Impact of Breast Cancer Early Detection Training on Rwandan Health Workers’ Knowledge and Skills

Pace, Lydia E.; Dusengimana, Jean-Marie Vianney; Keating, Nancy L.; Hategekimana, Vedaste; Rugema, Vestine; Bigirimana, Jean Bosco; Costas‐Chavarri, Ainhoa; Umwizera, Aline; Park, Paul H.; Shulman, Lawrence N.; Mpunga, Tharcisse

doi:10.1200/jgo.17.00098

Cited by 23 publications

(29 citation statements)

References 21 publications

(25 reference statements)

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“…Efforts to improve early detection of breast cancer have focused on educating community health care workers in performing clinical breast examinations and using appropriate referral protocols. 18 These training programs are being expanded across the country. Further improvements in early detection of breast cancer will include reducing the delay from presentation to diagnosis by expanding breast imaging capabilities for symptomatic and high-risk individuals and increasing the number health care professionals trained to recognize early signs and symptoms of the disease.…”

Section: Cancer Prevention Early Detection and Screeningmentioning

confidence: 99%

State of Cancer Control in Rwanda: Past, Present, and Future Opportunities

Rubagumya

Costas‐Chavarri

Manirakiza

et al. 2020

JCO Global Oncology

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Rwanda is a densely populated low-income country in East Africa. Previously considered a failed state after the genocide against the Tutsi in 1994, Rwanda has seen remarkable growth over the past 2 decades. Health care in Rwanda is predominantly delivered through public hospitals and is emerging in the private sector. More than 80% of patients are covered by community-based health insurance (Mutuelle de Santé). The cancer unit at the Rwanda Biomedical Center (a branch of the Ministry of Health) is responsible for setting and implementing cancer care policy. Rwanda has made progress with human papillomavirus (HPV) and hepatitis B vaccination. Recently, the cancer unit at the Rwanda Biomedical Center launched the country’s 5-year National Cancer Control Plan. Over the past decade, patients with cancer have been able to receive chemotherapy at Butaro Cancer Center, and recently, the Rwanda Cancer Center was launched with 2 linear accelerator radiotherapy machines, which greatly reduced the number of referrals for treatment abroad. Palliative care services are increasing in Rwanda. A cancer registry has now been strengthened, and more clinicians are becoming active in cancer research. Despite these advances, there is still substantial work to be done and there are many outstanding challenges, including the need to build capacity in cancer awareness among the general population (and shift toward earlier diagnosis), cancer care workforce (more in-country training programs are needed), and research.

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Section: Cancer Prevention Early Detection and Screeningmentioning

confidence: 99%

State of Cancer Control in Rwanda: Past, Present, and Future Opportunities

Rubagumya

Costas‐Chavarri

Manirakiza

et al. 2020

JCO Global Oncology

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“…36 Importantly, 63% (n=10/16) of studies had solely female CHWs. 2 33-36 38 39 43 44 46 Only one study from Rwanda, by Pace et al, 42 provided a detailed description regarding the characteristics of the CHWs, as well as their responsibilities beyond breast health. 42 In this study, CHWs (62% of who were female) were described as playing several roles, including building community awareness about preventive healthcare and connecting individuals to the wider healthcare system.…”

Section: Results Search Resultsmentioning

confidence: 99%

“…2 34 44 One study did not specifically describe a role for CHWs in a screening or early diagnosis programme but rather provided an in-depth assessment of a training programme designed for CHWs to assist in early detection more generally and was thus deemed appropriate for inclusion in the final review. 42 In the studies where early diagnosis was selected over general population screening, methods including 'case finding' were deemed more appropriate given the low incidences of breast cancer, young age of onset and difficulty in follow-up from initial presentation. In all 16 studies, CHWs had a variety of different roles in early detection initiatives.…”

Section: How Are Chws Currently Deployed In Breast Cancer Early Detecmentioning

confidence: 99%

Community health workers and early detection of breast cancer in low-income and middle-income countries: a systematic scoping review of the literature

et al. 2020

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BackgroundBreast cancer is the leading cause of female mortality in low-income and middle-income countries (LMICs). Early detection of breast cancer, either through screening or early diagnosis initiatives, led by community health workers (CHWs) has been proposed as a potential way to address the unjustly high mortality rates. We therefore document: (1) where and how CHWs are currently deployed in this role; (2) how CHWs are trained, including the content, duration and outcomes of training; and (3) the evidence on costs associated with deploying CHWs in breast cancer early detection.MethodsWe conducted a systematic scoping review and searched eight major databases, as well as the grey literature. We included original studies focusing on the role of CHWs to assist in breast cancer early detection in a country defined as a LMIC according to the World Bank.Findings16 eligible studies were identified. Several roles were identified for CHWs including awareness raising and community education (n=13); history taking (n=7); performing clinical breast examination (n=9); making onward referrals (n=7); and assisting in patient navigation and follow-up (n=4). Details surrounding training programmes were poorly reported and no studies provided a formal cost analysis.ConclusionsDespite the relative paucity of studies addressing the role of CHWs in breast cancer early detection, as well as the heterogeneity of existing studies, evidence suggests that CHWs can play a number of important roles in breast cancer early detection initiatives in LMICs. However, if they are to realise their full potential, they must be appropriately supported within the wider health system.

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“…35 Other studies have also demonstrated the efficacy of training community health workers in the early detection and referral of breast and cervical cancer. [35][36][37][38][39][40][41] Whether such interventions in the adult cancer space can translate effectively to improvments in the early detection of childhood cancers in LMICs is a subject for future research. is thus dependent on cancer type and jurisdiction.…”

Section: Discussionmentioning

confidence: 99%

Interventions to improve early detection of childhood cancer in low‐ and middle‐income countries: A systematic review

Zabih

Thota

Mbah

et al. 2020

Pediatric Blood & Cancer

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Background: Childhood cancer outcomes in low-and middle-income countries (LMICs) lag behind those in high-income countries (HICs), in part due to late presentation and diagnosis. Though several interventions targeting early detection of childhood cancer have been implemented in LMICs, little is known about their efficacy. Methods: We conducted a systematic review to identify studies describing such interventions. We searched multiple databases from inception to December 4, 2019. Studies were included if they reported on LMIC interventions focused on: (a) training of health care providers on early recognition of childhood cancer, or (ii) public awareness campaigns. We used preferred reporting items for systematic reviews and metaanalyses (PRISMA) guidelines to conduct our review. The risk of bias in nonrandomized studies of interventions (ROBINS-I) checklist was used to assess quality of studies. Results: Twelve studies met inclusion criteria (n = 5 full text, n = 7 abstract only). Five studies focused on retinoblastoma only, while the others focused on all types of childhood cancer. The majority studied multiple interventions of which early detection was one component, but reported overall outcomes. All identified studies used pre-post evaluative designs to measure efficacy. Five studies reported statistically significant results postintervention: decrease in extraocular spread of retinoblastoma, decrease in rates of refusal/abandonment of treatment, increase in number of new referrals, increase in knowledge, and an absolute increase in median 5-year survival. Other studies reported improvements without tests of statistical significance. Two studies reported no difference in survival postintervention. The ROBINS-I checklist indicated that all studies were at serious risk of bias. Conclusion: Though current evidence suggests that LMIC interventions targeting early detection of childhood cancer through health professional training and/or public awareness campaigns may be effective, this evidence is limited and of poor quality. Robust trials or quasi-experimental designs with long-term follow up are needed to identify the most effective interventions. Such studies will facilitate and inform the widespread uptake of early detection interventions across LMIC settings.

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Impact of Breast Cancer Early Detection Training on Rwandan Health Workers’ Knowledge and Skills

Cited by 23 publications

References 21 publications

State of Cancer Control in Rwanda: Past, Present, and Future Opportunities

State of Cancer Control in Rwanda: Past, Present, and Future Opportunities

Community health workers and early detection of breast cancer in low-income and middle-income countries: a systematic scoping review of the literature

Interventions to improve early detection of childhood cancer in low‐ and middle‐income countries: A systematic review

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