 1 School of Public Health, University of Michigan Health System , Ann Arbor, Michigan
| | | | | | - Matthew R Dunn
- 1 School of Public Health, University of Michigan Health System , Ann Arbor, Michigan
| | - Noura Bashshur
- 1 School of Public Health, University of Michigan Health System , Ann Arbor, Michigan
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Patel K, Strother RM, Ndiangui F, Chumba D, Jacobson W, Dodson C, Resnic MB, Strate RW, Smith JW. Development of immunohistochemistry services for cancer care in western Kenya: Implications for low- and middle-income countries. Afr J Lab Med 2016; 5:187. [PMID: 28879100 PMCID: PMC5436389 DOI: 10.4102/ajlm.v5i1.187] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 12/03/2015] [Indexed: 01/07/2023] Open
Abstract
Background Cancer is becoming a major cause of mortality in low- and middle-income countries. Unlike infectious disease, malignancy and other chronic conditions require significant supportive infrastructure for diagnostics, staging and treatment. In addition to morphologic diagnosis, diagnostic pathways in oncology frequently require immunohistochemistry (IHC) for confirmation. We present the experience of a tertiary-care hospital serving rural western Kenya, which developed and validated an IHC laboratory in support of a growing cancer care service. Objectives, methods and outcomes Over the past decade, in an academic North-South collaboration, cancer services were developed for the catchment area of Moi Teaching and Referral Hospital in western Kenya. A major hurdle to treatment of cancer in a resource-limited setting has been the lack of adequate diagnostic services. Building upon the foundations of a histology laboratory, strategic investment and training were used to develop IHC services. Key elements of success in this endeavour included: translation of resource-rich practices to a resource-limited setting, such as using manual, small-batch IHC instead of disposable- and maintenance-intensive automated machinery, engagement of outside expertise to develop reagent-efficient protocols and supporting all levels of staff to meet the requirements of an external quality assurance programme. Conclusion Development of low- and middle-income country models of services, such as the IHC laboratory presented in this paper, is critical for the infrastructure in resource-limited settings to address the growing cancer burden. We provide a low-cost model that effectively develops these necessary services in a challenging laboratory environment.
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Affiliation(s)
- Kirtika Patel
- Department of Immunology, Moi University, Eldoret, Kenya
| | | | - Francis Ndiangui
- Department of Pathology, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - David Chumba
- Department of Pathology, Moi University College of Health Sciences, Eldoret, Kenya
| | - William Jacobson
- Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Cecelia Dodson
- Histology Laboratory, Indiana University Health, Indianapolis, Indiana, United States
| | - Murray B Resnic
- Department of Pathology, Brown University, Providence, Rhode Island, United States
| | - Randall W Strate
- Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - James W Smith
- Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana, United States
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Pace LE, Shulman LN. Breast Cancer in Sub-Saharan Africa: Challenges and Opportunities to Reduce Mortality. Oncologist 2016; 21:739-44. [PMID: 27091419 DOI: 10.1634/theoncologist.2015-0429] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 01/26/2016] [Indexed: 12/13/2022] Open
Abstract
UNLABELLED : The objective of this review is to describe existing data on breast cancer incidence and mortality in low- and middle-income countries (LMICs), in particular in sub-Saharan Africa; identify the limitations of these data; and review what is known about breast cancer control strategies in sub-Saharan African countries and other LMICs. Available estimates demonstrate that breast cancer incidence and mortality are rising in LMICs, including in Africa, although high-quality data from LMICs (and particularly from sub-Saharan Africa) are largely lacking. Case fatality rates from breast cancer appear to be substantially higher in LMICs than in high-income countries. Significant challenges exist to developing breast cancer control programs in LMICs, perhaps particularly in sub-Saharan Africa, and the most effective strategies for treatment and early detection in the context of limited resources are uncertain. High-quality research on breast cancer incidence and mortality and implementation research to guide effective breast cancer control strategies in LMICs are urgently needed. Enhanced investment in breast cancer research and treatment in LMICs should be a global public health priority. IMPLICATIONS FOR PRACTICE The numbers of new cases of breast cancer, and breast cancer deaths per year, in low- and middle-income countries are rising. Engagement by the international breast cancer community is critical to reduce global disparities in breast cancer outcomes. Cancer specialists and institutions in high-income countries can serve as key partners in training initiatives, clinical care, protocol and program development, and research. This article provides an overview of what is known about breast cancer incidence, mortality, and effective strategies for breast cancer control in sub-Saharan Africa and identifies key gaps in the literature. This information can help guide priorities for engagement by the global cancer community.
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Affiliation(s)
- Lydia E Pace
- Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Lawrence N Shulman
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Pace LE, Dusengimana JMV, Hategekimana V, Habineza H, Bigirimana JB, Tapela N, Mutumbira C, Mpanumusingo E, Brock JE, Meserve E, Uwumugambi A, Dillon D, Keating NL, Shulman LN, Mpunga T. Benign and Malignant Breast Disease at Rwanda's First Public Cancer Referral Center. Oncologist 2016; 21:571-5. [PMID: 27009935 DOI: 10.1634/theoncologist.2015-0388] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 01/12/2016] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Breast cancer incidence is rising in low- and middle-income countries. Understanding the distribution of breast disease seen in clinical practice in such settings can guide early detection efforts and clinical algorithms, as well as support future monitoring of cancer detection rates and stage. PATIENTS AND METHODS We conducted a retrospective medical record review of 353 patients who presented to Butaro Cancer Center of Excellence in Rwanda with an undiagnosed breast concern during the first 18 months of the cancer program. RESULTS Eighty-two percent of patients presented with a breast mass. Of these, 55% were diagnosed with breast cancer and 36% were diagnosed with benign disease. Cancer rates were highest among women 50 years and older. Among all patients diagnosed with breast cancer, 20% had stage I or II disease at diagnosis, 46% had locally advanced (stage III) disease, and 31% had metastatic disease. CONCLUSION After the launch of Rwanda's first public cancer referral center and breast clinic, cancer detection rates were high among patients presenting with an undiagnosed breast concern. These findings will provide initial data to allow monitoring of changes in the distribution of benign and malignant disease and of cancer stage as cancer awareness and services expand nationally. IMPLICATIONS FOR PRACTICE The numbers of cases and deaths from breast cancer are rising in low-income countries. In many of these settings, health care systems to address breast problems and efficiently refer patients with symptoms concerning for cancer are rudimentary. Understanding the distribution of breast disease seen in such settings can guide early detection efforts and clinical algorithms. This study describes the characteristics of patients who came with a breast concern to Rwanda's first public cancer referral center during its first 18 months. More than half of patients with a breast mass were diagnosed with cancer; most had late-stage disease. Monitoring changes in the types of breast disease and cancer stages seen in Rwanda will be critical as breast cancer awareness and services grow.
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Affiliation(s)
- Lydia E Pace
- Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA
| | | | | | | | | | - Neo Tapela
- Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA Partners in Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | | | - Jane E Brock
- Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA
| | - Emily Meserve
- Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA
| | | | - Deborah Dillon
- Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA
| | - Nancy L Keating
- Brigham and Women's Hospital, Boston, Massachusetts, USA Harvard Medical School, Boston, Massachusetts, USA
| | - Lawrence N Shulman
- Harvard Medical School, Boston, Massachusetts, USA Partners in Health/Inshuti Mu Buzima, Kigali, Rwanda Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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Tapela NM, Mpunga T, Hedt-Gauthier B, Moore M, Mpanumusingo E, Xu MJ, Nzayisenga I, Hategekimana V, Umuhizi DG, Pace LE, Bigirimana JB, Wang J, Driscoll C, Uwizeye FR, Drobac PC, Ngoga G, Shyirambere C, Muhayimana C, Lehmann L, Shulman LN. Pursuing equity in cancer care: implementation, challenges and preliminary findings of a public cancer referral center in rural Rwanda. BMC Cancer 2016; 16:237. [PMID: 26992690 PMCID: PMC4797361 DOI: 10.1186/s12885-016-2256-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 03/08/2016] [Indexed: 11/29/2022] Open
Abstract
Background Cancer services are inaccessible in many low-income countries, and few published examples describe oncology programs within the public sector. In 2011, the Rwanda Ministry of Health (RMOH) established Butaro Cancer Center of Excellence (BCCOE) to expand cancer services nationally. In hopes of informing cancer care delivery in similar settings, we describe program-level experience implementing BCCOE, patient characteristics, and challenges encountered. Methods Butaro Cancer Center of Excellence was founded on diverse partnerships that emphasize capacity building. Services available include pathology-based diagnosis, basic imaging, chemotherapy, surgery, referral for radiotherapy, palliative care and socioeconomic access supports. Retrospective review of electronic medical records (EMR) of patients enrolled between July 1, 2012 and June 30, 2014 was conducted, supplemented by manual review of paper charts and programmatic records. Results In the program’s first 2 years, 2326 patients presented for cancer-related care. Of these, 70.5 % were female, 4.3 % children, and 74.3 % on public health insurance. In the first year, 66.3 % (n = 1144) were diagnosed with cancer. Leading adult diagnoses were breast, cervical, and skin cancer. Among children, nephroblastoma, acute lymphoblastic leukemia, and Hodgkin lymphoma were predominant. As of June 30, 2013, 95 cancer patients had died. Challenges encountered include documentation gaps and staff shortages. Conclusion Butaro Cancer Center of Excellence demonstrates that complex cancer care can be delivered in the most resource-constrained settings, accessible to vulnerable patients. Key attributes that have made BCCOE possible are: meaningful North–south partnerships, innovative task- and infrastructure-shifting, RMOH leadership, and an equity-driven agenda. Going forward, we will apply our experiences and lessons learned to further strengthen BCCOE, and employ the developed EMR system as a valuable platform to assess long-term clinical outcomes and improve care.
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Affiliation(s)
- Neo M Tapela
- Botswana Ministry of Health, Gaborone, Botswana. .,Dana-Farber/Brigham & Women's Cancer Center, Boston, USA. .,Harvard Medical School, Boston, USA. .,Division of Global Health Equity, Brigham and Women's Hospital, Boston, USA.
| | | | - Bethany Hedt-Gauthier
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda.,Dana-Farber/Brigham & Women's Cancer Center, Boston, USA.,Harvard Medical School, Boston, USA
| | - Molly Moore
- University of Vermont College of Medicine, Burlington, USA
| | | | | | | | | | | | | | | | - JingJing Wang
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | | | - Peter C Drobac
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda.,Dana-Farber/Brigham & Women's Cancer Center, Boston, USA.,Harvard Medical School, Boston, USA
| | - Gedeon Ngoga
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | | | - Leslie Lehmann
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda.,Dana-Farber/Brigham & Women's Cancer Center, Boston, USA.,Harvard Medical School, Boston, USA.,Boston Children's Hospital, Boston, USA
| | - Lawrence N Shulman
- Partners In Health/Inshuti Mu Buzima, Kigali, Rwanda.,Dana-Farber/Brigham & Women's Cancer Center, Boston, USA.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA
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Mpunga T, Hedt-Gauthier BL, Tapela N, Nshimiyimana I, Muvugabigwi G, Pritchett N, Greenberg L, Benewe O, Shulman DS, Pepoon JR, Shulman LN, Milner DA. Implementation and Validation of Telepathology Triage at Cancer Referral Center in Rural Rwanda. J Glob Oncol 2016; 2:76-82. [PMID: 28717686 PMCID: PMC5495446 DOI: 10.1200/jgo.2015.002162] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Connecting a cancer patient to the appropriate treatment requires the correct diagnosis provided in a timely manner. In resource-limited settings, the anatomic pathology bridge to efficient, accurate, and timely cancer care is often challenging. In this study, we present the first phase of an anatomic telepathology triage system, which was implemented and validated at the Butaro District Hospital in northern rural Rwanda. Methods Select cases over a 9-month period in three segments were evaluated by static image telepathology and were independently evaluated by standard glass slide histology. Each case via telepathology was classified as malignant, benign, infectious/inflammatory, or nondiagnostic and was given an exact histologic diagnosis. Results For cases triaged as appropriate for telepathology, correlation with classification and exact diagnosis demonstrated greater than 95% agreement over the study. Cases in which there was disagreement were analyzed for cause, and the triage process was adjusted to avoid future problems. Conclusion Challenges to obtaining a correct and complete diagnosis with telepathology alone included the need for immunohistochemistry, assessment of the quality of images, and the lack of images representing an entire sample. The next phase of the system will assess the effect of telepathology triage on turnaround time and the value of on-site immunohistochemistry in reducing that metric and the need for evaluation outside of telepathology.
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Affiliation(s)
- Tharcisse Mpunga
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Bethany L Hedt-Gauthier
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Neo Tapela
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Irenee Nshimiyimana
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Gaspard Muvugabigwi
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Natalie Pritchett
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Lauren Greenberg
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Origene Benewe
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - David S Shulman
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - James R Pepoon
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Lawrence N Shulman
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
| | - Danny A Milner
- , , , Ministry of Health; , , University of Rwanda; Bethany L. Hedt-Gauthier, Neo Tapela, Natalie Pritchett, , , , Partners In Health, Kigali, Rwanda; , , , Brigham and Women's Hospital; , , Boston Children's Hospital; , Dana-Farber Cancer Institute, Boston, MA; and , Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA
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Sullivan R, Alatise OI, Anderson BO, Audisio R, Autier P, Aggarwal A, Balch C, Brennan MF, Dare A, D'Cruz A, Eggermont AMM, Fleming K, Gueye SM, Hagander L, Herrera CA, Holmer H, Ilbawi AM, Jarnheimer A, Ji JF, Kingham TP, Liberman J, Leather AJM, Meara JG, Mukhopadhyay S, Murthy SS, Omar S, Parham GP, Pramesh CS, Riviello R, Rodin D, Santini L, Shrikhande SV, Shrime M, Thomas R, Tsunoda AT, van de Velde C, Veronesi U, Vijaykumar DK, Watters D, Wang S, Wu YL, Zeiton M, Purushotham A. Global cancer surgery: delivering safe, affordable, and timely cancer surgery. Lancet Oncol 2016; 16:1193-224. [PMID: 26427363 DOI: 10.1016/s1470-2045(15)00223-5] [Citation(s) in RCA: 403] [Impact Index Per Article: 50.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 08/07/2015] [Accepted: 08/07/2015] [Indexed: 12/20/2022]
Abstract
Surgery is essential for global cancer care in all resource settings. Of the 15.2 million new cases of cancer in 2015, over 80% of cases will need surgery, some several times. By 2030, we estimate that annually 45 million surgical procedures will be needed worldwide. Yet, less than 25% of patients with cancer worldwide actually get safe, affordable, or timely surgery. This Commission on global cancer surgery, building on Global Surgery 2030, has examined the state of global cancer surgery through an analysis of the burden of surgical disease and breadth of cancer surgery, economics and financing, factors for strengthening surgical systems for cancer with multiple-country studies, the research agenda, and the political factors that frame policy making in this area. We found wide equity and economic gaps in global cancer surgery. Many patients throughout the world do not have access to cancer surgery, and the failure to train more cancer surgeons and strengthen systems could result in as much as US $6.2 trillion in lost cumulative gross domestic product by 2030. Many of the key adjunct treatment modalities for cancer surgery--e.g., pathology and imaging--are also inadequate. Our analysis identified substantial issues, but also highlights solutions and innovations. Issues of access, a paucity of investment in public surgical systems, low investment in research, and training and education gaps are remarkably widespread. Solutions include better regulated public systems, international partnerships, super-centralisation of surgical services, novel surgical clinical trials, and new approaches to improve quality and scale up cancer surgical systems through education and training. Our key messages are directed at many global stakeholders, but the central message is that to deliver safe, affordable, and timely cancer surgery to all, surgery must be at the heart of global and national cancer control planning.
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Affiliation(s)
- Richard Sullivan
- Institute of Cancer Policy, King's Health Partners Comprehensive Cancer Centre, London, UK; King's Centre for Global Health, King's Health Partners and King's College London, London, UK.
| | | | - Benjamin O Anderson
- University of Washington School of Medicine, Seattle, WA, USA; Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | - Ajay Aggarwal
- Institute of Cancer Policy, King's Health Partners Comprehensive Cancer Centre, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK; London School of Hygiene & Tropical Medicine, London, UK
| | - Charles Balch
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Anna Dare
- Centre for Global Health Research, St Michael's Hospital, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Anil D'Cruz
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | | | - Kenneth Fleming
- Green Templeton College, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Trust, Oxford, UK
| | - Serigne Magueye Gueye
- University Cheikh Anta Diop, Dakar, Senegal; Grand Yoff General Hospital, Dakar, Senegal
| | - Lars Hagander
- Paediatric Surgery and Global Paediatrics, Department of Paediatrics, Lund University, Lund, Sweden
| | - Cristian A Herrera
- Cabinet of the Minister, Ministry of Health, Santiago, Chile; Department of Public Health, School of Medicine, Pontificia Universidad Católica, Santiago, Chile
| | - Hampus Holmer
- Paediatric Surgery and Global Paediatrics, Department of Paediatrics, Lund University, Lund, Sweden
| | - André M Ilbawi
- University of Texas MD Anderson Cancer Centre, Houston, TX, USA; Union for International Cancer Control, Geneva, Switzerland
| | - Anton Jarnheimer
- Paediatric Surgery and Global Paediatrics, Department of Paediatrics, Lund University, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Jia-Fu Ji
- Peking University Cancer Hospital and Institute, Beijing, China; Chinese Anti-Cancer Association, Tianjin, China
| | | | | | - Andrew J M Leather
- King's Centre for Global Health, King's Health Partners and King's College London, London, UK
| | - John G Meara
- Program in Global Surgery and Social Change, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Swagoto Mukhopadhyay
- Program in Global Surgery and Social Change, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shilpa S Murthy
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard School of Public Health, Boston, MA, USA; Department of General Surgery, Indiana University, Bloomington, IN, USA
| | | | - Groesbeck P Parham
- Department of Obstetrics and Gynecology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA; University of Zambia, Lusaka, Zambia
| | - C S Pramesh
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Robert Riviello
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard School of Public Health, Boston, MA, USA
| | - Danielle Rodin
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Luiz Santini
- INCA (Brazilian National Cancer Institute), Rio de Janeiro, Brazil
| | | | - Mark Shrime
- Program in Global Surgery and Social Change, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert Thomas
- Department of Health & Human Services, Melbourne, VIC, Australia
| | - Audrey T Tsunoda
- Gyne-Oncology Department, Barretos Cancer Hospital, Barretos, Brazil
| | - Cornelis van de Velde
- Department of Surgical Oncology, Endocrine and Gastrointestinal Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | | | | | - David Watters
- Deakin University, Geelong, VIC, Australia; Barwon Health, Geelong, VIC, Australia
| | - Shan Wang
- Peking University People's Hospital, Beijing, China; Chinese College of Surgeons, Beijing, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangzhou, China; Guangdong Academy of Medical Sciences, Guangzhou, China; Chinese Society of Clinical Oncology, Beijing, China
| | - Moez Zeiton
- Sadeq Institute, Tripoli, Libya; Trauma and Orthopaedic Rotation, North-West Deanery, Manchester, UK
| | - Arnie Purushotham
- Institute of Cancer Policy, King's Health Partners Comprehensive Cancer Centre, London, UK; King's Centre for Global Health, King's Health Partners and King's College London, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK
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Tapela NM, Mpunga T, Karema N, Nzayisenga I, Fadelu T, Uwizeye FR, Hirschhorn LR, Muhimpundu MA, Balinda JP, Amoroso C, Wagner CM, Binagwaho A, Shulman LN. Implementation Science for Global Oncology: The Imperative to Evaluate the Safety and Efficacy of Cancer Care Delivery. J Clin Oncol 2015; 34:43-52. [PMID: 26578617 DOI: 10.1200/jco.2015.61.7738] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE The development of cancer care treatment facilities in resource-constrained settings represents a challenge for many reasons. Implementation science-the assessment of how services are set up and delivered; contextual factors that affect delivery, treatment safety, toxicity, and efficacy; and where adaptations are needed-is essential if we are to understand the performance of a treatment program, know where the gaps in care exist, and design interventions in care delivery models to improve outcomes for patients. METHODS The field of implementation science in relation to cancer care delivery is reviewed, and the experiences of the integrated implementation science program at the Butaro Cancer Center of Excellence in Rwanda are described as a practical application. Implementation science of HIV and tuberculosis care delivery in similar challenging settings offers some relevant lessons. RESULTS Integrating effective implementation science into cancer care in resource-constrained settings presents many challenges, which are discussed. However, with carefully designed programs, it is possible to perform this type of research, on regular and ongoing bases, and to use the results to develop interventions to improve quality of care and patient outcomes and provide evidence for effective replication and scale-up. CONCLUSION Implementation science is both critical and feasible in evaluating, improving, and supporting effective expansion of cancer care in resource-limited settings. In ideal circumstances, it should be a prospective program, established early in the lifecycle of a new cancer treatment program and should be an integrated and continual process.
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Affiliation(s)
- Neo M Tapela
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA.
| | - Tharcisse Mpunga
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Nadine Karema
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Ignace Nzayisenga
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Temidayo Fadelu
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Frank R Uwizeye
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Lisa R Hirschhorn
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Marie Aimee Muhimpundu
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Jean Paul Balinda
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Cheryl Amoroso
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Claire M Wagner
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Agnes Binagwaho
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
| | - Lawrence N Shulman
- Neo M. Tapela and Temidayo Fadelu, Brigham and Women's Hospital; Neo M. Tapela, Temidayo Fadelu, Lisa R. Hirschhorn, and Agnes Binagwaho, Harvard Medical School; Lisa R. Hirschhorn, Ariadne Labs; Claire M. Wagner and Lawrence N. Shulman, Dana-Farber Cancer Institute, Boston, MA; Tharcisse Mpunga and Agnes Binagwaho, Rwandan Ministry of Health; Marie Aimee Muhimpundu and Jean Paul Balinda, Rwanda Biomedical Center, Kigali; Neo M. Tapela, Nadine Karema, Ignace Nzayisenga, Temidayo Fadelu, Frank R. Uwizeye, and Cheryl Amoroso, Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Claire M. Wagner, Union for International Cancer Control, Geneva, Switzerland; Agnes Binagwaho, Geisel School of Medicine, Dartmouth College, Hanover, NH; and Lawrence N. Shulman, Abramson Cancer Center, Philadelphia, PA
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Stulac S, Binagwaho A, Tapela NM, Wagner CM, Muhimpundu MA, Ngabo F, Nsanzimana S, Kayonde L, Bigirimana JB, Lessard AJ, Lehmann L, Shulman LN, Nutt CT, Drobac P, Mpunga T, Farmer PE. Capacity building for oncology programmes in sub-Saharan Africa: the Rwanda experience. Lancet Oncol 2015; 16:e405-13. [DOI: 10.1016/s1470-2045(15)00161-8] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 08/28/2014] [Accepted: 09/09/2014] [Indexed: 01/30/2023]
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Pace LE, Mpunga T, Hategekimana V, Dusengimana JMV, Habineza H, Bigirimana JB, Mutumbira C, Mpanumusingo E, Ngiruwera JP, Tapela N, Amoroso C, Shulman LN, Keating NL. Delays in Breast Cancer Presentation and Diagnosis at Two Rural Cancer Referral Centers in Rwanda. Oncologist 2015; 20:780-8. [PMID: 26032138 DOI: 10.1634/theoncologist.2014-0493] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 03/27/2015] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Breast cancer incidence is increasing in low- and middle-income countries (LMICs). Mortality/incidence ratios in LMICs are higher than in high-income countries, likely at least in part because of delayed diagnoses leading to advanced-stage presentations. In the present study, we investigated the magnitude, impact of, and risk factors for, patient and system delays in breast cancer diagnosis in Rwanda. MATERIALS AND METHODS We interviewed patients with breast complaints at two rural Rwandan hospitals providing cancer care and reviewed their medical records to determine the diagnosis, diagnosis date, and breast cancer stage. RESULTS A total of 144 patients were included in our analysis. Median total delay was 15 months, and median patient and system delays were both 5 months. In multivariate analyses, patient and system delays of ≥6 months were significantly associated with more advanced-stage disease. Adjusting for other social, demographic, and clinical characteristics, a low level of education and seeing a traditional healer first were significantly associated with a longer patient delay. Having made ≥5 health facility visits before the diagnosis was significantly associated with a longer system delay. However, being from the same district as one of the two hospitals was associated with a decreased likelihood of system delay. CONCLUSION Patients with breast cancer in Rwanda experience long patient and system delays before diagnosis; these delays increase the likelihood of more advanced-stage presentations. Educating communities and healthcare providers about breast cancer and facilitating expedited referrals could potentially reduce delays and hence mortality from breast cancer in Rwanda and similar settings. IMPLICATIONS FOR PRACTICE Breast cancer rates are increasing in low- and middle-income countries, and case fatality rates are high, in part because of delayed diagnosis and treatment. This study examined the delays experienced by patients with breast cancer at two rural Rwandan cancer facilities. Both patient delays (the interval between symptom development and the patient's first presentation to a healthcare provider) and system delays (the interval between the first presentation and diagnosis) were long. The total delays were the longest reported in published studies. Longer delays were associated with more advanced-stage disease. These findings suggest that an opportunity exists to reduce breast cancer mortality in Rwanda by addressing barriers in the community and healthcare system to promote earlier detection.
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Affiliation(s)
- Lydia E Pace
- Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Ministry of Health, Butaro, Rwanda; Partners in Health, Kigali, Rwanda; Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Tharcisse Mpunga
- Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Ministry of Health, Butaro, Rwanda; Partners in Health, Kigali, Rwanda; Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Vedaste Hategekimana
- Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Ministry of Health, Butaro, Rwanda; Partners in Health, Kigali, Rwanda; Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jean-Marie Vianney Dusengimana
- Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Ministry of Health, Butaro, Rwanda; Partners in Health, Kigali, Rwanda; Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Hamissy Habineza
- Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Ministry of Health, Butaro, Rwanda; Partners in Health, Kigali, Rwanda; Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jean Bosco Bigirimana
- Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Ministry of Health, Butaro, Rwanda; Partners in Health, Kigali, Rwanda; Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Cadet Mutumbira
- Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Ministry of Health, Butaro, Rwanda; Partners in Health, Kigali, Rwanda; Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Egide Mpanumusingo
- Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Ministry of Health, Butaro, Rwanda; Partners in Health, Kigali, Rwanda; Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jean Paul Ngiruwera
- Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Ministry of Health, Butaro, Rwanda; Partners in Health, Kigali, Rwanda; Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Neo Tapela
- Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Ministry of Health, Butaro, Rwanda; Partners in Health, Kigali, Rwanda; Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Cheryl Amoroso
- Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Ministry of Health, Butaro, Rwanda; Partners in Health, Kigali, Rwanda; Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Lawrence N Shulman
- Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Ministry of Health, Butaro, Rwanda; Partners in Health, Kigali, Rwanda; Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Nancy L Keating
- Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA; Ministry of Health, Butaro, Rwanda; Partners in Health, Kigali, Rwanda; Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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Shulman LN, Mpunga T, Tapela N, Wagner CM, Fadelu T, Binagwaho A. Bringing cancer care to the poor: experiences from Rwanda. Nat Rev Cancer 2014; 14:815-21. [PMID: 25355378 DOI: 10.1038/nrc3848] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The knowledge and tools to cure many cancer patients exist in developed countries but are unavailable to many who live in the developing world, resulting in unnecessary loss of life. Bringing cancer care to the poor, particularly to low-income countries, is a great challenge, but it is one that we believe can be met through partnerships, careful planning and a set of guiding principles. Alongside vaccinations, screening and other cancer-prevention efforts, treatment must be a central component of any cancer programme from the start. It is also critical that these programmes include implementation research to determine programmatic efficacy, where gaps in care still exist and where improvements can be made. This article discusses these issues using the example of Rwanda's expanding national cancer programme.
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Affiliation(s)
- Lawrence N Shulman
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, Massachusetts 02215, USA; and at Partners In Heath, 888 Commonwealth Avenue, third Floor, Boston, Massachusetts 02215, USA
| | - Tharcisse Mpunga
- Ministry of Health, Government of Rwanda, P.O. Box 84, Kigali, Rwanda; and at the University of Rwanda College of Medicine and Health Sciences, P.O. Box 59, Musanze, Rwanda
| | - Neo Tapela
- Partners In Health - Inshuti Mu Buzima, P.O. Box 3432, Kigali, Rwanda; and at the Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts 02115 USA
| | - Claire M Wagner
- Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, Massachusetts 02215, USA
| | - Temidayo Fadelu
- Partners In Heath - Inshuti Mu Buzima, P.O. Box 3432, Kigali, Rwanda
| | - Agnes Binagwaho
- Ministry of Health, Government of Rwanda, PO Box 84, Kigali, Rwanda; Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts 02115; and at the Geisel School of Medicine at Dartmouth, 1 Rope Ferry Road, Hanover, New Hampshire 03755, USA
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Guarner J, Fleming K. Cancer in low- and middle-income countries: where to start? Is it pathology? Am J Clin Pathol 2014; 142:435-6. [PMID: 25239408 DOI: 10.1309/ajcpm9xq4yhuwbec] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- Jeannette Guarner
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | - Kenneth Fleming
- Royal College of Pathologists, London, England, and Green Templeton College, University of Oxford, Oxford, England
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