Collaborations in gynecologic oncology education and research in low- and middle- income countries: Current status, barriers and opportunities

Chuang, Linus; Berek, Jonathan S.; Randall, Thomas C.; McCormack, Mary; Schmeler, Kathleen M.; Manchanda, Ranjit; Rebbeck, Timothy R.; Jeng, Cherng-Jye; Pyle, Doug; Quinn, Michael J.; Trimble, Edward L.; Naik, Raj; Lai, Cheng‐Hung; Ochiai, Kazunori; Denny, Lynette; Bhatla, Neerja

doi:10.1016/j.gore.2018.05.005

Cited by 9 publications

(6 citation statements)

References 12 publications

(13 reference statements)

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“…The purpose of this series of studies was to explore the feasibility and scalability of a replicable, multiphasic screening event targeting multiple types of cancer in rural settings. While attempting to target the common challenge of LMICs related to lack of infrastructure to conduct cancer screening and provide follow-up testing and care, 12 our team also strategized ways to minimize the individual-level barriers that could affect participation in the jornadas. The barriers identified by this community were similar to others Feasibility of Multiphasic Cancer Screening in Honduras noted within LMICs: lack of understanding of process and benefit of screening, 1,13,14 investment of time, 14 distance, 1,14 and costs.…”

Section: Discussionmentioning

confidence: 99%

“…The importance of culturally sensitive community engagement for dissemination and sustainability of screening efforts in LMICs has been noted as a key component of the degree to which implementation efforts succeed or fail. 1,12 As such, the events were feasible to execute and became more complex across the years, offering more screening targets and opportunities for health education.…”

Section: Discussionmentioning

confidence: 99%

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Feasibility of Brigade-Style, Multiphasic Cancer Screening in Rural Honduras

Lyons

Kennedy

LaRochelle

et al. 2020

JCO Global Oncology

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PURPOSE To evaluate the feasibility of brigade-style, multiphasic cancer screening in Honduras, exploring data from 3 screening events that each tested for multiple cancers on single occasions. METHODS This series of 3 studies each used a single-arm, post-test–only design to explore the feasibility of implementing multiphasic, community-based cancer screening at the same rural location in 2013, 2016, and 2017. The 2013 event for women screened for 2 cancers (breast and cervix), and the 2016 event for women screened for 3 cancers (breast, cervix, and thyroid). The 2017 event for men screened for 5 cancers (skin, prostate, colorectal, oropharynx, and testes). RESULTS Totals of 473 and 401 women participated in the 2013 and 2016 events, respectively, and 301 men participated in the 2017 event. Staffing for each event varied from 33 to 44 people and relied primarily on in-country medical students and local community members. High rates (mean, 88%) of compliance with referral for follow-up testing at clinics and primary care facilities were observed after the screening events. CONCLUSION The multiphasic, community-based approach proved feasible for both women and men and resulted in high rates of compliance with follow-up testing. This approach appears highly replicable: it was conducted multiple times across the years with different screening targets, which could be further scaled elsewhere using the same technique.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Feasibility of Brigade-Style, Multiphasic Cancer Screening in Rural Honduras

Lyons

Kennedy

LaRochelle

et al. 2020

JCO Global Oncology

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“…However, outside of specialized centers within high-HDI regions, there is a paucity of specialty training with few clinicians available to skillfully manage these patients. 5 Some of the presumptions inherent in the guideline include that chemotherapy and specialized surgery are not available in basic settings (Table 2). As a result of these disparities, the American Society of Clinical Oncology (ASCO) Resource-Stratified Guidelines Advisory Group chose epithelial cancer of the ovary as a priority topic for guideline development.…”

Section: High Plus Very High V 4 Low Plus Medium [Mortality])mentioning

confidence: 99%

Assessment of Adult Women With Ovarian Masses and Treatment of Epithelial Ovarian Cancer: ASCO Resource-Stratified Guideline

Vanderpuye

Clemenceau

Temin

et al. 2022

Obstetrical &Amp; Gynecological Survey

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The lack of reliable screening modalities for ovarian cancer results in most women being diagnosed on the basis of symptomatic presentation with the majority at advanced stages. Nonspecific symptoms may be overlooked or misdiagnosed regardless of how resource-rich the health care system. Pathology and surgical staging are important aspects of diagnosis and treatment of epithelial ovarian cancer (EOC), and the availability of these services varies around the world and may be limited in countries with low Human Development Index (HDI).This American Society of Clinical Oncology (ASCO) guideline offers recommendations in the diagnosis and treatment of EOC in resource-constrained settings. The goals of the guideline are to answer 4 overarching questions in this population: what are the optimal diagnosis and staging strategies for women with ovarian masses and/or EOC, what is the optimal surgery for women with stages I to IV EOC, what is the optimal adjuvant and/or systematic therapy for stages I to IV EOC, and what is the optimal therapy for women with recurrent EOC. This guideline developed through an ADAPTE methodology is informed by a systematic review of high-quality published guidelines and the consensus of a multinational, multidisciplinary expert panel.Diagnosis and staging begin with identification of clinical symptoms associated with possible EOC. Workup in a basic resource setting depends on patient's history and physical examination and generally includes measurement of CA-125, as well as pelvic ultrasound and referral to a higher-level center for evaluation including a CT scan for extraovarian evaluation and treatment planning. Surgery is an essential element of diagnosis and initial care by providing tissue pathology diagnosis, surgical staging, and tumor debulking. In resource-limited settings, patients should be referred to next level of care to receive essential surgical staging and cytoreduction by trained clinicians only. First-line therapy for EOC should be platinumbased chemotherapy with neoadjuvant chemotherapy followed by evaluation for interval debulking surgery recommended in cases of advanced-stage disease. Patients with stage 1 ovarian cancer that is incompletely or completely staged with residual disease experience survival benefit from adjuvant chemotherapy; however, this should not replace additional surgery if feasible. Resource-limited settings should refer to higher-level treatment centers for adjuvant therapy or restaging when possible, and if not feasible, close monitoring for recurrence is warranted. Targeted therapy is not recommended in resourcelimited settings given the morbidity and mortality of potential adverse effects. Fertility-preserving surgery should be offered to women with early-stage EOC (low grade) after discussion about the risks of recurrent ovarian cancer, and when possible, referral to the highest-level center for presurgery counseling and surgery should be done. Finally, cancer clinical trials play a pivotal role in improving cancer care, and the expansion of onco...

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“…Hence, training in a LMIC differs from training in a HIC. Partnerships with identified cancer centres and accreditation with international oncology societies will improve training and ensure trainee satisfaction 23 24 . For example, Christian Medical College, Vellore, is accredited by the European Society of Gynaecological Oncology.…”

Section: Training In India: Opportunities For Next-generation Gynaeco...mentioning

confidence: 99%

Training for next-generation gynaecologic surgical & radiation oncologists – opportunities & challenges

et al. 2021

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Collaborations in gynecologic oncology education and research in low- and middle- income countries: Current status, barriers and opportunities

Cited by 9 publications

References 12 publications

Feasibility of Brigade-Style, Multiphasic Cancer Screening in Rural Honduras

Feasibility of Brigade-Style, Multiphasic Cancer Screening in Rural Honduras

Assessment of Adult Women With Ovarian Masses and Treatment of Epithelial Ovarian Cancer: ASCO Resource-Stratified Guideline

Training for next-generation gynaecologic surgical & radiation oncologists – opportunities & challenges

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