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McLeod M, Torode J, Leung K, Bhoo-Pathy N, Booth C, Chakowa J, Gralow J, Ilbawi A, Jassem J, Parkes J, Mallafré-Larrosa M, Mutebi M, Pramesh CS, Sengar M, Tsunoda A, Unger-Saldaña K, Vanderpuye V, Yusuf A, Sullivan R, Aggarwal A. Quality indicators for evaluating cancer care in low-income and middle-income country settings: a multinational modified Delphi study. Lancet Oncol 2024; 25:e63-e72. [PMID: 38301704 DOI: 10.1016/s1470-2045(23)00568-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 02/03/2024]
Abstract
This Policy Review sourced opinions from experts in cancer care across low-income and middle-income countries (LMICs) to build consensus around high-priority measures of care quality. A comprehensive list of quality indicators in medical, radiation, and surgical oncology was identified from systematic literature reviews. A modified Delphi study consisting of three 90-min workshops and two international electronic surveys integrating a global range of key clinical, policy, and research leaders was used to derive consensus on cancer quality indicators that would be both feasible to collect and were high priority for cancer care systems in LMICs. Workshop participants narrowed the list of 216 quality indicators from the literature review to 34 for inclusion in the subsequent surveys. Experts' responses to the surveys showed consensus around nine high-priority quality indicators for measuring the quality of hospital-based cancer care in LMICs. These quality indicators focus on important processes of care delivery from accurate diagnosis (eg, histologic diagnosis via biopsy and TNM staging) to adequate, timely, and appropriate treatment (eg, completion of radiotherapy and appropriate surgical intervention). The core indicators selected could be used to implement systems of feedback and quality improvement.
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Affiliation(s)
- Megan McLeod
- Department of Otolaryngology, Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Julie Torode
- Institute of Cancer Policy, Centre for Cancer, Society and Public Health, King's College London, London, UK
| | - Kari Leung
- Guy's and St Thomas' NHS Trust, London, UK
| | - Nirmala Bhoo-Pathy
- Department of Clinical Epidemiology, Universiti Malaya Medical Centre, Kuala Lampar, Malaysia
| | - Christopher Booth
- Department of Medical Oncology, Queen's University, Kingston, ON, Canada
| | | | - Julie Gralow
- American Society of Clinical Oncology, Alexandria, VA, USA
| | | | - Jacek Jassem
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Jeannette Parkes
- Division of Radiation Oncology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Merixtell Mallafré-Larrosa
- City Cancer Challenge, Geneva, Switzerland; Department of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University, Nairobi, Kenya
| | - C S Pramesh
- Department of Thoracic Surgery, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Manju Sengar
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Audrey Tsunoda
- Department of Gynecologic Oncology, Pontifical Catholic University of Paraná, Curitiba, Brazil
| | | | - Verna Vanderpuye
- National Centre for Radiotherapy, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Aasim Yusuf
- Department of Gastroenterology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Peshawar, Pakistan
| | - Richard Sullivan
- Institute of Cancer Policy, Centre for Cancer, Society and Public Health, King's College London, London, UK; Global Oncology Group, Centre for Cancer, Society and Public Health, King's College London, London, UK
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Guarner J, Hale MJ, Milner DA, Nelson AM. Short Course Training on a Quality Management System for Pathologists, Trainees, and Histotechnologists During the African Pathology Assembly. Am J Clin Pathol 2023; 160:450-454. [PMID: 37418601 DOI: 10.1093/ajcp/aqad072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/26/2023] [Indexed: 07/09/2023] Open
Abstract
OBJECTIVES Provide quality management training in anatomic pathology so that slides are of adequate quality and can be interpreted. METHODS During the first African Pathology Assembly, we performed a needs assessment and knowledge quizzes, then presented 4 modules of the quality management system (personnel management, process control, sample management, and equipment) that are used to train quality in vertical programs by the World Health Organization. RESULTS Participants included 14 (34%) trainees, 14 (34%) pathologists, and 9 (22%) technologists from South Africa (11), Nigeria (6), Tanzania (4), and other countries (18). Thirty (73%) participants took the course because they had interest in the topic while 6 (15%) did it because it was recommended by a supervisor. Most participants thought that the quality of slides was medium to high in their institution and that clinicians trust results. The most frequent quality issues cited included problems from processing to staining, long turnaround times, and preanalytical issues (fixation, lack of clinical history). The average result of the knowledge quiz was 6.7 (range, 2-10) before (38 participants) the course and 8.3 (range, 5-10) after (30 participants) the course. CONCLUSIONS This assessment suggests there is a need for quality management courses in pathology in Africa.
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Affiliation(s)
- Jeannette Guarner
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, US
| | - Martin John Hale
- Division of Anatomical Pathology, School of Pathology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | | | - Ann Marie Nelson
- International Pathology and Laboratory Consulting, Joint Pathology Center, Silver Spring, MD, US
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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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Yadav K, Cree I, Field A, Vielh P, Mehrotra R. Importance of Cytopathologic Diagnosis in Early Cancer Diagnosis in Resource-Constrained Countries. JCO Glob Oncol 2022; 8:e2100337. [PMID: 35213215 PMCID: PMC8887942 DOI: 10.1200/go.21.00337] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/22/2021] [Accepted: 01/13/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The rising cancer burden in low- and middle-income countries (LMICs) stresses already weak health care systems and poses unique challenges. In resource-constrained LMICs and in circumstances where most patients must pay out of pocket for diagnostic tests, these may not be available or affordable for many. Cytopathology provides a simple, inexpensive, standardized, and low-technology diagnostic procedure that is increasingly used as an effective tool to address the hurdles faced in cancer control programs in LMICs. This review explores the potential role of cytopathology in LMICs in reducing the cancer burden. METHODS This review studied the existing literature across the globe regarding the utilization of cytopathology as a diagnostic or screening tool for various types of malignancies as well as its advantages and disadvantages, depending on the local situation. RESULTS Apart from the usefulness of cytopathology, this review also sheds light on the barriers to using cytopathology in LMICs. Most recently, SARS-CoV-2 has produced several unique challenges for cytopathology. These are being met with innovative measures to combat the effects of the pandemic and ensure the safe delivery of essential cytopathology services. CONCLUSION The usefulness of cytopathologic techniques has been demonstrated via various studies, even during the recent pandemic. If cytology is to be used appropriately, the focus needs to be on integrating it into the national cancer screening and diagnostic programs as well as providing well-trained human resources.
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Affiliation(s)
- Kavita Yadav
- Centre of Social Medicine & Community Health, JNU, New Delhi, India
| | - Ian Cree
- WHO Classification of Tumours, International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Andrew Field
- Department of Anatomical Pathology, University of NSW and Notre Dame University Medical Schools, St Vincent's Hospital, Sydney, New South Wales, Australia
| | | | - Ravi Mehrotra
- Chip Foundation, Noida, India
- Rollins School of Public Health, Emory University, Atlanta, GA
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