Practical Successes in Telepathology Experiences in Africa

Montgomery, Nathan D.; Tomoka, Tamiwe; Krysiak, Robert; Powers, Eric R.; Mulenga, Maurice; Kampani, Coxcilly; Chimzimu, Fred; Owino, Michael K.; Dhungel, Bal M.; Gopal, Satish; Fedoriw, Yuri

doi:10.1016/j.cll.2017.10.011

“…However, this process is not satisfactory. In the near future, IHC should be implemented in Abidjan and in anticipation, one of our Ivorian pathologist colleagues has received specific training in IHC procedure and interpretation.Telepathology represents also an attractive approach15 .ConclusionFinally, this prospective study confirms that treatment refusal and abandonment are major issues for treatment of ML in LMIC. Some parameters should be considered such as education, communication with patients and families, access to medical staff, motivation and logistics.…”

supporting

confidence: 72%

AMAFRICA, a patient-navigator program for accompanying lymphoma patients during chemotherapy in Ivory Coast: a prospective randomized study

Koffi

¹

,

Silué

²

,

Laurent

³

et al. 2019

Preprint

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Background Previous studies have indicated that accompanying socially undeserved cancer patients through Patient Navigator (PN) or PN-derived procedures improves therapy management and reassurance. At the Cancer Institute of Toulouse-Oncopole (France), we have implemented AMA (Ambulatory Medical Assistance), a PN-based procedure adapted for malignant lymphoma (ML) patients under therapy. We found that AMA improve adherence to chemotherapy and safety. In low-middle income countries (LMIC), refusal and abandonment were documented as major adverse factors for cancer therapy. We reasoned that AMA could improve clinical management of ML patients in LMIC. Methods This study was set up in the Abidjan University Medical Center (Ivory Coast) in collaboration with Toulouse. Hundred African patients were randomly assigned to either AMA or control group. Main criteria of judgment were refusal and abandonment of CHOP or ABVD chemotherapy. Results We found that AMA was feasible and has significant impact on refusal and abandonment. However, only one third of patients completed their therapy in both groups. No differences were noted in terms of complete response rate (CRR) (16% based on intent-to-treat) and median overall survival (OS) (6 months). The main reason for refusal and abandonment was limitation of financial resources. Conclusion Altogether, this study showed that PN may reduce refusal and abandonment of treatment. However, due to insufficient health care coverage, its ultimate impact on OS remains limited.

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“…We classified the malignant lesions further to carcinoma, lymphoma, sarcoma, and unclassified, according to the cytology report. The diagnoses were reported by experienced Pathologists onsite and only diagnostically challenging cases and those cases enrolled for ongoing lymphoma research were only reviewed through tele-pathology with UNC Pathologist[ 7 , 15 ].…”

Section: Methodsmentioning

confidence: 99%

Utilization of fine needle aspiration cytology at Kamuzu central hospital

Khan¹,

Liomba

²

,

Rosenberg³

et al. 2018

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BackgroundFine needle aspiration cytology (FNAC) has been widely accepted to be a safe, accurate, prompt and inexpensive procedure for diagnosis of both neoplastic and infectious diseases in adult and pediatric populations. Despite its value for diagnosis, FNAC is underutilized in resource limited countries. We reviewed the utilization of FNAC after it was introduced at Kamuzu Central Hospital (KCH).MethodsA retrospective review of all FNAC performed at KCH laboratory during the period of January 2012 to July 2014 was conducted using an electronic database from KCH laboratory. We evaluated factors associated with a diagnostic sample using multivariate logistic regression model.Results750 FNAC were reviewed from 722 patients: 56.9% were adults >15 years and 54% were female. The number of FNAC increased annually from 56 (2012) to 379 (2013) to 315 (up to July 2014). Of 750 FNAC, 56.4% were performed by non-pathologists. The most common sites were lymph nodes (38.1%), abdomen (25.8%), breast (16.3%), and head & neck (15.7%). Most of the samples (77.6%) were diagnostic. FNAC was more likely to be diagnostic if performed by pathologists versus non-pathologists (OR 1.78, 95% CI 1.20–2.64), in 2013 compared to 2012 (OR 1.95, 95% CI 1.05–3.56), or performed on a deep lesion versus a subcutaneous lesion (OR 1.71, 95% CI 1.15–2.5), or if samples were taken from the head and neck (OR 2.4, 95% CI: 1.39–4.39), and abdomen (OR 2.66, 95%CI1.59–4.42) compared to those from the lymph nodes. The odds of a diagnostic test did not differ significantly according to gender, HIV status, or age groups.ConclusionMost FNACs successfully diagnosed the presence or absence of disease, with substantial improvements over time. However, training for non-pathologists may facilitate more diagnostic results.

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“…Telepathology represents also an attractive approach 15 . Overall survival in AMAFRICA and non-AMAFRICA groups…”

Section: Discussionmentioning

confidence: 99%

AMAFRICA, a patient-navigator program for accompanying lymphoma patients during chemotherapy in Ivory Coast: a prospective randomized study

Koffi

¹

,

Silué

²

,

Laurent

³

et al. 2019

Preprint

0

View full text Add to dashboard Cite

Background Previous studies have indicated that accompanying socially undeserved cancer patients through Patient Navigator (PN) or PN-derived procedures improves therapy management and reassurance. At the Cancer Institute of Toulouse-Oncopole (France), we have implemented AMA (Ambulatory Medical Assistance), a PN-based procedure adapted for malignant lymphoma (ML) patients under therapy. We found that AMA improve adherence to chemotherapy and safety. In low-middle income countries (LMIC), refusal and abandonment were documented as major adverse factors for cancer therapy. We reasoned that AMA could improve clinical management of ML patients in LMIC. Methods This study was set up in the Abidjan University Medical Center (Ivory Coast) in collaboration with Toulouse. Hundred African patients were randomly assigned to either AMA or control group. Main criteria of judgment were refusal and abandonment of CHOP or ABVD chemotherapy. Results We found that AMA was feasible and has significant impact on refusal and abandonment. However, only one third of patients completed their therapy in both groups. No differences were noted in terms of complete response rate (CRR) (16% based on intent-to-treat) and median overall survival (OS) (6 months). The main reason for refusal and abandonment was limitation of financial resources. Conclusion Altogether, this study showed that PN may reduce refusal and abandonment of treatment. However, due to insufficient health care coverage, its ultimate impact on OS remains limited.

show abstract

Practical Successes in Telepathology Experiences in Africa

Cited by 36 publications

References 28 publications

AMAFRICA, a patient-navigator program for accompanying lymphoma patients during chemotherapy in Ivory Coast: a prospective randomized study

AMAFRICA, a patient-navigator program for accompanying lymphoma patients during chemotherapy in Ivory Coast: a prospective randomized study

Utilization of fine needle aspiration cytology at Kamuzu central hospital

AMAFRICA, a patient-navigator program for accompanying lymphoma patients during chemotherapy in Ivory Coast: a prospective randomized study

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