Implementation of a population-based cancer registry network in Mexico 2017-2020

The growing cancer burden particularly among less developed countries requires local data to plan and evaluate cancer control measures. This article describes the development of a population-based cancer registry network (PBCRN) in Mexico that took place between 2017 and 2020 and present related data. The PBCRN, led by the National Cancer Institute (Incan), included nine registries representing 11.3% of the Mexican population. Definitions, coding, and operative processes were based on international standards. All cities were visited to set up local structure; personnel were hired by Incan and trained in basic cancer registration in Merida. A specific software was developed. Regular virtual meetings took place for data verification and quality control. Data collection included institutions of the public and private health system. Personnel included 34 registrars, nine local leaders, and 12 staff members at the Incan. A total of 13 517 cases were recorded between 2017-2020, 64% percent of them were among females. Breast cancer was the more frequent malignancy (23.3%), followed by digestive organs with (18.4%) and female genital cancers (13.5%). Childhood (0-14 years) and adolescents cancer represented 4.4% of the total new cancer cases. The network was suspended in 2020. The present effort lacked sustainability and data were only partial. However, the experience provides valuable insights to be considered for the renewed cancer registration efforts that are currently ongoing in Mexico.

The Golden Hour: Sustainability and Clinical Outcomes of Adequate Time to Antibiotic Administration in Children with Cancer and Febrile Neutropenia in Northwestern Mexico

PURPOSE

Time to antibiotic administration (TTA) is a commonly used standard of care in pediatric cancer settings in high-income countries. Effective interventions to improve outcomes in cancer patients with febrile neutropenia (FN) often address timely and appropriate antibiotic administration. We assessed the effectiveness of a locally adapted multimodal strategy in decreasing TTA in a resource-constrained pediatric cancer center in Mexico.

METHODS

We conducted a prospective observational study between January 2014 and April 2019. A three-phase (phase I: execution, phase II: consolidation, phase III: sustainability) multimodal improvement strategy that combined system change, FN guideline development, education, auditing and monitoring, mentoring, and dissemination was implemented to decrease TTA in inpatient and ambulatory areas. Sustainability factors were measured by using a validated tool during phases I and III.

RESULTS

Our population included 105 children with cancer with 204 FN events. The baseline assessment revealed that only 50% of patients received antibiotics within 60 minutes of prescription (median time: inpatient, 75 minutes; ambulatory, 65 minutes). After implementing our improvement strategy, the percentage of patients receiving antibiotics within 60 minutes of prescription increased to 88%. We significantly decreased median TTA in both clinical areas during the three phases of the study. In phase III (sustainability), the median TTA was 40 minutes (P = .023) in the inpatient area and 30 minutes (P = .012) in the ambulatory area. The proportion of patients with sepsis decreased from 30% (baseline) to 5% (phase III) (P = .001).

CONCLUSION

Our results demonstrate that locally adapted multimodal interventions can reduce TTA in resource-constrained settings. Mentoring and dissemination were novel components of the multimodal strategy to improve FN-associated clinical outcomes. Improving local infrastructure, ongoing monitoring systems, and leadership engagement have been key factors to achieving sustainability during the 5-year period.