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Foley S, Flowers A, Hall T, Jansen MT, Burcin M. "That Was an Eye Opener for Me": Mixed-Methods Outcomes Educating Texas Community Health Workers on HPV Vaccination Using Project ECHO ®. Vaccines (Basel) 2024; 12:806. [PMID: 39066444 PMCID: PMC11281520 DOI: 10.3390/vaccines12070806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 07/11/2024] [Accepted: 07/14/2024] [Indexed: 07/28/2024] Open
Abstract
Human papillomavirus (HPV) is known to cause six different types of cancer. HPV vaccination can prevent over 90% of these cancers. Community health workers (CHWs) have the potential to drive HPV vaccination demand through education and navigation by addressing vaccine hesitancy and dis/misinformation and by reaching non-English speaking, vulnerable, or rural populations. Despite their possible reach, there is limited research on HPV vaccination education programs for CHWs. In 2020-2021, the American Cancer Society (ACS) HPV Cancer Free Texas (HPVCFT) Project implemented the eight-session Mission: HPVCFT Vaccination ECHO-CHW Program ten times. This manuscript details the program's implementation processes and outcomes. The program used the Project ECHO model and was offered in both English and Spanish. One hundred and forty-six Texan CHWs completed pre- and post-training surveys. The participants demonstrated significant HPV vaccination knowledge increases and desirable shifts in their foundational HPV vaccination beliefs, including the belief that the HPV vaccine is for cancer prevention. The participants also reported increased confidence in communicating about the HPV vaccine in the community. Improving knowledge, beliefs, and confidence in HPV vaccination is the first step in addressing concerns and increasing uptake. Future research and interventions are needed to better understand how CHWs can be more systematically linked to vaccination opportunities or provided with clearer paths for directing patients to providers that vaccinate.
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Affiliation(s)
- Shaylen Foley
- Interventions and Implementation Department, American Cancer Society, 3380 Chastain Meadows Pkwy NW, Suite 20, Kennesaw, GA 30144, USA; (A.F.); (M.B.)
| | - Ashleigh Flowers
- Interventions and Implementation Department, American Cancer Society, 3380 Chastain Meadows Pkwy NW, Suite 20, Kennesaw, GA 30144, USA; (A.F.); (M.B.)
| | - Tralisa Hall
- Interventions and Implementation Department, American Cancer Society, 3380 Chastain Meadows Pkwy NW, Suite 20, Kennesaw, GA 30144, USA; (A.F.); (M.B.)
| | | | - Michelle Burcin
- Interventions and Implementation Department, American Cancer Society, 3380 Chastain Meadows Pkwy NW, Suite 20, Kennesaw, GA 30144, USA; (A.F.); (M.B.)
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Yeh PG, Choh AC, Fisher-Hoch SP, McCormick JB, Lairson DR, Reininger BM. The association of cancer-preventive lifestyle with colonoscopy screening use in border Hispanic adults along the Texas-Mexico border. Cancer Causes Control 2024:10.1007/s10552-024-01885-1. [PMID: 38743343 DOI: 10.1007/s10552-024-01885-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/26/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE The relationship between engaging in two domains of cancer-preventive behaviors, lifestyle behaviors and colonoscopy screening, is unknown in Hispanic adults. Accordingly, the study examined the association between lifestyle and colonoscopy screening in Hispanic adults along the Texas-Mexico border, where there is suboptimal colorectal cancer prevention. METHODS Lifestyle behavior adherence and compliance with colonoscopy screening schedules were assessed using 2013-2023 data from the Cameron County Hispanic Cohorta population-based sample of Hispanic adults living along the Texas-Mexico border. The 2018 World Cancer Research Fund scoring system characterized healthy lifestyle engagement. Multivariable logistic regression quantified the association between lifestyle behaviors and colonoscopy screening. RESULTS Among 914 Hispanic adults, there was a mean adherence score of 2.5 out of 7 for recommended behaviors. Only 33.0% (95% CI 25.64-41.39%) were up-to-date with colonoscopy. Complete adherence to fruit and vegetable (AOR [adjusted odds ratio] 5.2, 95% CI 1.68-16.30; p = 0.004), fiber (AOR 2.2, 95% CI 1.06-4.37; p = 0.04), and ultra-processed foods (AOR 2.8, 95% CI 1.30-6.21; p = 0.01) consumption recommendations were associated with up-to-date colonoscopy screening. Having insurance versus being uninsured (AOR 10.8, 95% CI 3.83-30.62; p < 0.001) and having local medical care versus in Mexico (AOR 7.0, 95% CI 2.26-21.43; p < 0.001) were associated with up-to-date colonoscopy. CONCLUSIONS Adherence to dietary lifestyle recommendations was associated with being up-to-date with colonoscopy screenings. Those with poor dietary behavior are at risk for low-colonoscopy use. Improving lifestyle behaviors may complement colonoscopy promotion interventions. Healthcare accessibility influences up-to-date colonoscopy prevalence. Our findings can inform cancer prevention strategies for the Hispanic population.
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Affiliation(s)
- Paul Gerardo Yeh
- Department of Management, Policy, and Community Health, University of Texas Health Science Center School of Public Health, 1200 Pressler Street RAS E-311, Houston, TX, 77030, USA.
| | - Audrey C Choh
- Department of Epidemiology, University of Texas Health Science Center School of Public Health, Brownsville Regional Campus, Brownsville, TX, USA
| | - Susan P Fisher-Hoch
- Department of Epidemiology, University of Texas Health Science Center School of Public Health, Brownsville Regional Campus, Brownsville, TX, USA
| | - Joseph B McCormick
- Department of Epidemiology, University of Texas Health Science Center School of Public Health, Brownsville Regional Campus, Brownsville, TX, USA
| | - David R Lairson
- Department of Management, Policy, and Community Health, University of Texas Health Science Center School of Public Health, 1200 Pressler Street RAS E-311, Houston, TX, 77030, USA
| | - Belinda M Reininger
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center School of Public Health, Brownsville Regional Campus, Brownsville, TX, USA
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Allanson ER, Zafar SN, Anakwenze CP, Schmeler KM, Trimble EL, Grover S. The global burden of cervical cancer requiring surgery: database estimates. Infect Agent Cancer 2024; 19:5. [PMID: 38409082 PMCID: PMC10898027 DOI: 10.1186/s13027-023-00562-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 12/05/2023] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Scaling up surgical services for cervical cancer in low and middle income countries requires quantification of the need for those services. The aim of this study was to estimate the global burden of cervical cancer for which access to surgery is required. METHODS This was a retrospective analysis of publicly available data. Cervical cancer incidence was extracted for each country from the World Health Organization, International Agency for Research, Global Cancer Observatory. The proportion of cases requiring surgery was extrapolated from the United States Surveillance, Epidemiology and End-Result database. The need for cervical cancer surgery was tested against development indicators. RESULTS Data were available for 175 countries, representing 2.9 billion females aged 15 and over. There were approximately 566,911 women diagnosed with cervical cancer (95% CI 565,462-568,360). An estimated 56.9% of these women (322,686) would require surgery for diagnosis, treatment or palliation (95% CI 321,955 - 323,417). Cervical cancers for which surgery is required represent less than 1% of cancers in high income countries, and nearly 10% of cancers in low income countries. CONCLUSIONS At least 300,000 cervical cancer cases worldwide require access to surgical services annually. Gathering data on available cervical cancer surgery services in LMIC are a critical next step.
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Affiliation(s)
- Emma R Allanson
- The Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, WA, Australia
| | | | - Chidinma P Anakwenze
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kathleen M Schmeler
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Edward L Trimble
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Surbhi Grover
- Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, USA
- Botswana-UPENN Partnership, Gaborone, GA, Botswana
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Riano I, Contreras-Chavez P, Pabon CM, Meza K, Kiel L, Bejarano S, Florez N. An Overview of Cervical Cancer Prevention and Control in Latin America and the Caribbean Countries. Hematol Oncol Clin North Am 2024; 38:13-33. [PMID: 37330343 DOI: 10.1016/j.hoc.2023.05.012] [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] [Indexed: 06/19/2023]
Abstract
Cervical cancer is a health crisis affecting women and their families across the world. It is known that developed countries have comprehensive protocols with recommendations regarding workforce, expertise, and medical resources to address this common cancer among women. In contrast, disparities in addressing cervical cancer remain present in Latin America and Caribbean countries. Here, we reviewed the current strategies of cervical cancer prevention and control in the region.
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Affiliation(s)
- Ivy Riano
- Division of Hematology and Oncology, Dartmouth Cancer Center, Geisel School of Medicine Dartmouth, One Medical Drive, Lebanon, NH 03766, USA.
| | - Pamela Contreras-Chavez
- Division of Hematology and Oncology, Dana Farber Cancer Institute, St. Elizabeth's Medical Center, 736 Cambridge Street, Brighton, MA 02135, USA. https://twitter.com/PamChMD
| | - Cindy Medina Pabon
- Division of Hematology and Oncology, The University of Texas MD Anderson Cancer Center, Unit 0463, 1515 Holcombe Boulevard, FC11.3055, Houston, TX 77030, USA. https://twitter.com/cmpabon
| | - Kelly Meza
- Division of Internal Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA. https://twitter.com/KellyMezaMD
| | - Lauren Kiel
- Dana Farber Cancer Institute, Harvard School of Medicine, 450 Brookline Avenue - DA1230, Boston, MA 02215, USA
| | - Suyapa Bejarano
- Department of Radiation Oncology, Liga Contra el Cancer, San Pedro Sula, Honduras
| | - Narjust Florez
- Dana Farber Cancer Institute, Harvard School of Medicine, 450 Brookline Avenue - DA1230, Boston, MA 02215, USA. https://twitter.com/NarjustFlorezMD
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Booker R. Building bridges between clinic and community: Supporting patients and caregivers living in rural and remote Canada. Can Oncol Nurs J 2023; 33:509-516. [PMID: 38919591 PMCID: PMC11195820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024] Open
Abstract
Advances in the detection, diagnosis, and treatment of cancer have paralleled significant developments in the understanding of tumour biology, pathophysiology, and genomics. In spite of this, cancer remains the leading cause of death in Canada, with an estimated two in five Canadians expected to be diagnosed with cancer and one in four Canadians expected to die of cancer in their lifetime. Although Canada has a publicly funded, universal healthcare system, profound inequities exist across the country. Such inequities are often due to a multitude of intersecting factors. The focus of this paper is to review the impact of rurality on cancer care. People residing in rural and remote regions are known to have reduced access to and availability of cancer care, from prevention through diagnosis, treatment, follow-up, and palliative care. Potential strategies to mitigate the challenges associated with rurality will be discussed, including an overview of the role that nurses can play in addressing the needs of patients in rural regions. Oncology nurses are well suited to help support patients, their loved ones, and healthcare colleagues in rural settings with a view to helping improve equity in access to care, quality of care, and outcomes of care for all Canadians.
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Affiliation(s)
- Reanne Booker
- Tom Baker Cancer Centre, 1331, 29 Street NW, Calgary, Alberta T2N 4N2,
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Corcorran MA, Thornton K, Struminger B, Easterbrook P, Scott JD. Training the healthcare workforce: the global experience with telementorship for hepatitis B and hepatitis C. BMC Health Serv Res 2023; 23:824. [PMID: 37533025 PMCID: PMC10394928 DOI: 10.1186/s12913-023-09849-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 07/26/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Telementorship has emerged as an innovative strategy to decentralise medical knowledge and increase healthcare capacity across a wide range of disease processes. We report the global experience with telementorship to support healthcare workers delivering hepatitis B virus (HBV) and hepatitis C virus (HCV) care and treatment. METHODS In early 2020, we conducted a survey of HBV and HCV telementorship programmes, followed by an in-depth interview with programme leads. Programmes were eligible to participate if they were located outside of the United States (U.S.), focused on support to healthcare workers in management of HBV and/or HCV, and were affiliated with or maintained adherence to the Project ECHO model, a telementorship programme pioneered at the University of New Mexico. One programme in the U.S., focused on HCV treatment in the Native American community, was purposively sampled and invited to participate. Surveys were administered online, and all qualitative interviews were performed remotely. Descriptive statistics were calculated for survey responses, and qualitative interviews were assessed for major themes. RESULTS Eleven of 18 eligible programmes completed the survey and follow up interview. Sixty-four percent of programmes were located at regional academic medical centers. The majority of programmes (64%) were led by hepatologists. Most programmes (82%) addressed both HBV and HCV, and the remainder focused on HCV only. The median number of participating clinical spoke sites per programme was 22, and most spoke site participants were primary care providers. Most ECHO sessions were held monthly (36%) or bimonthly (27%), with sessions ranging from 45 min to 2 h in length. Programme leaders identified collective learning, empowerment and collaboration to be key strengths of their telementorship programme, while insufficient funding and a lack of protected time for telementorship leaders and participants were identified as major barriers to success. CONCLUSION The Project ECHO model for telementorship can be successfully implemented across high and low-and-middle-income countries to improve provider knowledge and experience in management of viral hepatitis. There is a tremendous opportunity to further expand upon the existing experience with telementorship to support non-specialist healthcare workers and promote elimination of viral hepatitis.
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Affiliation(s)
- Maria A Corcorran
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA.
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington School of Medicine, Harborview Medical Center, 325 9th Ave, Box 359782, Seattle, WA, 98104, USA.
| | - Karla Thornton
- Division of Infectious Diseases, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- Project ECHO, University of New Mexico, Albuquerque, NM, USA
| | - Bruce Struminger
- Division of Infectious Diseases, Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
- Project ECHO, University of New Mexico, Albuquerque, NM, USA
| | - Philippa Easterbrook
- Department of Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - John D Scott
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA, USA
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Batman S, Varon ML, San Miguel-Majors SL, Benitez Majano S, Pontremoli Salcedo M, Montealegre J, Arrossi S, Oliveira MTDC, Oliveira LHD, Luciani S, Milan J, Trimble EL, Schmeler KM, Maza M. Elimination of cervical cancer in Latin America (Project ECHO-ELA): lessons from phase one of implementation. Rev Panam Salud Publica 2023; 47:e113. [PMID: 37489237 PMCID: PMC10361421 DOI: 10.26633/rpsp.2023.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 05/02/2023] [Indexed: 07/26/2023] Open
Abstract
We describe the outcomes of The Extension for Community Healthcare Outcomes-Elimination of Cervical Cancer in The Americas (ECHO-ELA) program, which was developed as a tri-lateral cooperation between Pan American Health Organization (PAHO), the U.S. National Cancer Institute (NCI) and The University of Texas MD Anderson Cancer Center (MD Anderson). The program's purpose is to disseminate strategies for cervical cancer prevention and is structured around the three pillars of the World Health Organization's (WHO) Cervical Cancer Elimination Strategy and the associated 90-70-90 target goals. The target audience includes health authorities from Latin American and Caribbean countries, as well as PAHO's non-communicable disease Focal Points in country offices as well as clinical and public health collaborators. The virtual sessions are held in Spanish for 1.5 hours every month using the ECHO® format. From May 2020 to June 2021, 14 ECHO sessions were held with an average of 74 participants per session (range: 46 - 142). We conducted two anonymous surveys (baseline and follow up) and two focus groups. Respondents stated that the topics they learned the most about included the state of HPV vaccination in the region and strategies for implementing HPV vaccination. Identified needs included support between ECHO sessions and country-specific technical assistance. The ECHO-ELA program provides a forum for increased collaboration between countries in Latin America/Caribbean and the dissemination of best-practice strategies to reach the WHO Cervical Cancer Elimination target goals.
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Affiliation(s)
- Samantha Batman
- The University of Texas MD Anderson Cancer CenterHoustonUnited States of AmericaThe University of Texas MD Anderson Cancer Center, Houston, United States of America.
| | - Melissa Lopez Varon
- The University of Texas MD Anderson Cancer CenterHoustonUnited States of AmericaThe University of Texas MD Anderson Cancer Center, Houston, United States of America.
| | - Sandra L. San Miguel-Majors
- US National Cancer InstituteBethesdaUnited States of AmericaUS National Cancer Institute, Bethesda, United States of America.
| | - Sara Benitez Majano
- Pan American Health Organization (PAHO)Washington, DCUnited States of AmericaPan American Health Organization (PAHO), Washington, DC, United States of America.
| | - Mila Pontremoli Salcedo
- The University of Texas MD Anderson Cancer CenterHoustonUnited States of AmericaThe University of Texas MD Anderson Cancer Center, Houston, United States of America.
| | - Jane Montealegre
- Baylor College of MedicineHoustonUnited States of AmericaBaylor College of Medicine, Houston, United States of America.
| | - Silvina Arrossi
- Consejo Nacional de Investigaciones Científicas y TécnicasCentro de Estudios de Estado y SociedadBuenos AiresArgentinaConsejo Nacional de Investigaciones Científicas y Técnicas, Centro de Estudios de Estado y Sociedad, Buenos Aires, Argentina.
| | - Maria Tereza da Costa Oliveira
- Pan American Health Organization (PAHO)Washington, DCUnited States of AmericaPan American Health Organization (PAHO), Washington, DC, United States of America.
| | - Lucia H. De Oliveira
- Pan American Health Organization (PAHO)Washington, DCUnited States of AmericaPan American Health Organization (PAHO), Washington, DC, United States of America.
| | - Silvana Luciani
- Pan American Health Organization (PAHO)Washington, DCUnited States of AmericaPan American Health Organization (PAHO), Washington, DC, United States of America.
| | - Jessica Milan
- The University of Texas MD Anderson Cancer CenterHoustonUnited States of AmericaThe University of Texas MD Anderson Cancer Center, Houston, United States of America.
| | - Edward L. Trimble
- US National Cancer InstituteBethesdaUnited States of AmericaUS National Cancer Institute, Bethesda, United States of America.
| | - Kathleen M. Schmeler
- The University of Texas MD Anderson Cancer CenterHoustonUnited States of AmericaThe University of Texas MD Anderson Cancer Center, Houston, United States of America.
| | - Mauricio Maza
- Pan American Health Organization (PAHO)Washington, DCUnited States of AmericaPan American Health Organization (PAHO), Washington, DC, United States of America.
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Rueter J, Anderson EC, Graham LC, Antov A, Helbig P, Gaitor L, Bourne J, Edelman E, Reed EK, Reddi HV, Mockus S, DiPalazzo J, Lu-Emerson C, Inhorn R, Sinclair SJ, Thomas CA, Brooks PL, Rasmussen K, Han P, Liu ET. The Maine Cancer Genomics Initiative: Implementing a Community Cancer Genomics Program Across an Entire Rural State. JCO Precis Oncol 2023; 7:e2200619. [PMID: 37163717 PMCID: PMC10309567 DOI: 10.1200/po.22.00619] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/24/2023] [Accepted: 02/22/2023] [Indexed: 05/12/2023] Open
Abstract
PURPOSE The Maine Cancer Genomics Initiative (MCGI) aimed to overcome patient- and provider-level barriers to using genomic tumor testing (GTT) in rural practices by providing genomic tumor boards (GTBs), clinician education, and access to comprehensive large-panel next-generation sequencing to all patients with cancer in Maine. This paper describes the successful implementation of the initiative and three key services made operative between 2016 and 2020. METHODS A community-inclusive, hub-and-spoke approach was taken to implement the three program components: (1) a centralized GTB program; (2) a modular online education program, designed using an iterative approach with broad clinical stakeholders; and (3) GTT free of charge to clinicians and patients. Implementation timelines, participation metrics, and survey data were used to describe the rollout. RESULTS The MCGI was launched over an 18-month period at all 19 oncology practices in the State. Seventy-nine physicians (66 medical oncologists, 5 gynecologic oncologists, 1 neuro-oncologist, and 7 pediatric oncologists) enrolled on the study, representing 100% of all practicing oncologists in Maine. Between July 2017 and September 2020, 1610 patients were enrolled. A total of 515 cases were discussed by 47 (73%) clinicians in 196 GTBs. Clinicians who participated in the GTBs enrolled significantly more patients on the study, stayed in Maine, and reported less time spent in clinical patient care. CONCLUSION The MCGI was able to engage geographically and culturally disparate cancer care practices in a precision oncology program using a hub-and-spoke model. By facilitating access to GTT, structured education, and GTBs, we narrowed the gap in the implementation of precision oncology in one of the most rural states in the country.
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Affiliation(s)
| | - Eric C. Anderson
- Center for Interdisciplinary Population & Health Research (CIPHR), MaineHealth Institute for Research (MHIR), Portland, ME
- Tufts University School of Medicine, Boston, MA
| | | | | | | | | | | | - Emily Edelman
- The Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - E. Kate Reed
- The Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - Honey V. Reddi
- The Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - Susan Mockus
- The Jackson Laboratory for Genomic Medicine, Farmington, CT
| | - John DiPalazzo
- Center for Interdisciplinary Population & Health Research (CIPHR), MaineHealth Institute for Research (MHIR), Portland, ME
| | | | | | | | | | | | | | - Paul Han
- Center for Interdisciplinary Population & Health Research (CIPHR), MaineHealth Institute for Research (MHIR), Portland, ME
| | - Edison T. Liu
- The Jackson Laboratory for Genomic Medicine, Farmington, CT
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Rojas-Mezarina L, Escobar-Agreda S, Chahuara-Rojas M, Silva-Valencia J, Espinoza-Herrera DH, Reátegui-Rivera CM, Moscoso-Porras M, Quispe-Gamarra J, Ronceros G. Usability and perceptions of a one-on-one telementoring program for young physicians in rural settings of Peru: a mixed method study. BMC MEDICAL EDUCATION 2023; 23:175. [PMID: 36949455 PMCID: PMC10031997 DOI: 10.1186/s12909-023-04142-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Telementoring seems to be a promising strategy to deliver training and counselling to physicians in remote areas. In Peru, early graduated physicians must work for the Rural and Urban-Edge Health Service Program where they face important training needs. The aim of this study was to describe the usage of a one-on-one telementoring program for rural physicians and evaluate the aspects related to the perceptions of acceptability and usability. METHODS Mixed methods study on recently graduated physicians who work in rural areas and participate in the telementoring program. The program used a mobile application to connect these young doctors with specialized mentors to answer queries about real-life problems raised by working in a rural area. We summarize administrative data to assess participant characteristics and their participation in the program. Additionally, we conducted in-depth interviews to explore the perceived usability, ease of use, and reason for non-use of the telementoring program. RESULTS Of 74 physicians (mean age 25, 51.4% women) enrolled, 12 (16.2%) actively used the program and performed a total of 27 queries, which received response in an average time of 5.4 ± 6.3 h. In the interviews, the main reasons for non-use were connectivity issues, feelings of shame, and self-efficacy. For those who used the telementoring program they referred it was easy to use and solve their inquiries timely. CONCLUSIONS The implementation of a telementoring program sought to provide guidance to recently graduated physicians working in rural areas. Low use rates show that administrative and process-related deficiencies in the program implementation need to be improved.
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Affiliation(s)
- Leonardo Rojas-Mezarina
- Unidad de Telesalud, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Av. Grau 755, Cercado de Lima, 15001, Peru.
| | - Stefan Escobar-Agreda
- Unidad de Telesalud, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Av. Grau 755, Cercado de Lima, 15001, Peru
- Asociación Para El Desarrollo de La Investigación Estudiantil en Ciencias de La Salud (ADIECS), Jr. Sergio Bernales 771, Cercado de Lima, 15001, Peru
| | - Max Chahuara-Rojas
- Unidad de Telesalud, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Av. Grau 755, Cercado de Lima, 15001, Peru
| | - Javier Silva-Valencia
- Unidad de Telesalud, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Av. Grau 755, Cercado de Lima, 15001, Peru
- Asociación Para El Desarrollo de La Investigación Estudiantil en Ciencias de La Salud (ADIECS), Jr. Sergio Bernales 771, Cercado de Lima, 15001, Peru
| | - Daniel Hector Espinoza-Herrera
- Unidad de Telesalud, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Av. Grau 755, Cercado de Lima, 15001, Peru
| | - C Mahony Reátegui-Rivera
- Unidad de Telesalud, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Av. Grau 755, Cercado de Lima, 15001, Peru
- Asociación Para El Desarrollo de La Investigación Estudiantil en Ciencias de La Salud (ADIECS), Jr. Sergio Bernales 771, Cercado de Lima, 15001, Peru
| | - Miguel Moscoso-Porras
- Escuela de Medicina Humana, Universidad Continental, Av. San Carlos 1980, Huancayo, 12001, Peru
| | - Juan Quispe-Gamarra
- Unidad de Telesalud, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Av. Grau 755, Cercado de Lima, 15001, Peru
| | - Gerardo Ronceros
- Unidad de Telesalud, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Av. Grau 755, Cercado de Lima, 15001, Peru
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Daw JM, Armbruster T, Deyo Z, Walker J, Rosman LA, Sears SF, Mazzella AJ, Gehi AK. Development and Feasibility of a Primary Care Provider Training Intervention to Improve Atrial Fibrillation Management. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.21.23287553. [PMID: 36993684 PMCID: PMC10055598 DOI: 10.1101/2023.03.21.23287553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Background Disparities in atrial fibrillation (AF) care are partially attributed to inadequate access to providers with specialized training in AF. Primary care providers (PCPs) are often the sole providers of AF care in under-resourced regions. Objective To create a virtual education intervention for PCPs and evaluate its impact on use of stroke risk reduction strategies in AF patients. Methods A multi-disciplinary team mentored PCPs on AF management over 6 months using a virtual case-based training format. Surveys of participant knowledge and confidence in AF care were compared pre- and post-intervention. Hierarchical logistic regression modeling was used to evaluate change in stroke risk reduction therapies among patients seen by participants before or after training. Results Of 41 participants trained, 49% worked in family medicine, 41% internal medicine, and 10% general cardiology. Participants attended a mean of 14 one-hour sessions. Overall, appropriate use of oral anticoagulation (OAC) therapy (CHA 2 DS 2 -VASc score ≥1 men, ≥2 women) increased from 37% to 46% (p<.001) comparing patients seen pre- (n=1739) to post- (n=610) intervention. Factors independently associated with appropriate OAC use included participant training (OR 1.4, p=.002) and participant competence in AF management (by survey). Factors associated with decreased OAC use included patient age (OR 0.8 per 10 years, p=.008), nonwhite race (OR 0.7, p=.028). Provider knowledge and confidence in AF care both improved (p<.001). Conclusions A virtual case-based PCP training intervention improved use of stroke risk reduction therapy in outpatients with AF. This widely scalable intervention could improve AF care in under-resourced communities. CONDENSED ABSTRACT A virtual educational model was developed for primary care providers to improve competency in AF care in their community. Following a 6-month training intervention, the rate of appropriate oral anticoagulation (OAC) therapy among patients cared for by participating providers increased from 37% to 46% (p<.001). Among participants, knowledge and confidence in AF care improved. These findings suggest a virtual AF training intervention can improve PCP competency in AF care. This widely scalable intervention could help improve AF care in under-resourced communities.
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Katzman JG, Herring D, Wheat S, Groves RJ, Kazhe-Dominguez B, Martin C, Norsworthy K, Liu J, Lord S, Tomedi LE. Climate Change ECHO: Telementoring to Improve Climate Literacy for Health Professionals. AJPM FOCUS 2023; 2:100051. [PMID: 37789933 PMCID: PMC10546522 DOI: 10.1016/j.focus.2022.100051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Introduction Climate change is a global public health crisis. Most clinicians and public health professionals do not receive adequate education to manage and communicate climate-related health impacts to their patients. Methods From July 2021 to February 2022, the Project ECHO Climate Change and Human Health program completed 22 weekly trainings for health professionals. These virtual telementoring sessions were designed to improve both knowledge and self-efficacy about climate-related health impacts and climate change‒related communication skills. Results Between July 2021 and February 2022, a total of 804 unique participants (from 44 states and 25 countries) attended the sessions. Participants were nurses (24.7%), physicians (16.8%), and public health professionals (8.5%). They completed weekly Zoom polls measuring their knowledge and self-efficacy. On average, participants strongly agreed or agreed that they had learned skills taught in each session (average percentage of those who strongly agreed or agreed=94.6%, range=66.7%-100.0%). Participants (31%) also completed a weekly postsession survey. A total of 91% rated the sessions as excellent or very good regarding evidenced-basis, and 89% rated sessions as excellent or very good regarding improved communication skills with patients and colleagues. Conclusions Given the global climate crisis, the Climate Change and Human Health ECHO is successfully building resources and capacity for clinicians and public health professionals.
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Affiliation(s)
- Joanna G. Katzman
- Department of Neurosurgery, The University of New Mexico School of Medicine, Albuquerque, New Mexico
- Project ECHO, The University of New Mexico, Albuquerque, New Mexico
| | - David Herring
- National Oceanic and Atmospheric Administration, Silver Spring, Maryland
| | - Stefan Wheat
- Anschutz Medical Campus, University of Colorado, Aurora, Colorado
| | - Ralph J. Groves
- Office of Assistant Secretary - Indian Affairs, U.S. Department of the Interior, U.S. Public Health Service, Albuquerque, New Mexico
| | | | - Chamron Martin
- Project ECHO, The University of New Mexico, Albuquerque, New Mexico
| | - Kent Norsworthy
- Project ECHO, The University of New Mexico, Albuquerque, New Mexico
| | - Jinyang Liu
- Project ECHO, The University of New Mexico, Albuquerque, New Mexico
| | - Sabrina Lord
- Presbyterian Health System, Albuquerque, New Mexico
| | - Laura E. Tomedi
- Project ECHO, The University of New Mexico, Albuquerque, New Mexico
- College of Population Health, University of New Mexico, Albuquerque, New Mexico
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Tulsidás S, Fontes F, Brandão M, Lunet N, Carrilho C. Oncology in Mozambique: Overview of the Diagnostic, Treatment, and Research Capacity. Cancers (Basel) 2023; 15:cancers15041163. [PMID: 36831505 PMCID: PMC9953997 DOI: 10.3390/cancers15041163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/30/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023] Open
Abstract
Mozambique is one of the poorest countries worldwide, with nearly two thirds of the population living below the poverty line. Similarly to other less developed countries, there is a weak provision of health care for non-communicable diseases due to competing priorities with infectious diseases. Although the leading causes of death in Mozambique in 2019 were Acquired Immune Deficiency Syndrome/Human Immunodeficiency Virus and other sexually transmitted diseases and respiratory infections and tuberculosis, with increasing urbanization and westernization of lifestyles, deaths attributed to cancer are also on the rise. This review summarizes cancer burden, cancer prevention and screening, cancer care resources, and trends in cancer training and research in Mozambique, providing a background for the development of cancer care policies in the country.
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Affiliation(s)
- Satish Tulsidás
- Serviço de Oncologia Médica, Hospital Central de Maputo, nº 1653 Avenida Eduardo Mondlane, Maputo 1101, Mozambique
- EPIUnit–Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal
| | - Filipa Fontes
- EPIUnit–Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
- Unidade de Investigação em Enfermagem Oncológica, Centro de Investigação do Instituto Português de Oncologia do Porto, Rua Dr António Bernardino de Almeida, 4200-072 Porto, Portugal
| | - Mariana Brandão
- EPIUnit–Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Rue Meylemeersch 90, 1070 Anderlecht, Belgium
| | - Nuno Lunet
- EPIUnit–Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, n° 135, 4050-600 Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Rua Doutor Plácido da Costa, 4200-450 Porto, Portugal
| | - Carla Carrilho
- Departamento de Patologia, Faculdade de Medicina, Universidade Eduardo Mondlane, Avenida Salvador Allende, nº 702, Maputo 1101, Mozambique
- Serviço de Anatomia Patológica, Hospital Central de Maputo, Avenida Eduardo Mondlane, nº 1653, Maputo 1101, Mozambique
- Correspondence: ; Tel.: +258-823055650
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Moss JL, Stoltzfus KC, Popalis ML, Calo WA, Kraschnewski JL. Assessing the use of constructs from the consolidated framework for implementation research in U.S. rural cancer screening promotion programs: a systematic search and scoping review. BMC Health Serv Res 2023; 23:48. [PMID: 36653800 PMCID: PMC9846667 DOI: 10.1186/s12913-022-08976-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/16/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Cancer screening is suboptimal in rural areas, and interventions are needed to improve uptake. The Consolidated Framework for Implementation Research (CFIR) is a widely-used implementation science framework to optimize planning and delivery of evidence-based interventions, which may be particularly useful for screening promotion in rural areas. We examined the discussion of CFIR-defined domains and constructs in programs to improve cancer screening in rural areas. METHODS We conducted a systematic search of research databases (e.g., Medline, CINAHL) to identify studies (published through November 2022) of cancer screening promotion programs delivered in rural areas in the United States. We identified 166 records, and 15 studies were included. Next, two reviewers used a standardized abstraction tool to conduct a critical scoping review of CFIR constructs in rural cancer screening promotion programs. RESULTS Each study reported at least some CFIR domains and constructs, but studies varied in how they were reported. Broadly, constructs from the domains of Process, Intervention, and Outer setting were commonly reported, but constructs from the domains of Inner setting and Individuals were less commonly reported. The most common constructs were planning (100% of studies reporting), followed by adaptability, cosmopolitanism, and reflecting and evaluating (86.7% for each). No studies reported tension for change, self-efficacy, or opinion leader. CONCLUSIONS Leveraging CFIR in the planning and delivery of cancer screening promotion programs in rural areas can improve program implementation. Additional studies are needed to evaluate the impact of underutilized CFIR domains, i.e., Inner setting and Individuals, on cancer screening programs.
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Affiliation(s)
- Jennifer L Moss
- Penn State College of Medicine, Hershey, PA, USA.
- Department of Family and Community Medicine, Department of Public Health Sciences, Penn State College of Medicine, The Pennsylvania State University, 90 Hope Drive, #2120E, MC A172, P.O. Box 855, Hershey, PA, 17033, USA.
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Piña-Sánchez P. Human Papillomavirus: Challenges and Opportunities for the Control of Cervical Cancer. Arch Med Res 2022; 53:753-769. [PMID: 36462952 DOI: 10.1016/j.arcmed.2022.11.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/18/2022] [Indexed: 12/05/2022]
Abstract
Viruses are the most abundant and genetically diverse entities on the planet, infect all life forms and have evolved with their hosts. To date, 263 viral species have been identified that infect humans, of which only seven are considered type I oncogenic. Human papillomavirus (HPV) is the main virus associated with cancer and is responsible for practically all cases of cervical carcinoma. Screening tests for early detection have been available since the 1960s. Undoubtedly, the entailment between knowledge of HPV biology and the natural history of cervical cancer has contributed to the significant advances that have been made for its prevention since the 21st century, with the development of prophylactic vaccines and improved screening strategies. Therefore, it is possible to eradicate invasive cervical cancer as a worldwide public health problem, as proposed by the WHO with the 90-70-90 initiative based on vaccination coverage, screening, and treatment, respectively. In addition, the emerging knowledge of viral biology generates opportunities that will contribute to strengthening prevention and treatment strategies in HPV-associated neoplasms.
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Affiliation(s)
- Patricia Piña-Sánchez
- Laboratorio Molecular de Oncología, Unidad de Investigación Oncológica, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de México, México.
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Kudo K, Kudo T, Ueda S, Antoku Y, Tomimatsu S, Shiaw-Hooi H, Hisada Y, Shimizu S, Moriyama T. The administrative burden on physicians and technicians for organizing international telemedicine conferences: utility of a shared program management system in an international telemedicine network. Heliyon 2022; 8:e11297. [PMID: 36338885 PMCID: PMC9618460 DOI: 10.1016/j.heliyon.2022.e11297] [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: 07/05/2022] [Revised: 10/07/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
Abstract
Background The use of international telemedicine conferences for doctor-to-doctor education has increased following the coronavirus disease 2019 pandemic to ensure health and safety. Previous studies have shown that administrative tasks are an obstacle to promoting international telemedicine conferences but have not identified the type of system needed to alleviate this burden. Objective The Asia-Pacific Advanced Network Medical Working Group (APAN-MWG) is an international telemedicine network that includes 1171 medical institutions and 3653 members as of July 21, 2021. The APAN-MWG has supported international telemedicine conferences since 2005 and implemented a program management system in 2014. The present study explores the conference organizers' tasks and evaluates the APAN-MWG management system through a survey of organizers. Methods We developed a system called med-hok for managing conference programs, international medical institutions, and their members. We investigated all event programs using the med-hok system from June 3, 2015 to July 21, 2021. The target samples included 64 conference programs in 12 series hosted by 13 program organizers. The effectiveness of the system was evaluated using a four-point Likert scale (very good, good, poor, and very poor). The User Experience Questionnaire (UEQ) was used to assess user experience. Results The survey response rate of the program organizers, who hosted 11 different program series in 7 Asian countries, was 92% (12/13). The administrative tasks for managing the programs were primarily handled by physicians (67%, 8/12), followed by technicians (17%, 2/12). The average program scope encompassed 7 countries, 10 institutions, and 44 members. The largest program comprised 194 members from 49 institutions in 25 countries and was managed by two physicians and one technician. Most program organizers (8/12, 67%) indicated that verifying member information was the most burdensome aspect of organizing teleconferences. Over 90% of respondents positively evaluated med-hok in the following areas: "Confirmation of institution information," "Confirmation of member information," "Confirmation of technical information," "Maintaining the latest status of the program," "Announcing and publicizing the event," and "Formatting and correcting misspellings." They rated user experience positively for all aspects (attractiveness: 1.22; practical quality: 1.42; and hedonic quality: 1.24). Conclusions Many tasks of organizing casual international telemedicine conferences are handled by physicians and technicians with no operating funds or staff, unlike those in large academic conferences. The proposed system was found to help program organizers manage participants and communicate information effectively. These findings suggest that international telemedicine networks should implement an administrative support system to conduct program operations efficiently.
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Affiliation(s)
- Kuriko Kudo
- Telemedicine Development Center of Asia, International Medical Department, Kyushu University Hospital, Fukuoka, Japan
| | - Tatsuro Kudo
- Department of Information Network Engineering, Kurume Institute of Technology, Kurume, Japan
| | - Shintaro Ueda
- Telemedicine Development Center of Asia, International Medical Department, Kyushu University Hospital, Fukuoka, Japan
| | - Yasuaki Antoku
- Hospital Informatics Center, Oita University Hospital, Oita, Japan
| | - Shunta Tomimatsu
- Telemedicine Development Center of Asia, International Medical Department, Kyushu University Hospital, Fukuoka, Japan
| | - Ho Shiaw-Hooi
- Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Yukiko Hisada
- Telemedicine Development Center of Asia, International Medical Department, Kyushu University Hospital, Fukuoka, Japan
| | - Shuji Shimizu
- Telemedicine Development Center of Asia, International Medical Department, Kyushu University Hospital, Fukuoka, Japan
| | - Tomohiko Moriyama
- Telemedicine Development Center of Asia, International Medical Department, Kyushu University Hospital, Fukuoka, Japan
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Milgrom ZZ, Severance TS, Scanlon CM, Carson AT, Janota AD, Vik TA, Duwve JM, Dixon BE, Mendonca EA. An evaluation of an Extension for Community Healthcare Outcomes (ECHO) intervention in cancer prevention and survivorship care. BMC Med Inform Decis Mak 2022; 22:135. [PMID: 35581580 PMCID: PMC9112252 DOI: 10.1186/s12911-022-01874-x] [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: 11/09/2021] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
To improve cancer care in Indiana, a telementoring program using the Extension for Community Healthcare Outcomes (ECHO) model was introduced in September 2019 to promote best-practice cancer prevention, screening, and survivorship care by primary care providers (PCPs). The aim of this study was to evaluate the program’s educational outcomes in its pilot year, using Moore’s Evaluation Framework for Continuing Medical Education and focusing on the program’s impact on participants’ knowledge, confidence, and professional practice. We collected data in 22 semi-structured interviews (13 PCPs and 9 non-PCPs) and 30 anonymous one-time surveys (14 PCPs and 16 non-PCPs) from the program participants (hub and spoke site members), as well as from members of the target audience who did not participate. In the first year, average attendance at each session was 2.5 PCPs and 12 non-PCP professionals. In spite of a relatively low PCP participation, the program received very positive satisfaction scores, and participants reported improvements in knowledge, confidence, and practice. Both program participants and target audience respondents particularly valued three features of the program: its conversational format, the real-life experiences gained, and the support received from a professional interdisciplinary community. PCPs reported preferring case discussions over didactics. Our results suggest that the Cancer ECHO program has benefits over other PCP-targetted cancer control interventions and could be an effective educational means of improving cancer control capacity among PCPs and others. Further study is warranted to explain the discrepancies among study participants’ perceptions of the program’s strengths and the relatively low PCP participation before undertaking a full-scale effectiveness study.
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Affiliation(s)
- Zheng Z Milgrom
- Center for Biomedical Informatics, Regenstrief Institute, 1101 West Tenth Street, Indianapolis, IN, 46202, USA.,Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Boulevard, Indianapolis, IN, 46202, USA
| | - Tyler S Severance
- Riley Hospital for Children, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA.,Indiana University School of Medicine, 340 West Tenth Street, Fairbanks Hall, Suite 6200, Indianapolis, IN, 46202, USA
| | - Caitlin M Scanlon
- Riley Hospital for Children, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA
| | - Anyé T Carson
- Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Boulevard, Indianapolis, IN, 46202, USA
| | - Andrea D Janota
- Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Boulevard, Indianapolis, IN, 46202, USA
| | - Terry A Vik
- Riley Hospital for Children, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA.,Indiana University School of Medicine, 340 West Tenth Street, Fairbanks Hall, Suite 6200, Indianapolis, IN, 46202, USA
| | - Joan M Duwve
- Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Boulevard, Indianapolis, IN, 46202, USA.,Kansas Department of Health and Environment, Curtis State Office Building, 1000 SW Jackson St, Topeka, KS, 66612, USA
| | - Brian E Dixon
- Center for Biomedical Informatics, Regenstrief Institute, 1101 West Tenth Street, Indianapolis, IN, 46202, USA.,Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Boulevard, Indianapolis, IN, 46202, USA
| | - Eneida A Mendonca
- Center for Biomedical Informatics, Regenstrief Institute, 1101 West Tenth Street, Indianapolis, IN, 46202, USA. .,Indiana University School of Medicine, 340 West Tenth Street, Fairbanks Hall, Suite 6200, Indianapolis, IN, 46202, USA.
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Diao K, Lombe DC, Mwaba CK, Wu J, Kizub DA, Cameron CA, Chiao EY, Msadabwe SC, Lin LL. Building Capacity for Cancer Research in the Era of COVID-19: Implementation and Results From an International Virtual Clinical Research Training Program in Zambia. JCO Glob Oncol 2022; 8:e2100372. [PMID: 35594499 PMCID: PMC9173571 DOI: 10.1200/go.21.00372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The incidence of cancer in sub-Saharan Africa is increasing rapidly, yet cancer research in the region continues to lag. One contributing factor is limited exposure to clinical research among trainees. We describe implementation and results of a virtual clinical research training program for Zambian clinical oncology fellows developed jointly by the Cancer Diseases Hospital in Zambia and the MD Anderson Cancer Center to address this need.
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Affiliation(s)
- Kevin Diao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Dorothy C. Lombe
- Department of Radiation Oncology, MidCentral District Health Board, Palmerston North, New Zealand
| | | | - Juliana Wu
- University of Texas Health Science Center School of Public Health, Houston, TX
| | - Darya A. Kizub
- Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Carrie A. Cameron
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Elizabeth Y. Chiao
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Lilie L. Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Blecker S, Paul MM, Jones S, Billings J, Bouchonville MF, Hager B, Arora S, Berry CA. A Project ECHO and Community Health Worker Intervention for Patients with Diabetes. Am J Med 2022; 135:e95-e103. [PMID: 34973203 DOI: 10.1016/j.amjmed.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 12/01/2021] [Accepted: 12/05/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Both community health workers and the Project ECHO model of specialist telementoring are innovative approaches to support primary care providers in the care of complex patients with diabetes. We studied the effect of an intervention that combined these 2 approaches on glycemic control. METHODS Patients with diabetes were recruited from 10 federally qualified health centers in New Mexico. We used electronic health record (EHR) data to compare HbA1c levels prior to intervention enrollment with HbA1c levels after 3 months (early follow-up) and 12 months (late follow-up) following enrollment. We propensity matched intervention patients to comparison patients from other sites within the same electronic health records databases to estimate the average treatment effect. RESULTS Among 557 intervention patients with HbA1c data, mean HbA1c decreased from 10.5% to 9.3% in the pre- versus postintervention periods (P < .001). As compared to the comparison group, the intervention was associated with a change in HbA1c of -0.2% (95% confidence interval [CI] -0.4%-0.5%) and -0.3 (95% CI -0.5-0.0) in the early and late follow-up cohorts, respectively. The intervention was associated with a significant increase in percentage of patients with HbA1c <8% in the late follow-up cohort (8.1%, 95% CI 2.2%-13.9%) but not the early follow-up cohort (3.6%, 95% CI -1.5% to 8.7%) DISCUSSION: The intervention was associated with a substantial decrease in HbA1c in intervention patients, although this improvement was not different from matched comparison patients in early follow-up. Although combining community health workers with Project ECHO may hold promise for improving glycemic control, particularly in the longer term, further evaluations are needed.
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Affiliation(s)
- Saul Blecker
- Department of Population Health, NYU Grossman School of Medicine, New York, NY; Department of Medicine, NYU Grossman School of Medicine, New York, NY.
| | - Margaret M Paul
- Department of Population Health, NYU Grossman School of Medicine, New York, NY
| | - Simon Jones
- Department of Population Health, NYU Grossman School of Medicine, New York, NY
| | - John Billings
- Wagner School of Public Service, New York University, New York, NY
| | - Matthew F Bouchonville
- Department of Medicine, University of New Mexico School of Medicine, Albuquerque; ECHO Institute, University of New Mexico Health Sciences Center, Albuquerque
| | - Brant Hager
- ECHO Institute, University of New Mexico Health Sciences Center, Albuquerque; Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque
| | - Sanjeev Arora
- Department of Medicine, University of New Mexico School of Medicine, Albuquerque; ECHO Institute, University of New Mexico Health Sciences Center, Albuquerque
| | - Carolyn A Berry
- Department of Population Health, NYU Grossman School of Medicine, New York, NY
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Arora S, Ryals C, Rodriguez JA, Byers E, Clewett E. Leveraging Digital Technology to Reduce Cancer Care Inequities. Am Soc Clin Oncol Educ Book 2022; 42:1-8. [PMID: 35503982 DOI: 10.1200/edbk_350151] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The rise of digital technologies such as telehealth, mobile apps, electronic medical records, and telementoring for rural primary care providers could provide opportunities for improving equity in cancer care delivery and outcomes. Benefitting from new technologies requires access to broadband internet, appropriate devices (smartphones, computers, etc.) along with basic digital literacy skills to use the devices. When these requirements are not met, the likelihood of widening existing inequities in access to care increases. This article introduces opportunities for improving cancer care using health informatics systems for engaging patients and flagging bias and existing videoconferencing technology to build workforce capacity. Policy recommendations for expanding evidence-based interventions are also highlighted, with the aim of mitigating the effects of workforce shortages and reducing persistent inequities in access to and quality of care.
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Affiliation(s)
- Sanjeev Arora
- University of New Mexico Health Sciences Center, Albuquerque, NM
| | - Cleo Ryals
- Flatiron Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Emily Byers
- University of New Mexico Health Sciences Center, Albuquerque, NM
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Milgrom ZZ, Severance TS, Scanlon CM, Carson AT, Janota AD, Burns JL, Vik TA, Duwve JM, Dixon BE, Mendonca EA. Enhancing cancer prevention and survivorship care with a videoconferencing model for continuing education: a mixed-methods study to identify barriers and incentives to participation. JAMIA Open 2022; 5:ooac004. [PMID: 35178505 PMCID: PMC8846362 DOI: 10.1093/jamiaopen/ooac004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/21/2021] [Accepted: 01/31/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To enhance cancer prevention and survivorship care by local health care providers, a school of public health introduced an innovative telelearning continuing education program using the Extension for Community Healthcare Outcomes (ECHO) model. In ECHO's hub and spoke structure, synchronous videoconferencing connects frontline health professionals at various locations ("spokes") with experts at the facilitation center ("hub"). Sessions include experts' didactic presentations and case discussions led by spoke site participants. The objective of this study was to gain a better understanding of the reasons individuals choose or decline to participate in the Cancer ECHO program and to identify incentives and barriers to doing so. MATERIALS AND METHODS Study participants were recruited from the hub team, spoke site participants, and providers who attended another ECHO program but not this one. Participants chose to take a survey or be interviewed. The Consolidated Framework for Implementation Research guided qualitative data coding and analysis. RESULTS We conducted 22 semistructured interviews and collected 30 surveys. Incentives identified included the program's high-quality design, supportive learning climate, and access to information. Barriers included a lack of external incentives to participate and limited time available. Participants wanted more adaptability in program timing to fit providers' busy schedules. CONCLUSION Although the merits of the Cancer ECHO program were widely acknowledged, adaptations to facilitate participation and emphasize the program's benefits may help overcome barriers to attending. As the number of telelearning programs grows, the results of this study point to ways to expand participation and spread health benefits more widely.
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Affiliation(s)
- Zheng Z Milgrom
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Tyler S Severance
- Division of Pediatric Hematology Oncology, Riley Hospital for Children, Indianapolis, Indiana, USA
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Caitlin M Scanlon
- Division Palliative Care, Riley Hospital for Children, Indianapolis, Indiana, USA
| | - Anyé T Carson
- Dean’s Office, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Andrea D Janota
- Dean’s Office, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - John L Burns
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Terry A Vik
- Division of Pediatric Hematology Oncology, Riley Hospital for Children, Indianapolis, Indiana, USA
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Joan M Duwve
- Dean’s Office, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
- Kansas Department of Health and Environment, Topeka, Kansas, USA
| | - Brian E Dixon
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
- Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA
| | - Eneida A Mendonca
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
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21
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Crabtree-Ide C, Sevdalis N, Bellohusen P, Constine LS, Fleming F, Holub D, Rizvi I, Rodriguez J, Shayne M, Termer N, Tomaszewski K, Noyes K. Strategies for Improving Access to Cancer Services in Rural Communities: A Pre-implementation Study. FRONTIERS IN HEALTH SERVICES 2022; 2:818519. [PMID: 36925773 PMCID: PMC10012790 DOI: 10.3389/frhs.2022.818519] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/28/2022] [Indexed: 12/18/2022]
Abstract
Background Implementation science is defined as the scientific study of methods and strategies that facilitate the uptake of evidence-based practice into regular use by practitioners. Failure of implementation is more common in resource-limited settings and may contribute to health disparities between rural and urban communities. In this pre-implementation study, we aimed to (1) evaluate barriers and facilitators for implementation of guideline-concordant healthcare services for cancer patients in rural communities in Upstate New York and (2) identify key strategies for successful implementation of cancer services and supportive programs in resource-poor settings. Methods The mixed methods study was guided by the Consolidated Framework for Implementation Research (CFIR). Using engagement approaches from Community-Based Participatory Research, we collected qualitative and quantitative data to assess barriers and facilitators to implementation of rural cancer survivorship services (three focus groups, n = 43, survey n = 120). Information was collected using both in-person and web-based approaches and assessed attitude and preferences for various models of cancer care organization and delivery in rural communities. Stakeholders included cancer survivors, their families and caregivers, local public services administrators, health providers, and allied health-care professionals from rural and remote communities in Upstate New York. Data was analyzed using grounded theory. Results Responders reported preferences for cross-region team-based cancer care delivery and emphasized the importance of connecting local providers with cancer care networks and multidisciplinary teams at large urban cancer centers. The main reported barriers to rural cancer program implementation included regional variation in infrastructure and services delivery practices, inadequate number of providers/specialists, lack of integration among oncology, primary care and supportive services within the regions, and misalignment between clinical guideline recommendations and current reimbursement policies. Conclusions Our findings revealed a unique combination of community, socio-economic, financial, and workforce barriers to implementation of guideline-concordant healthcare services for cancer patients in rural communities. One strategy to overcome these barriers is to improve provider cross-region collaboration and care coordination by means of teamwork and facilitation. Augmenting implementation framework with provider team-building strategies across and within regions could improve rural provider confidence and performance, minimize chances of implementation failure, and improve continuity of care for cancer patients living in rural areas.
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Affiliation(s)
- Christina Crabtree-Ide
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Nick Sevdalis
- Center for Implementation Science, King's College London, London, United Kingdom
| | - Patricia Bellohusen
- Judy DiMarzo Cancer Survivorship Program, University of Rochester, Rochester, NY, United States
| | - Louis S. Constine
- Department of Radiation Oncology, Wilmot Cancer Institute, Rochester, NY, United States
| | - Fergal Fleming
- Surgical Health Outcomes & Research Enterprise (SHORE), University of Rochester Medical Center, Rochester, NY, United States
| | - David Holub
- Department of Family Medicine, University of Rochester, Rochester, NY, United States
| | - Irfan Rizvi
- Mid-Atlantic Permanente Medical Group, McLean, VA, United States
| | - Jennifer Rodriguez
- Livingston County Public Health Department, Mt. Morris, NY, United States
| | - Michelle Shayne
- Department of Family Medicine, University of Rochester, Rochester, NY, United States
| | - Nancy Termer
- Flatiron Healthcare Inc., New York, NY, United States
| | | | - Katia Noyes
- Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY, United States
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22
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Ko LK, Scarinci IC, Bouchard EG, Drake BF, Rodriguez EM, Chen MS, Kepka D, Kruse-Diehr AJ, Befort C, Shannon J, Farris PE, Trentham-Dietz A, Onega T. A Framework for Equitable Partnerships to Promote Cancer Prevention and Control in Rural Settings. JNCI Cancer Spectr 2022; 6:pkac017. [PMID: 35603844 PMCID: PMC8997116 DOI: 10.1093/jncics/pkac017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/29/2021] [Accepted: 01/05/2022] [Indexed: 11/24/2022] Open
Abstract
Rural populations continue to experience persistent cancer disparities compared with urban populations particularly in cancers that can be prevented or detected early through screening and vaccination. Although the National Cancer Institute and the larger cancer research community have identified rural community partnerships as the foundation for reducing the disparities, we have identified limited application of community-based participatory research in cancer prevention and control research. Guided by the Community-Based Participatory Research Conceptual Model and our collective experience, we provide a framework for a community-cancer center partnership that focuses on promoting health equity. In this commentary, we articulate that the partnership process must foster capacity for communities and cancer centers, strive for rural representation in clinical trials and biobanking, build a pipeline for dissemination and implementation research, and create a bidirectional flow of knowledge between communities and academic institutions. Authentic partnerships with rural communities should be the ultimate goal of cancer centers, and the process described in this commentary can serve as an initial platform to build capacity and continue to strive toward that goal.
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Affiliation(s)
- Linda K Ko
- Department of Health Systems and Population Health, University of Washington, Hans Rosling Center for Population Health, Seattle, WA, USA
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Isabel C Scarinci
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth G Bouchard
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Bettina F Drake
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, Alvin J. Siteman Cancer Center, St. Louis, MO, USA
| | - Elisa M Rodriguez
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Moon S Chen
- Division of Hematology and Oncology, School of Medicine, UC Davis and UC Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Deanna Kepka
- College of Nursing, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Aaron J Kruse-Diehr
- Markey Cancer Center, Cancer Prevention and Control Program, University of Kentucky College of Public Health, Lexington, KY, USA
| | - Christie Befort
- University of Kansas Medical Center, Cancer Prevention and Control, University of Kansas Cancer Center, Kansas City, KS, USA
| | - Jackilen Shannon
- Oregon Health & Science University-Portland State University School of Public Health, Knight Cancer Institute, Portland, OR, USA
| | - Paige E Farris
- Oregon Health & Science University-Portland State University School of Public Health, Knight Cancer Institute, Portland, OR, USA
| | - Amy Trentham-Dietz
- Department of Population Health Sciences and Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Tracy Onega
- Department of Population Health Sciences, University of Utah, Huntsman Cancer Institute, Salt Lake City, UT, USA
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23
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Phoolcharoen N, Varon ML, Baker E, Parra S, Carns J, Cherry K, Smith C, Sonka T, Doughtie K, Lorenzoni C, Richards-Kortum R, Schmeler K, Salcedo MP. Hands-On Training Courses for Cervical Cancer Screening, Diagnosis, and Treatment Procedures in Low- and Middle-Income Countries. JCO Glob Oncol 2022; 8:e2100214. [PMID: 34985911 PMCID: PMC8769104 DOI: 10.1200/go.21.00214] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
In 2018, there were approximately 570,000 new cases of cervical cancer worldwide. More than 85% of cases occurred in low- and middle-income countries (LMICs), primarily because of poor access to screening and a limited number of medical providers trained to diagnose and treat cervical precancerous lesions. Our objective was to provide locally arranged, hands-on training courses for medical providers in LMICs to learn to perform cervical cancer screening, diagnosis, and treatment procedures. The courses included didactic lectures and hands-on training stations using low-cost simulation models developed by bioengineers and students at Rice University in Houston, TX, United States, and the Malawi Polytechnic in Blantyre, Malawi. The hands-on training stations included visual inspection with acetic acid (VIA), colposcopy, cervical biopsy, endocervical curettage, loop electrosurgical excision procedure (LEEP), and thermal ablation. Provider pre- and postcourse confidence levels in performing the procedures were evaluated. From February 2017 to January 2020, we arranged 15 hands-on training courses in seven cities across six countries (El Salvador, Mozambique, Trinidad and Tobago, Lesotho, Malawi, and Nepal). Overall, there were 506 participants. The average number of participants per course was 38 (range 19-92). The participants included doctors, nurses, and midwives. The course duration varied from 1 to 3 days. Increased confidence in performing VIA, colposcopy and cervical biopsy, ablation, and LEEP was reported by 69%, 71%, 61%, and 76% of participants, respectively. Our findings suggest that locally arranged, hands-on cervical cancer prevention training courses in LMICs can improve provider confidence in performing cervical cancer screening, diagnosis, and treatment procedures. These courses are part of a larger strategy to build local capacity for delivering and improving cervical cancer prevention services in LMICs. Hands-on training courses improved provider confidence in cervical cancer screening, diagnostic and treatment in LMICs.![]()
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Affiliation(s)
- Natacha Phoolcharoen
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.,Department of Obstetrics and Gynecology, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Melissa Lopez Varon
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ellen Baker
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sonia Parra
- Department of Bioengineering, Rice University, Houston, TX
| | - Jennifer Carns
- Department of Bioengineering, Rice University, Houston, TX
| | - Katelin Cherry
- Department of Bioengineering, Rice University, Houston, TX
| | - Chelsey Smith
- Department of Bioengineering, Rice University, Houston, TX
| | - Theresa Sonka
- Department of Bioengineering, Rice University, Houston, TX
| | - Kathleen Doughtie
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Cesaltina Lorenzoni
- Ministério da Saúde de Moçambique (MISAU), Maputo, Mozambique.,Pathology Department, Hospital Central de Maputo, Maputo, Mozambique
| | | | - Kathleen Schmeler
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mila Pontremoli Salcedo
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.,Department of Obstetrics and Gynecology, Federal University of Health Science of Porto Alegre (UFCSPA)/Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
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24
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Cofer J, Hurst AN, Winter T, Moreno M, Cinciripini PM, Walsh MT, Tektiridis J, Hawk E. A Comprehensive Program to Reduce Tobacco-related Cancers Through Actions by a National Cancer Institute-designated Cancer Center. Cancer Control 2022; 29:10732748221138713. [DOI: 10.1177/10732748221138713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Tobacco use accounts for 30% of all cancer-related deaths worldwide and 20% in the US, despite effective, evidence-based interventions for reducing tobacco use and tobacco-related cancers and deaths. In 2012, to reduce the burden of tobacco-related cancer and associated population-level risks across Texas, The University of Texas MD Anderson Cancer Center initiated the EndTobacco® program to promote statewide cancer control activities. We created evidence-based initiatives, established selection criteria, and implemented actions involving policy, education, and tobacco treatment services. As a result, EndTobacco has supported, educated, and convened local and state coalitions in policymaking; provided tobacco treatment education to health professionals; implemented Texas’ only certified tobacco treatment training program; and led an initiative to enhance the tobacco-free culture of the state’s publicly funded university system. Supported by commitments from MD Anderson, we developed and implemented evidence-based actions for tobacco control tailored to the center’s mission, values, expertise, resources, and partnerships. By 2021, the adult smoking rate in Texas dropped from 19.2% (2014) to 13.2%. Contributors to this drop include state tobacco control policies, programs and services from multiple agencies and associations, and EndTobacco activities that complement the statewide effort to prevent youth smoking initiation and increase quit attempts among youth and adults.
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Affiliation(s)
- Jennifer Cofer
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Alex N. Hurst
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Tiffany Winter
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Mark Moreno
- Governmental Relations, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Paul M. Cinciripini
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael T Walsh
- Cancer Prevention and Control Platform, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jennifer Tektiridis
- Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ernest Hawk
- Division of Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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25
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Szkwarko D, Urbanowski ME, Thal R, Iyer P, Foley S, Randall LM, Bernardo J, Savageau JA, Cochran J. Expanding Latent Tuberculosis Infection Testing and Treatment in Massachusetts Primary Care Clinics via the ECHO Model. J Prim Care Community Health 2022; 13:21501319221119942. [PMID: 36000470 PMCID: PMC9425883 DOI: 10.1177/21501319221119942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION/OBJECTIVES In the US, reactivation of latent tuberculosis infection (LTBI) accounts for 80% of new cases. In 2016, the US Preventive Services Task Force provided a new recommendation that primary care providers (PCPs) should conduct LTBI screening, whereas in the past, LTBI cases were evaluated and treated by specialty providers. This shift in care revealed knowledge gaps surrounding LTBI treatment among PCPs. This study assessed changes in PCPs' confidence for performing key aspects of LTBI care before and after participation in an LTBI Extension for Community Healthcare Outcomes (ECHO) course. METHODS The ECHO Model™ is an evidence-based telementoring intervention. Participants were primary care team members from clinics throughout Massachusetts who voluntarily enrolled in the ECHO course. In this mixed-methods evaluation, primary outcomes were PCP self-reported confidence changes by pre- and post-course surveys and post-course semi-structured interviews. RESULTS Twenty PCPs (43% of registered PCPs) attended at least 3 of the 6 sessions and 24 PCPs (31% of registered PCPs) completed at least one survey. Confidence increased in selecting a test (P = .004), interpreting tuberculosis infection test results (P = .03), and selecting a treatment regimen (P = .004). Qualitative interviews with 3 PCPs revealed practice changes including switching to interferon gamma release assays for testing and using rifampin for treatment. CONCLUSIONS Use of the ECHO model to train PCPs in LTBI management is feasible and efficacious. For continuing medical education, ECHO courses can be leveraged to reduce health disparities in settings where PCPs' lack of familiarity about a treatment topic contributes to poor health outcomes.
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Affiliation(s)
- Daria Szkwarko
- Department of Family Medicine, The Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Family Medicine and Community Health, The University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Michael E. Urbanowski
- Department of Family Medicine and Community Health, The University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Rebecca Thal
- Family Health Center of Worcester, Worcester, MA, USA
- Tan Chingfen Graduation School of Nursing, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Patricia Iyer
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA, USA
| | - Susan Foley
- Department of Family Medicine and Community Health, The University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Liisa M. Randall
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA, USA
| | - John Bernardo
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA, USA
- Department of Medicine, Division of Pulmonary, Allergy, Sleep & Critical Care Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Judith A. Savageau
- Department of Family Medicine and Community Health, The University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Jennifer Cochran
- Bureau of Infectious Disease and Laboratory Sciences, Massachusetts Department of Public Health, Boston, MA, USA
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26
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Jin ML, Brown MM, Patwa D, Nirmalan A, Edwards PA. Telemedicine, telementoring, and telesurgery for surgical practices. Curr Probl Surg 2021; 58:100986. [PMID: 34895561 DOI: 10.1016/j.cpsurg.2021.100986] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 03/14/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Man Li Jin
- Resident in Ophthalmology, Henry Ford Hospital, Detroit, MI.
| | - Meghan M Brown
- Medical Student, Oakland University William Beaumont School of Medicine, Rochester, MI
| | - Dhir Patwa
- Medical Student, Wayne State University School of Medicine, Detroit, MI
| | - Aravindh Nirmalan
- Medical Student, Wayne State University School of Medicine, Detroit, MI
| | - Paul A Edwards
- Chairman, Department of Ophthalmology, Henry Ford Hospital, Detroit, MI
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27
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Allanson ER, Schmeler KM. Preventing Cervical Cancer Globally: Are We Making Progress? Cancer Prev Res (Phila) 2021; 14:1055-1060. [PMID: 34853026 DOI: 10.1158/1940-6207.capr-21-0016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 06/01/2021] [Accepted: 08/03/2021] [Indexed: 12/24/2022]
Abstract
An unacceptable number of women continue to die from cervical cancer around the world each year. Despite established primary and secondary prevention measures, and a natural history of disease which provides a long latent phase in which to intervene, there are still more than 500,000 women diagnosed with cervical cancer globally each year, and 300,000 related deaths. Approximately 90% of these cervical cancer cases and deaths occur in low- and middle-income countries (LMIC). The World Health Organization (WHO) recently launched a Global Strategy to Accelerate the Elimination of Cervical Cancer that outlines 3 key steps: (i) vaccination against human papillomavirus (HPV); (ii) cervical screening; and (iii) treatment of precancerous lesions and management of invasive cancer. Successful implementation of all 3 steps could reduce more than 40% of new cervical cancer cases and 5 million related deaths by 2050. However, this initiative requires high level commitment to HPV immunization programs, innovative approaches to screening, and strengthening of health systems to provide treatment for both precancerous lesions as well as invasive cervical cancer.
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Affiliation(s)
- Emma R Allanson
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kathleen M Schmeler
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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28
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In Brief. Curr Probl Surg 2021. [DOI: 10.1016/j.cpsurg.2021.100987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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29
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Karim S, Sunderji Z, Jalink M, Mohamed S, Mallick I, Msadabwe-Chikuni SC, Delgarno NJ, Hammad N, Berry S. Oncology training and education initiatives in low and middle income countries: a scoping review. Ecancermedicalscience 2021; 15:1296. [PMID: 34824619 PMCID: PMC8580602 DOI: 10.3332/ecancer.2021.1296] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Indexed: 01/26/2023] Open
Abstract
Background The global cancer burden falls disproportionately on low and middle-income countries (LMICs). One significant barrier to adequate cancer control in these countries is the lack of an adequately trained oncology workforce. Oncology education and training initiatives are a critical component of building the workforce. We performed a scoping review of published training and education initiatives for health professionals in LMICs to understand the strategies used to train the global oncology workforce. Methods We searched Ovid MEDLINE and Embase from database inception (1947) to 4 March 2020. Articles were eligible if they described an oncology medical education initiative (with a clear intervention and outcome) within an LMIC. Articles were classified based on the target population, the level of medical education, degree of collaboration with another institution and if there was an e-learning component to the intervention. Findings Of the 806 articles screened, 25 met criteria and were eligible for analysis. The majority of initiatives were targeted towards physicians and focused on continuing medical education. Almost all the initiatives were done in partnership with a collaborating organisation from a high-income country. Only one article described the impact of the initiative on patient outcomes. Less than half of the initiatives involved e-learning. Conclusions There is a paucity of oncology training and education initiatives in LMICs published in English. Initiatives for non-physicians, efforts to foster collaboration within and between LMICs, knowledge sharing initiatives and studies that measure the impact of these initiatives on developing an effective workforce are highly recommended.
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Affiliation(s)
- Safiya Karim
- Department of Medical Oncology, University of Calgary, Tom Baker Cancer Centre, 1331 29 St NW, Calgary, AB T2N 4N2, Canada
| | - Zahra Sunderji
- Department of Family Medicine, University of British Columbia, Vancouver, BC V6T 2A1, Canada
| | - Matthew Jalink
- Department of Oncology, Queen's University, Kingston, ON K7L 5P9, Canada
| | - Sahar Mohamed
- Department of Public Health Sciences, Queen's University, Kingston, ON K7L 3N6, Canada
| | - Indranil Mallick
- Department of Radiation Oncology, Tata Medical Center, Kolkata 700 160, India
| | | | - Nancy J Delgarno
- Office of Professional Development and Educational Scholarship, Faculty of Health Sciences, Queen's University, Kingston, ON K7L 0E9, Canada
| | - Nazik Hammad
- Department of Oncology, Queen's University, Kingston, ON K7L 5P9, Canada
| | - Scott Berry
- Department of Oncology, Queen's University, Kingston, ON K7L 5P9, Canada
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30
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Randall TC, Somashekhar SP, Chuang L, Ng JS, Schmeler KM, Quinn M. Reaching the women with the greatest needs: Two models for initiation and scale-up of gynecologic oncology fellowship trainings in low-resource settings. Int J Gynaecol Obstet 2021; 155 Suppl 1:115-122. [PMID: 34669202 PMCID: PMC9298416 DOI: 10.1002/ijgo.13869] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Women in low- and middle-income countries (LMICs) are significantly more likely to develop and die from invasive cervical cancer, while rates of other gynecologic malignancies are comparable to those faced by women in high-income countries. Despite this increased need, there are few specialist physicians in LMICs available to treat women with gynecologic cancers. Training specialists in low-resource settings faces multiple challenges, including ensuring protected time from other clinical demands, access to best practice guidelines, training that is tailored to the specific challenges faced in the trainee's environment, and isolation from other fully trained professionals and securing support services. In addition, training specialists from LMICs in high-resource settings is costly and return of trainees to their own country is not guaranteed. Here we describe two approaches to gynecologic oncology training in LMICs. The International Gynecologic Cancer Society (IGCS) developed the Global Curriculum Mentorship and Training Program (Global Curriculum) to support gynecologic oncology fellowships in regions of the world that do not currently have formal training in gynecologic oncology. In India, on the other hand, leaders in world-class gynecologic oncology centers must find a way to meet the training needs of a vast and disparate country.
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Affiliation(s)
- Thomas C. Randall
- Division of Gynecologic OncologyThe Massachusetts General HospitalBostonMassachusettsUSA
| | | | - Linus Chuang
- Department of Obstetrics and GynecologyNuvance HealthWestchesterNew YorkUSA
| | | | - Kathleen M. Schmeler
- Department of Gynecologic Oncology and Reproductive MedicineThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
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Nhung LH, Dien TM, Lan NP, Thanh PQ, Cuong PV. Use of Project ECHO Telementoring Model in Continuing Medical Education for Pediatricians in Vietnam: Preliminary Results. Health Serv Insights 2021; 14:11786329211036855. [PMID: 34408433 PMCID: PMC8366124 DOI: 10.1177/11786329211036855] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 07/01/2021] [Indexed: 12/30/2022] Open
Abstract
The ECHO (Extension for Community Health Outcomes) model has been introduced and implemented in several hospitals and health programs in Vietnam since 2015. In 2018, Vietnam National Children’s Hospital (VNCH) officially implemented the ECHO model to provide continuing medical education (CME) credits on pediatrics topics for medical staff in its satellite hospitals and health centers in the Northern region of Vietnam. This paper presents preliminary results of the ECHO program at VNCH. Methods included pre- and post-program assessments of pediatricians’ clinical knowledge, self-efficacy, and professional satisfaction. The analysis compared the differences between pre/post scores descriptively. Knowledge of participants increased by 22.5% points on average. More than 90% of Project ECHO-Pediatrics participants experienced increased confidence. Overall, there was an improvement in participants’ self-efficacy in the post-training compared to the pre-training (range 14.7%-22.6% difference from pre-training). All participants improved on their results in the clinical test immediately after the training and maintained it after 3 months. The study demonstrated the ability Project ECHO to improve healthcare worker knowledge and satisfaction.
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Affiliation(s)
- Le Hong Nhung
- Vietnam National Children's Hospital, Hanoi, Vietnam
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Varon ML, Baker E, Byers E, Cirolia L, Bogler O, Bouchonville M, Schmeler K, Hariprasad R, Pramesh CS, Arora S. Project ECHO Cancer Initiative: a Tool to Improve Care and Increase Capacity Along the Continuum of Cancer Care. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:25-38. [PMID: 34292501 DOI: 10.1007/s13187-021-02031-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/24/2021] [Indexed: 06/13/2023]
Abstract
Solving health problems requires not only the development of new medical knowledge but also its dissemination, particularly to underserved communities. The barriers to effective dissemination also contribute to the disparities in cancer care experienced most everywhere. This concern is particularly acute in low and middle-income countries which already bear a disproportionate burden of cancer, a situation that is projected to worsen. Project ECHO (Extension for Community Healthcare Outcomes) is a knowledge dissemination platform that can increase workforce capacity across many fields, including cancer care by scaling best practices. Here we describe how Project ECHO works and illustrate this with existing programs that span the cancer care continuum and the globe. The examples provided combined with the explanation of how to build effective Project ECHO communities provide an accessible guide on how this education strategy can be integrated into existing work to help respond to the challenge of cancer.
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Affiliation(s)
| | - Ellen Baker
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Emily Byers
- ECHO Institute, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
- UNM School of Medicine, Albuquerque, NM, USA
| | - Lucca Cirolia
- ECHO Institute, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
- UNM School of Medicine, Albuquerque, NM, USA
| | - Oliver Bogler
- Center for Cancer Training, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Matthew Bouchonville
- ECHO Institute, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | | | - Roopa Hariprasad
- Division of Clinical Oncology, National Institute of Cancer Prevention and Research, New Delhi, India
| | | | - Sanjeev Arora
- ECHO Institute, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
- UNM School of Medicine, Albuquerque, NM, USA.
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Troncoso EL, Breads J. Best of both worlds: digital health and nursing together for healthier communities. Int Nurs Rev 2021; 68:504-511. [PMID: 34133028 DOI: 10.1111/inr.12685] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/02/2021] [Accepted: 04/14/2021] [Indexed: 11/30/2022]
Abstract
AIM This manuscript offers a set of practical recommendations to the nursing and digital health communities in order to achieve a common vision of nurses fully engaged with and leading digital health solutions for universal health coverage. BACKGROUND Nurses comprise the largest occupation of health workers in the world and play a central role in efforts to achieve Sustainable Development Goals. Nevertheless, though they are essential to delivering health care, nursing voices are too often absent in the design and implementation of new technology and digital health advances. The World Health Organization recognizes digital health as a critical catalyst for advancing universal health coverage and the aims of the Sustainable Development Goals. Therefore, the use of digital health by nurses is globally recommended as a channel of practice to strengthen nursing services and allow practitioners to significantly improve health outcomes. SOURCES OF EVIDENCE Websites of the World Health Organization, United Nations, peer-reviewed research search engines, as well as the experiences of both authors. DISCUSSION Digital health is transforming the entirety of the healthcare provision system and these systemic changes require engagement, leadership and championing from nurses. CONCLUSION AND IMPLICATIONS FOR NURSING PRACTICE AND POLICY Both the nursing and digital health communities have much to gain from each other and can be stronger together. The authors offer a set of practical recommendations for both the nursing and digital health communities to implement to optimize mutual efforts towards achieving universal health coverage.
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Zapata J, Colistra A, Lesser J, Flores B, Zavala-Idar A, Moreno-Vasquez A. Opioid Use Disorder ECHO: A Program Evaluation of a Project That Provides Knowledge and Builds Capacity for Community Health Workers in Medically Underserved Areas of South Texas. Issues Ment Health Nurs 2021; 42:381-390. [PMID: 32926794 DOI: 10.1080/01612840.2020.1814911] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Opioid use disorder is a growing public health concern in South Texas. To assist in mitigating the effects of this epidemic, staff produced a program that focused on replicating, modifying, and evaluating the impact of the "Opioid Addiction Treatment ECHO™ (Extension of Community Health Outcomes) for CHWs (community health workers) program" on 26 CHWs practicing in rural and other medically underserved areas through teleconferencing technology. CHWs trained on the topic of substance use disorder concentrated on behavioral health integration with a focus on opioid prescription misuse. The analysis found that knowledge attainment was increased above the pretest means. The ECHO™ model proved to be effective at linking subject matter experts and specialists at an academic "hub" with CHWs in local communities.
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Affiliation(s)
- Jose Zapata
- South Texas AHEC, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,School of Nursing, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Angela Colistra
- Behavioral Sciences in the Department of Family Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
| | - Janna Lesser
- South Texas AHEC, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,School of Nursing, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Belinda Flores
- South Coastal AHEC, The University of Texas Health Science Center at San Antonio, Corpus Christi, Texas, USA
| | - Annette Zavala-Idar
- South Texas AHEC, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,School of Nursing, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Andrea Moreno-Vasquez
- South Texas AHEC, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.,School of Nursing, The University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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McLeod ME, Oladeru OT, Hao J, Malhotra SH, Chang BT, Li BC. Leveraging Telehealth and Medical Student Volunteers to Bridge Gaps in Education Access for Providers in Limited-Resource Settings. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:390-394. [PMID: 33264112 DOI: 10.1097/acm.0000000000003865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PROBLEM High-quality training opportunities for providers in limited-resource settings are often scarce or nonexistent. This can lead to a dearth of boots-on-the-ground workers capable of translating knowledge into effective action. The tested telehealth education model of Project ECHO (Extension for Community Healthcare Outcomes) can help address this disparity. However, the planning and logistical coordination required can be limiting. APPROACH Medical student volunteers interested in health disparities and global health can be leveraged to reduce the costs of administration for Project ECHO programs. From mid-2018 to present (2020), student organizations have been formed at Vanderbilt University School of Medicine, University of California, San Francisco, School of Medicine, and Albert Einstein College of Medicine. These organizations have recruited and trained volunteers, who play an active role in assessing the needs of local clinics and providers, developing curricula, and coordinating the logistical aspects of programs. OUTCOMES In the first 4 student-coordinated Project ECHO cohorts (2019-2020), 25 clinics in 14 countries participated, with a potential impact on over 20,000 cancer patients annually. Satisfaction with the telehealth education programs was high among local clinicians and expert educators. Students' perceived ability to conduct activities important to successfully orchestrating a telehealth education program was significantly greater among students who had coordinated one or more Project ECHO programs than among students who had yet to participate for 7 of 9 competencies. There also appears to be an additive effect of participating in additional Project ECHO programs on perceived confidence and career path intentions. NEXT STEPS The student-led model of coordinating telehealth education programs described here can be readily expanded to medical schools across the nation and beyond. With continued expansion, efforts are needed to develop assessments that provide insights into participants' learning, track changes in patient outcomes, and provide continuing medical education credits to local clinicians.
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Affiliation(s)
- Megan E McLeod
- M.E. McLeod is a third-year medical student, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Oluwadamilola T Oladeru
- O.T. Oladeru is resident physician, Harvard Radiation Oncology Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Jinxuan Hao
- J. Hao is a second-year medical student, Arizona College of Osteopathic Medicine, Glendale, Arizona
| | - Sameeksha H Malhotra
- S.H. Malhotra is research assistant, Memory and Alzheimer's Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Betty T Chang
- B.T. Chang is a first-year medical student, University of Illinois College of Medicine, Chicago, Illinois
| | - Benjamin C Li
- B.C. Li is resident physician, Department of Radiation Oncology, University of California, San Francisco, San Francisco, California; ORCID: https://orcid.org/0000-0002-1783-7013
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Ngwa W, Olver I, Schmeler KM. The Use of Health-Related Technology to Reduce the Gap Between Developed and Undeveloped Regions Around the Globe. Am Soc Clin Oncol Educ Book 2020; 40:1-10. [PMID: 32223667 DOI: 10.1200/edbk_288613] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cancer is the second leading cause of death worldwide, with approximately 70% of the 9.6 million deaths per year occurring in low- and middle-income countries (LMICs), where there is critical shortage of human and material resources or infrastructure to deal with cancer. If the current trend continues, the burden of cancer is expected to increase to 22 million new cases annually by 2030, with 81% of new cases and almost 88% of mortality occurring in LMICs. Global health places a priority on improving health and reducing these disparities to achieve equity in health for all people worldwide. In today's hyper-connected world, information and communication technologies (ICTs) will increasingly play an integral role in global health. Here, we focus on how the use of health-related technology, specifically ICTs and artificial intelligence (AI), can help in closing the gap between high-income countries (HICs) and LMICs in cancer care, research, and education. Key examples are highlighted on the use of telemedicine and tumor boards, as well as other online resources that can be leveraged to advance global health.
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Affiliation(s)
- Wilfred Ngwa
- Department of Radiation Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Ian Olver
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Kathleen M Schmeler
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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Stecklein SR, Taniguchi CM, Melancon AD, Lombe D, Lishimpi K, Banda L, Mwaba C, Pupwe G, Mwale M, Munkupa H, Kanduza M, Mule B, Mwale A, Court L, Ohrt JD, Kupferman ME, Jhingran A, Msadabwe-Chikuni SC. Radiation Sciences Education in Africa: An Assessment of Current Training Practices and Evaluation of a High-Yield Course in Radiation Biology and Radiation Physics. JCO Glob Oncol 2020; 6:1631-1638. [PMID: 33108232 PMCID: PMC7605372 DOI: 10.1200/go.20.00350] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Formal education in the radiation sciences is critical for the safe and effective delivery of radiotherapy. Practices and patterns of radiation sciences education and trainee performance in the radiation sciences are poorly described. This study assesses the current state of radiation sciences education in Africa and evaluates a high-yield, on-site educational program in radiation biology and radiation physics for oncology and radiation therapy trainees in Africa. METHODS An anonymous survey was distributed to members of the African Organization for Research and Treatment in Cancer Training Interest Group to assess current attitudes and practices toward radiation sciences education. A 2-week, on-site educational course in radiation biology and radiation physics was conducted at the Cancer Diseases Hospital in Lusaka, Zambia. Pre- and postcourse assessments in both disciplines were administered to gauge the effectiveness of an intensive high-yield course in the radiation sciences. RESULTS Significant deficiencies were identified in radiation sciences education, especially in radiation biology. Lack of expert instructors in radiation biology was reported by half of all respondents and was the major contributing factor to deficient education in the radiation sciences. The educational course resulted in marked improvements in radiation biology assessment scores (median pre- and posttest scores, 27% and 55%, respectively; P < .0001) and radiation physics assessment scores (median pre- and posttest scores, 30% and 57.5%, respectively; P < .0001). CONCLUSION Radiation sciences education in African oncology training programs is inadequate. International collaboration between expert radiation biology and radiation physics instructors can address this educational deficiency and improve trainee competence in the foundational radiation sciences that is critical for the safe and effective delivery of radiotherapy.
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Affiliation(s)
- Shane R Stecklein
- Department of Radiation Oncology, The University of Kansas School of Medicine, Kansas City, KS.,The University of Kansas Cancer Center, Kansas City, KS.,Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Cullen M Taniguchi
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Adam D Melancon
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | | | | | - Mulape Kanduza
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Laurence Court
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jared D Ohrt
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael E Kupferman
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Anuja Jhingran
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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38
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Salcedo MP, Oliveira C, Andrade V, Mariano AAN, Changule D, Rangeiro R, Monteiro ECS, Baker E, Phoolcharoen N, Varon ML, Thomas JP, Castle PE, Fregnani JHTG, Schmeler KM, Lorenzoni C. The Capulana study: a prospective evaluation of cervical cancer screening using human papillomavirus testing in Mozambique. Int J Gynecol Cancer 2020; 30:1292-1297. [PMID: 32737122 DOI: 10.1136/ijgc-2020-001643] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/30/2020] [Accepted: 07/06/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cervical cancer is the leading cause of cancer and related deaths among women in Mozambique. There is limited access to screening and few trained personnel to manage women with abnormal results. Our objective was to implement cervical cancer screening with human papillomavirus (HPV) testing, with navigation of women with abnormal results to appropriate diagnostic and treatment services. METHODS We prospectively enrolled women aged 30-49 years living in Maputo, Mozambique, from April 2018 to September 2019. All participants underwent a pelvic examination by a nurse, and a cervical sample was collected and tested for HPV using the careHPV test (Qiagen, Gaithersburg, Maryland, USA). HPV positive women were referred for cryotherapy or, if ineligible for cryotherapy, a loop electrosurgical excision procedure. Women with findings concerning for cancer were referred to the gynecologic oncology service. RESULTS Participants (n=898) had a median age of 38 years and 20.3% were women living with the human immunodeficiency virus. HPV positivity was 23.7% (95% confidence interval 21.0% to 26.6%); women living with human immunodeficiency virus were twice as likely to test positive for HPV as human immunodeficiency virus negative women (39.2% vs 19.9%, p<0.001). Most HPV positive women (194 of 213, 91.1%) completed all steps of their diagnostic work-up and treatment. Treatment included cryotherapy (n=158, 77.5%), loop electrosurgical excision procedure (n=30, 14.7%), or referral to a gynecologist or gynecologic oncologist (n=5, 2.5%). Of eight invasive cervical cancers, 5 (2.8%) were diagnosed in women living with human immunodeficiency virus and 3 (0.4%) in human immunodeficiency virus negative women (p=0.01). CONCLUSION Cervical cancer screening with HPV testing, including appropriate follow-up and treatment, was feasible in our study cohort in Mozambique. Women living with human immunodeficiency virus appear to be at a significantly higher risk for HPV infection and the development of invasive cervical cancer than human immunodeficiency virus negative women.
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Affiliation(s)
- Mila P Salcedo
- The Department of Obstetrics and Gynecology, Federal University of Health Science of Porto Alegre/Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil.,Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cristina Oliveira
- Life and Health Siences Research Institute (ICVS), University of Minho, Braga, Portugal.,Molecular Oncology Research Center, Hospital de Cancer de Barretos, Barretos, São Paulo, Brazil
| | - Viviane Andrade
- Research Support Center of Teaching and Research Institute, Hospital de Cancer de Barretos, Barretos, São Paulo, Brazil
| | | | - Dércia Changule
- Hospital Geral e Centro de Saúde de Mavalane, Maputo, Mozambique
| | | | | | - Ellen Baker
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Natacha Phoolcharoen
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Obstetrics and Gynecology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Melissa L Varon
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Joseph P Thomas
- Department of Oncology Care and Research Information Systems, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Philip E Castle
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, New York, New York, USA
| | | | - Kathleen M Schmeler
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cesaltina Lorenzoni
- Ministério da Saúde de Moçambique (MISAU), Maputo, Mozambique.,Pathology Department, Hospital Central de Maputo, Maputo, Mozambique
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Promoting evidence-based practices for breast cancer care through web-based collaborative learning. J Cancer Policy 2020; 25. [PMID: 32719736 DOI: 10.1016/j.jcpo.2020.100242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The Knowledge Summaries for Comprehensive Breast Cancer Control (KSBCs) are a series of 14 publications aligned with World Health Organization guidance on evidence-based breast cancer control and accepted frameworks for action. To study utilization of the KSBCs in the development of locally relevant breast cancer control policies and programs in limited resource settings, the National Cancer Institute Center for Global Health, the University of Washington and the Fred Hutchinson Cancer Research Center developed the Project ECHO® for KSBCs (KSBC ECHO). Project ECHO is an online model which employs case-based learning, while promoting multi-directional learning and network-building. The program was evaluated using a pre-post study design to assess if this online collaborative learning platform can be an effective model for dissemination and utilization of the KSBCs to inform breast cancer control programs and policy advocacy in limited resource settings. A total of 28 KSBC ECHO participants (57%) responded to the baseline and endpoint program evaluation surveys. Across all 28 respondents, analysis of the data indicates that knowledge increase was statistically significant overall: average knowledge gain was 0.77, 95% CI [0.44 - 1.08] and p value < 0.0001. A majority of responding team leads reported that the core ECHO components (case/didactic presentations, discussion) contributed to a great extent to strengthening their project proposal/goals. Program evaluation survey responses indicate that utilization of this online platform provided an opportunity for individual knowledge gain, multi-directional information exchange, network-building, and strengthening of the proposed breast cancer control projects based in limited resource settings.
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Varon ML, Baker E, Estrada EE, Schmeler KM, Pareja R. Advancing gynecologic oncology in Latin America through Project ECHO. Int J Gynecol Cancer 2020; 30:1840-1841. [PMID: 32522773 DOI: 10.1136/ijgc-2020-001559] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2020] [Indexed: 11/03/2022] Open
Affiliation(s)
- Melissa Lopez Varon
- Department of Gynecologic Oncology & Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ellen Baker
- Department of Gynecologic Oncology & Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Erick Estuardo Estrada
- Gynecology and Obstetrics, Hospital General San Juan de Dios, Guatemala City, Guatemala, Guatemala
| | - Kathleen M Schmeler
- Department of Gynecologic Oncology & Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Rene Pareja
- Gynecology, Instituto Nacional de Cancerología and Clínica de Oncología Astorga. Gynecologic Oncology Professor Universidad Pontificia Bolivariana. Colombia, Medellin, Colombia
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Yennurajalingam S, Amos CE, Weru J, Addo Opare-Lokko EBVND, Arthur JA, Nguyen K, Soyannwo O, Chidebe RCW, Williams JL, Lu Z, Baker E, Arora S, Bruera E, Reddy S. Extension for Community Healthcare Outcomes-Palliative Care in Africa Program: Improving Access to Quality Palliative Care. J Glob Oncol 2020; 5:1-8. [PMID: 31335237 PMCID: PMC6776016 DOI: 10.1200/jgo.19.00128] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE There is limited access to quality palliative care (PC) for patients with
advanced cancer in sub-Saharan Africa. Our aim was to describe the
development of the Project Extension for Community Healthcare
Outcomes-Palliative Care in Africa (ECHO-PACA) program and describe a
preliminary evaluation of attitudes and knowledge of participants regarding
the ability of the program to deliver quality PC. METHODS An interdisciplinary team at the MD Anderson Cancer Center, guided by experts
in PC in sub-Saharan Africa, adapted a standardized curriculum based on PC
needs in the region. Participants were then recruited, and monthly
telementoring sessions were held for 16 months. The monthly telementoring
sessions consisted of case presentations, discussions, and didactic
lectures. Program participants came from 14 clinics and teaching hospitals
in Ghana, Kenya, Nigeria, South Africa, and Zambia. Participants were
surveyed at the beginning, midpoint, and end of the 16-month program to
evaluate changes in attitudes and knowledge of PC. RESULTS The median number of participants per session was 30. Thirty-three (83%) of
40 initial participants completed the feedback survey. Health care
providers’ self-reported confidence in providing PC increased with
participation in the Project ECHO-PACA clinic. There was significant
improvement in the participants’ attitudes and knowledge, especially
in titrating opioids for pain control (P = .042),
appropriate use of non-opioid analgesics (P = .012),
and identifying and addressing communication issues related to end-of-life
care (P = .014). CONCLUSION Project ECHO-PACA was a successful approach for disseminating knowledge about
PC. The participants were adherent to ECHO PACA clinics and the completion
of feedback surveys. Future studies should evaluate the impact of Project
ECHO-PACA on changes in provider practice as well as patient outcomes.
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Affiliation(s)
| | - Charles E Amos
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - John Weru
- Aga Khan University Hospital, Nairobi, Kenya
| | | | | | - Kristy Nguyen
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | - Zhanni Lu
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ellen Baker
- University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Eduardo Bruera
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Suresh Reddy
- University of Texas MD Anderson Cancer Center, Houston, TX
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Penedo FJ, Oswald LB, Kronenfeld JP, Garcia SF, Cella D, Yanez B. The increasing value of eHealth in the delivery of patient-centred cancer care. Lancet Oncol 2020; 21:e240-e251. [PMID: 32359500 PMCID: PMC7643123 DOI: 10.1016/s1470-2045(20)30021-8] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/02/2020] [Accepted: 01/14/2020] [Indexed: 12/23/2022]
Abstract
The increasing use of eHealth has ushered in a new era of patient-centred cancer care that moves beyond the traditional in-person care model to real-time, dynamic, and technology-assisted assessments and interventions. eHealth has the potential to better the delivery of cancer care through improved patient-provider communication, enhanced symptom and toxicity assessment and management, and optimised patient engagement across the cancer care continuum. In this Review, we provide a brief, narrative appraisal of the peer reviewed literature over the past 10 years related to the uses of patient-centred eHealth to improve cancer care delivery. These uses include the addressal of symptom management, health-related quality of life, and other patient-reported outcomes across cancer care. In addition, we discuss the challenges of, and opportunities for, accessibility, scalability, and implementation of these technologies, important areas for further development, and future research directions.
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Affiliation(s)
- Frank J Penedo
- Department of Psychology, University of Miami, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA.
| | - Laura B Oswald
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL, USA
| | | | - Sofia F Garcia
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Betina Yanez
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
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Abstract
BACKGROUND Cervical cancer remains one of the leading causes of cancer for women in medically underserved areas. This is in part due to a lack of trained clinicians to provide the necessary diagnosis and treatment of precancerous lesions to prevent cervical cancer. Increasing medical provider knowledge and skills is important for the early detection and prevention of cervical precancer and cancer in medically underserved areas of the United States and globally. METHOD LUCIA is a low-cost, universal cervical cancer instructional apparatus that can be used to teach and practice a variety of essential skills for cervical cancer screening, diagnosis, and treatment, including: visual inspection with acetic acid, Pap and human papillomavirus DNA specimen collection, colposcopy, endocervical curettage, cervical biopsy, cryotherapy, and loop electrosurgical excision procedure. EXPERIENCE LUCIA was used to provide hands-on training in six courses held in Texas (n=3), El Salvador (n=1), and Mozambique, Africa (n=2). Standardized provider evaluations were administered at three of these courses and resulted in mean scores of 4.12/5 for usefulness, 4.46/5 for skill improvement, and 4.43/5 for ease of skill evaluation. CONCLUSION LUCIA provides dynamic, real-time feedback that allows trainees to learn and practice important skills related to cervical cancer prevention while simulating a patient exam.
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Sarfati D, Dyer R, Vivili P, Herman J, Spence D, Sullivan R, Weller D, Bray F, Hill S, Bates C, Foliaki S, Palafox N, Luciani S, Ekeroma A, Hospedales J. Cancer control in small island nations: from local challenges to global action. Lancet Oncol 2019; 20:e535-e548. [PMID: 31395475 PMCID: PMC7746435 DOI: 10.1016/s1470-2045(19)30511-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/13/2019] [Accepted: 06/13/2019] [Indexed: 12/16/2022]
Abstract
Cancer is a leading cause of death in small island nations and is forecast to increase substantially over the coming years. Governments, regional agencies, and health services of these nations face daunting challenges, including small and fragile economies, unequal distribution of resources, weak or fragmented health services, small population sizes that make sustainable workforce and service development problematic, and the unavailability of specialised cancer services to large parts of the population. Action is required to prevent large human and economic costs relating to cancer. This final Series paper highlights the challenges and opportunities for small island nations, and identifies ways in which the international community can support efforts to improve cancer control in these settings. Our recommendations focus on funding and investment opportunities to strengthen cancer-related health systems to improve sharing of technical assistance for research, surveillance, workforce, and service development, and to support small island nations with policy changes to reduce the consumption of commodities (eg, tobacco and unhealthy food products) that increase cancer risk.
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Affiliation(s)
- Diana Sarfati
- Department of Public Health, University of Otago, Wellington, Wellington, New Zealand.
| | - Rachel Dyer
- Department of Public Health, University of Otago, Wellington, Wellington, New Zealand
| | - Paula Vivili
- Public Health Division, Pacific Community, Noumea, New Caledonia
| | | | | | - Richard Sullivan
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - David Weller
- James Mackenzie Professor of General Practice, Usher Institute of Population Health, Sciences and Informatics, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Freddie Bray
- Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France
| | - Sarah Hill
- Global Health Policy Unit, University of Edinburgh, Edinburgh, UK
| | - Christopher Bates
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, Melbourne, VIC, Australia
| | - Sunia Foliaki
- Centre for Public Health Research, Massey University-Wellington Campus, Wellington, New Zealand
| | - Neal Palafox
- Pacific Regional Cancer Programs, Department of Family Medicine and Community Health, John A Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA; Population Sciences in the Pacific Program, University of Hawaii Cancer Center, Honolulu, HI, USA
| | - Silvana Luciani
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Alec Ekeroma
- Obstetrics and Gynaecology, University of Otago, Wellington, Wellington, New Zealand; National University of Samoa, Le Papaigalagala Campus, To'omatagi, Samoa
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Moretti-Marques R, Salcedo MP, Callegaro Filho D, Lopes A, Vieira M, Fontes Cintra G, Ribeiro M, Changule D, Daud S, Rangeiro R, Baker E, Lorenzoni C, Fregnani JHTG, Schmeler KM. Telementoring in gynecologic oncology training: changing lives in Mozambique. Int J Gynecol Cancer 2019; 30:150-151. [PMID: 31320489 DOI: 10.1136/ijgc-2019-000653] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2019] [Indexed: 11/03/2022] Open
Affiliation(s)
- Renato Moretti-Marques
- Gynecologic Oncology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil .,International Gynecology Cancer Society - IGCS, Austin, Texas, USA
| | - Mila Pontremoli Salcedo
- International Gynecology Cancer Society - IGCS, Austin, Texas, USA.,Department of Obstetrics and Gynecology, Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, Brazil
| | | | - Andre Lopes
- International Gynecology Cancer Society - IGCS, Austin, Texas, USA.,Gynecology Department, Instituto Brasileiro de Controle do Cancer, Sao Paulo, Brazil
| | - Marcelo Vieira
- International Gynecology Cancer Society - IGCS, Austin, Texas, USA.,Barretos Cancer Hospital, Barretos, Brazil
| | - Geórgia Fontes Cintra
- International Gynecology Cancer Society - IGCS, Austin, Texas, USA.,Hospital Sírio-Libanês, Sao Paulo, Brazil
| | | | - Dércia Changule
- International Gynecology Cancer Society - IGCS, Austin, Texas, USA.,Hospital Central de Maputo, Maputo, Mozambique
| | - Siro Daud
- Hospital Central de Maputo, Maputo, Mozambique
| | - Ricardina Rangeiro
- International Gynecology Cancer Society - IGCS, Austin, Texas, USA.,Hospital Central de Maputo, Maputo, Mozambique
| | - Ellen Baker
- University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cesaltina Lorenzoni
- Hospital Central de Maputo, Maputo, Mozambique.,Ministry of Health, Maputo, Mozambique
| | | | - Kathleen M Schmeler
- International Gynecology Cancer Society - IGCS, Austin, Texas, USA.,Gynecologic Oncology, MD Anderson Cancer Center, Houston, Texas, USA
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46
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Salcedo MP, Lorenzoni C, Schmeler KM. Working together to eliminate cervical cancer: a partnership across three countries "As mudanças no mundo são criadas por nós". Int J Gynecol Cancer 2019; 29:ijgc-2019-000372. [PMID: 30948429 DOI: 10.1136/ijgc-2019-000372] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2019] [Indexed: 11/04/2022] Open
Affiliation(s)
- Mila Pontremoli Salcedo
- The Department of Obstetrics and Gynecology, Universidade Federal de Ciencias da Saude de Porto Alegre, Porto Alegre, Brazil
- Department of Gynecologic Oncology & Reproductive Medicine, MD Anderson Cancer Center, Houston, Texas, USA
- Irmandade Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
| | - Cesaltina Lorenzoni
- Ministry of Health, Maputo, Mozambique
- Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Kathleen M Schmeler
- Department of Gynecologic Oncology & Reproductive Medicine, MD Anderson Cancer Center, Houston, Texas, USA
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47
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Vaughan EM, Naik AD, Lewis CM, Foreyt JP, Samson SL, Hyman DJ. Telemedicine Training and Support for Community Health Workers: Improving Knowledge of Diabetes. Telemed J E Health 2019; 26:244-250. [PMID: 30839244 DOI: 10.1089/tmj.2018.0313] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Community health workers (CHWs) are a well-established source to improve patient health care, yet their training and support remain suboptimal. This limits program expansion and potentially compromises patient safety. The objective of the study was to evaluate the feasibility and acceptability of weekly training and support by telemedicine (videoconferencing). Materials and Methods: CHWs (n = 6) who led diabetes group visits for low-income Latinos met weekly with a health care professional for training and support. Feasibility and acceptability outcome measures included telemedicine usability, knowledge of diabetes (baseline to 6 months), and program satisfaction. Results: Telemedicine training and support were found to be feasible and acceptable as measured by usability (Telehealth Usability Questionnaire: average 4.7/5.0, ±0.4), knowledge (Diabetes Knowledge Test: pretest 15.8 ± 1.3, posttest 21.8 ± 1.2, p < 0.001, respectively), and satisfaction (Texas Department of State Health Services survey: average 5.8/6.0, ±0.5). All CHWs preferred telemedicine to in-person training. Conclusions: Telemedicine is a feasible and acceptable modality to train and support CHWs.
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Affiliation(s)
| | - Aanand D Naik
- Department of Medicine, Houston, Texas.,Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E DeBakey VA Medical Center, Houston, Texas
| | - Courtney M Lewis
- School of Health Professions Baylor College of Medicine, Houston, Texas
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Morais A, Cossa M, Tivane A, Come J, Venetsky V, Torres F, Pacheco V, Reyes M, Pires G, Peyroteo M, Tulsidas S, Baker E, Sidat M, O Martins MDR, Santos LL. Identifying barriers and finding solutions to implement best practices for cancer surgery at Maputo Central Hospital, Mozambique. Ecancermedicalscience 2018; 12:878. [PMID: 30483358 PMCID: PMC6214672 DOI: 10.3332/ecancer.2018.878] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Indexed: 01/06/2023] Open
Abstract
Purpose The aim of this study was to assess the surgical resources and surgical oncology team skills at the Surgical Department of Maputo Central Hospital (MCH) in Mozambique in order to define an educational program to support surgical oncology practice. Methods From January 2017 to December 2017, a general evaluation of the resources of MCH was carried out, as well as its offerings in oncological care in different services. Data were obtained by reviewing documents, visiting surgical services and interviewing key-informants and others informally. In addition, a group of seven surgeons of the Surgical Department of MCH answered a questionnaire about the quality of the cancer units (The Cancer Units Assessment Checklist for low- or middle-income African countries). Subsequently, surgical, anaesthesiology and intensive care facilities were evaluated according to the Portuguese-speaking African Countries Assessment of Surgical Oncology Capacity Survey (PSAC-Surgery). All the data were triangulated in order to identify gaps, develop an action plan and define an educational program. Results Breast, oesophagus and colorectal cancers were the most commonly treated neoplasms in MCH. A range of technical and resource needs as well as the gaps in knowledge and skills were identified. All surgeons recognised the need to create a training program in oncology at the undergraduate level, specific training for residents and continuing oncological education for general surgeons to improve the practice of surgical oncology. It was evident that all these interventions needed to be formalised, appropriately certified and count for professional career progression. Based on the local epidemiological data and on these study findings, oncology education programs were developed for surgeons. Conclusions The findings of this study contributed to the development of an educational program in surgical oncology, considered essential to the training of surgeons at MCH. The cancer educational programs and the mobilisation of adequate resources will ensure the provision of adequate surgical oncology treatments for MCH. The training requirements should be tailored to suit the local needs based on the most prevalent malignancies diagnosed in the region. In our view, this methodology may apply to other countries with similar realities in the formation of surgical oncologists.
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Affiliation(s)
- Atílio Morais
- Thoracic Surgery, Surgical Department, Maputo Central Hospital, Av Agostinho Neto n° 164, Maputo 1164, Mozambique
| | - Matchecane Cossa
- Thoracic Surgery, Surgical Department, Maputo Central Hospital, Av Agostinho Neto n° 164, Maputo 1164, Mozambique
| | - Adriano Tivane
- Thoracic Surgery, Surgical Department, Maputo Central Hospital, Av Agostinho Neto n° 164, Maputo 1164, Mozambique
| | - Jotamo Come
- Breast Surgery, Surgical Department, Maputo Central Hospital, Av Agostinho Neto n° 164, Maputo 1164, Mozambique
| | - Volodimir Venetsky
- Breast Surgery, Surgical Department, Maputo Central Hospital, Av Agostinho Neto n° 164, Maputo 1164, Mozambique
| | - Fernando Torres
- Breast Surgery, Surgical Department, Maputo Central Hospital, Av Agostinho Neto n° 164, Maputo 1164, Mozambique
| | - Victor Pacheco
- Colorectal Surgery, Surgical Department, Maputo Central Hospital, Av Agostinho Neto n° 164, Maputo 1164, Mozambique
| | - Miguel Reyes
- Colorectal Surgery, Surgical Department, Maputo Central Hospital, Av Agostinho Neto n° 164, Maputo 1164, Mozambique
| | - Germano Pires
- Heath National Institute, Av Eduardo Mondlane, Maputo 264, Mozambique
| | - Mariana Peyroteo
- Surgical Oncology Department, Portuguese Institute of Oncology, Dr António Bernardino de Almeida Street, Porto 4200-072, Portugal
| | - Satish Tulsidas
- Medical Oncology Department, Maputo Central Hospital, Av Agostinho Neto n° 164, Maputo 1164, Mozambique
| | - Ellen Baker
- UT MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Moshin Sidat
- Department of Community Health, University Eduardo Mondlane, Av Julius Nyerere, Maputo 257, Mozambique.,Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, Universidade Nova de Lisboa, Junqueira Street 100, Lisboa 1349-008 Portugal
| | - Maria do Rosário O Martins
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, Universidade Nova de Lisboa, Junqueira Street 100, Lisboa 1349-008 Portugal
| | - Lúcio Lara Santos
- Surgical Oncology Department, Portuguese Institute of Oncology, Dr António Bernardino de Almeida Street, Porto 4200-072, Portugal.,Experimental Pathology and Therapeutics Research Group, Surgical Oncology Department, Portuguese Institute of Oncology, Dr António Bernardino de Almeida Street, Porto 4200-072, Portugal.,ONCOCIR-Education and Care in Oncology-Lusophone Africa, Quires Street 168, Moreira da Maia 4470-643, Portugal
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The burden of cancers and their variations across the states of India: the Global Burden of Disease Study 1990-2016. Lancet Oncol 2018; 19:1289-1306. [PMID: 30219626 PMCID: PMC6167407 DOI: 10.1016/s1470-2045(18)30447-9] [Citation(s) in RCA: 213] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 06/08/2018] [Accepted: 06/11/2018] [Indexed: 01/08/2023]
Abstract
Background Previous efforts to report estimates of cancer incidence and mortality in India and its different parts include the National Cancer Registry Programme Reports, Sample Registration System cause of death findings, Cancer Incidence in Five Continents Series, and GLOBOCAN. We present a comprehensive picture of the patterns and time trends of the burden of total cancer and specific cancer types in each state of India estimated as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 because such a systematic compilation is not readily available. Methods We used all accessible data from multiple sources, including 42 population-based cancer registries and the nationwide Sample Registration System of India, to estimate the incidence of 28 types of cancer in every state of India from 1990 to 2016 and the deaths and disability-adjusted life-years (DALYs) caused by them, as part of GBD 2016. We present incidence, DALYs, and death rates for all cancers together, and the trends of all types of cancers, highlighting the heterogeneity in the burden of specific types of cancers across the states of India. We also present the contribution of major risk factors to cancer DALYs in India. Findings 8·3% (95% uncertainty interval [UI] 7·9–8·6) of the total deaths and 5·0% (4·6–5·5) of the total DALYs in India in 2016 were due to cancer, which was double the contribution of cancer in 1990. However, the age-standardised incidence rate of cancer did not change substantially during this period. The age-standardised cancer DALY rate had a 2·6 times variation across the states of India in 2016. The ten cancers responsible for the highest proportion of cancer DALYs in India in 2016 were stomach (9·0% of the total cancer DALYs), breast (8·2%), lung (7·5%), lip and oral cavity (7·2%), pharynx other than nasopharynx (6·8%), colon and rectum (5·8%), leukaemia (5·2%), cervical (5·2%), oesophageal (4·3%), and brain and nervous system (3·5%) cancer. Among these cancers, the age-standardised incidence rate of breast cancer increased significantly by 40·7% (95% UI 7·0–85·6) from 1990 to 2016, whereas it decreased for stomach (39·7%; 34·3–44·0), lip and oral cavity (6·4%; 0·4–18·6), cervical (39·7%; 26·5–57·3), and oesophageal cancer (31·2%; 27·9–34·9), and leukaemia (16·1%; 4·3–24·2). We found substantial inter-state heterogeneity in the age-standardised incidence rate of the different types of cancers in 2016, with a 3·3 times to 11·6 times variation for the four most frequent cancers (lip and oral, breast, lung, and stomach). Tobacco use was the leading risk factor for cancers in India to which the highest proportion (10·9%) of cancer DALYs could be attributed in 2016. Interpretation The substantial heterogeneity in the state-level incidence rate and health loss trends of the different types of cancer in India over this 26-year period should be taken into account to strengthen infrastructure and human resources for cancer prevention and control at both the national and state levels. These efforts should focus on the ten cancers contributing the highest DALYs in India, including cancers of the stomach, lung, pharynx other than nasopharynx, colon and rectum, leukaemia, oesophageal, and brain and nervous system, in addition to breast, lip and oral cavity, and cervical cancer, which are currently the focus of screening and early detection programmes. Funding Bill & Melinda Gates Foundation; and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.
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Frech S, Muha CA, Stevens LM, Trimble EL, Brew R, Perin DP, Luciani S, Mohar A, Piñeros M, Vidaurre T, Morgan DR, Hawk ET, Schmeler KM, Foxhall LE, Rabadan-Diehl C, Duran D, Rendler-Garcia M, Cazap EL, Santini L, Zoss W, Delgado LB, Pearlman PC, Given L, Hohman K, Lopez MS, Kostelecky B. Perspectives on Strengthening Cancer Research and Control in Latin America Through Partnerships and Diplomacy: Experience of the National Cancer Institute's Center for Global Health. J Glob Oncol 2018; 4:1-11. [PMID: 30241245 PMCID: PMC6223440 DOI: 10.1200/jgo.17.00149] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
According to the Pan American Health Organization, noncommunicable diseases, including cancer, are the leading causes of preventable and premature death in the Americas. Governments and health care systems in Latin America face numerous challenges as a result of increasing morbidity and mortality from cancer. Multiple international organizations have recognized the need for collaborative action on and technical support for cancer research and control in Latin America. The Center for Global Health at the US National Cancer Institute (NCI-CGH) is one entity among many that are working in the region and has sought to develop a strategy for working in Latin America that draws on and expands the collaborative potential of engaged, skilled, and diverse partners. NCI-CGH has worked toward developing and implementing initiatives in collaboration with global partners that share the common objectives of building a global cancer research community and translating research results into evidence-informed policy and practice. Both objectives are complementary and synergistic and are additionally supported by an overarching strategic framework that is focused on partnerships and science diplomacy. This work highlights the overall strategy for NCI-CGH engagement in Latin America through partnerships and diplomacy, and highlights selected collaborative efforts that are aimed at improving cancer outcomes in the region.
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Affiliation(s)
- Silvina Frech
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Catherine A. Muha
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Lisa M. Stevens
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Edward L. Trimble
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Roxanne Brew
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Doug Puricelli Perin
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Silvana Luciani
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Alejandro Mohar
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Marion Piñeros
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Tatiana Vidaurre
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Douglas R. Morgan
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Ernest T. Hawk
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Kathleen M. Schmeler
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Lewis E. Foxhall
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Cristina Rabadan-Diehl
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Denise Duran
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Melissa Rendler-Garcia
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Eduardo L. Cazap
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Luiz Santini
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Walter Zoss
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Lucia B. Delgado
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Paul C. Pearlman
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Leslie Given
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Karin Hohman
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Melissa S. Lopez
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
| | - Brenda Kostelecky
- Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO
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