Leveraging International Expertise for Cancer Care in LMICs

Abstract

Cancer care in high-income countries (HICs) is often coordinated at multidisciplinary conferences (MDCs). However, among disparities encountered by cancer care providers in low-and middle-income countries (LMICs) is lack of access to specialized expertise. Modern communication technologies offer opportunity for remote MDCs; reports of this are limited and have described logistical barriers. We explored this concept further. Methods: We reviewed the experience of a cancer center in Lagos, Nigeria, connecting with multidisciplinary expertise in the United States (US). Multidisciplinary consultations were reviewed, and descriptive data were generated. Participating providers were surveyed. Results: Over a two-year period, 27 cases were referred for multidisciplinary consultation. Of these, 21 (78%) were referred to Roswell Park Comprehensive Cancer Center in Buffalo, NY, and 6 (22%) were referred to other US institutions. All but one (26, 97%) were referred using email, while one case was discussed via videoconference. Reasons for consultation were uncertainty about management in 10 patients (37%), need for validation of treatment plans in 14 patients (52%) and unusual clinical scenarios in 3 patients (11%). Limitations included incomplete documentation of treatment recommendations (5, 18.5%) and unavailable diagnostics (7, 26%) or therapies (3, 11%). Time to receive final recommendations ranged from 1 to 14 days, with a median of 3 days. Survey respondents (8, 100%) agreed or strongly agreed that remote MDCs added value, and that email was an effective, low-barrier method for their organization, with some drawbacks noted. Conclusion: This early experience demonstrates feasibility of remote MDCs to benefit providers and patients in LMICs. Future directions include using more sophisticated software and organization to maximize the scalability and sustainability of this concept.