American Society of Clinical Oncology (ASCO) Cervical Cancer Prevention Program: A Hands-On Training Course in Nepal

Abstract

Cervical cancer is the leading cause of death among women in Nepal. The American Society of Clinical Oncology (ASCO) and The University of Texas MD Anderson Cancer Center collaborated with international and local experts to hold a cervical cancer prevention course in Nepal in November 2019. The course included didactic lectures and a hands-on workshop. The didactic lectures included the epidemiology of cervical cancer globally and locally, cervical cancer screening guidelines, human papillomavirus vaccination, colposcopy and visual inspection with acetic acid (VIA), cervical dysplasia, and cervical cancer treatment. The hands-on workshop consisted of four stations: (1) VIA; (2) colposcopy, cervical biopsy, and endocervical curettage; (3) thermal ablation; and (4) loop electrosurgical excision procedure (LEEP). A train-the-trainer model short course was held by the international faculty to assist six local faculty to become familiar with the instruments, procedures, and models used in the hands-on training stations. Forty-two people (84% gynecologist, 8% radiation oncologist, and 8% other) attended the course. Following the course, the international faculty visited the regional hospitals for additional educational activities. Increased knowledge in cervical cancer screening guidelines and ability in performing VIA, colposcopy and cervical biopsy, thermal ablation, and LEEP were reported by 89%, 84%, 84%, 87%, and 84% of participants, respectively, from the postcourse on-site evaluations. From the 6-month follow-up survey, all respondents reported that they had made practice changes based on what they learned in the course and had implemented or tried to implement the cervical cancer screening guidelines presented at the course. In conclusion, the course evaluations suggested an improvement in participants' ability to perform cervical cancer screening and diagnostic procedures and reported the changes in practices after training.

Cervical cancer prevention program in Nepal: a ‘training of trainers’ approach

“…However, lack of a coordinated national screening program has led to cervical cancer screening utilization (16%) which is four times lower than the national target (70%). 6,7 Previous studies examining barriers to increased screening utilization have found issues with patient embarrassment related to the gynecologic exam, lack of knowledge on cervical cancer, limited trained health care personnel, inaccessibility of clinics, and cost of screening, among reasons for why utilization remains low. 7 To continue the work to further the WHO goals in Nepal, a multi-institution, international collaboration was started to increase patient knowledge and the number of providers skilled in cervical cancer screening, diagnosis, and treatment techniques.…”

Toward 70% cervical cancer screening coverage: Technical challenges and opportunities to increase access to human papillomavirus (HPV) testing

“…Currently, there are weak healthcare infrastructure and a lack of healthcare providers trained in cervical cancer prevention in most LMICs with a high burden of cervical cancer. Context-appropriate and effective training programs, like the Gynecologic Oncology Global Curriculum and Mentorship Program of the International Gynecologic Cancer Society, provide a good model for training healthcare providers to respond to an increase in screen-detected cancers [ 54 , 55 ].…”

Cervical cancer in Nepal: Current screening strategies and challenges

“…Skilled human personnel specialized in performing VIA, colposcopy and cervical biopsy, thermal ablation, and loop excision are acutely short in Nepal. Though infrequent, a recent visit by a team of experts from the USA comprising the members of The American Society of Clinical Oncology (ASCO) and The University of Texas MD Anderson Cancer Center trained 42 personnel in essential skills for the diagnostic procedure and management of cervical cancer ( 83 ). Appropriate cancer care requires a multidisciplinary approach with a team of experts consisting of oncologists, surgeons, pathologists, radiologists, oncology/radiation nurses, medical physicists, radiation therapy technicians, and trained social health workers.…”