Breast cancer treatment: A phased approach to implementation

Abstract

Optimal treatment outcomes for breast cancer are dependent on a timely diagnosis followed by an organized, multidisciplinary approach to care. However, in many low-and middle-income countries, effective care management pathways can be difficult to follow because of financial constraints, a lack of resources, an insufficiently trained workforce, and/or poor infrastructure. On the basis of prior work by the Breast Health Global Initiative, this article proposes a phased implementation strategy for developing sustainable approaches to enhancing patient care in limited-resource settings by creating roadmaps that are individualized and adapted to the baseline environment. This strategy proposes that, after a situational analysis, implementation phases begin with bolstering palliative care capacity, especially in settings where a late-stage diagnosis is common. This is followed by strengthening the patient pathway, with consideration given to a dynamic balance between centralization of services into centers of excellence to achieve better quality and decentralization of services to increase patient access. The use of resource checklists ensures that comprehensive therapy or palliative care can be delivered safely and effectively. Episodic or continuous monitoring with established process and quality metrics facilitates ongoing assessment, which should drive continual process improvements. A series of case studies provides a snapshot of country experiences with enhancing patient care, including the implementation of national cancer control plans in Kenya, palliative care in Romania, the introduction of a 1-stop clinic for diagnosis in Brazil, the surgical management of breast cancer in India, and the establishment of a women's cancer center in Ghana. Cancer 2020;126:2365-2378.

Microenvironmental Determinants of Breast Cancer Metastasis: Focus on the Crucial Interplay Between Estrogen and Insulin/Insulin-Like Growth Factor Signaling

“…The poor clinical prognosis is further exacerbated by the lack of effective targeted treatments and by acquired resistance to therapies. Notwithstanding the advances made with targeted therapies, the absence of defined molecular targets and the high tumor heterogeneity of metastatic BC have resulted in lack of benefit in several subgroups of these patients (Mutebi et al, 2020). The discovery of new molecular targeting agents for metastatic BC is therefore an unmet need.…”

The Breast Health Global Initiative 2018 Global Summit on Improving Breast Healthcare Through Resource‐Stratified Phased Implementation: Methods and overview

“…For breast cancer treatment, the BHGI proposes a generalized, 3‐step, phased‐implementation approach for establishing cancer treatment programs 70 : Phase 1: Establish a supportive care framework to provide essential services for palliative and end‐of‐life care; Phase 2: Develop a Center of Excellence for cancer treatment to achieve better quality care for a whole region or country; and Phase 3: Create a decentralized diagnosis and treatment network to improve access while maintaining diagnostic accuracy and quality. …”

Enhanced Cytotoxic Activity of Docetaxel-Loaded Silk Fibroin Nanoparticles against Breast Cancer Cells

“…Breast cancer is the most prevalent cancer among women, and it has now surpassed lung cancer as the most commonly diagnosed cancer worldwide [ 1 ]. Currently, many therapeutic modalities have been adopted to treat breast cancer, including chemotherapy and targeted therapy as standard treatments, as well as immunotherapy as a promising perspective [ 2 , 3 , 4 ]. Nevertheless, chemotherapy remains the main core for all therapeutic modalities either to combat cancer progression or to prevent disease recurrence and/or metastasis.…”