Project ECHO: A Telementoring Program for Cervical Cancer Prevention and Treatment in Low-Resource Settings

Abstract

Cervical cancer incidence and mortality rates are significantly higher in low- and middle-income countries compared with the United States and other developed countries. This disparity is caused by decreased access to screening, often coupled with low numbers of trained providers offering cancer prevention and treatment services. However, similar disparities are also found in underserved areas of the United States, such as the Texas-Mexico border, where cervical cancer mortality rates are 30% higher than in the rest of Texas. To address these issues, we have adopted the Project ECHO (Extension for Community Healthcare Outcomes) program, a low-cost telementoring model previously proven to be successful in increasing local capacity, improving patient management skills, and ultimately improving patient outcomes in rural and underserved areas. We use the Project ECHO model to educate local providers in the management of cervical dysplasia in a low-resource region of Texas and have adapted it to inform strategies for the management of advanced cervical and breast cancer in Latin America and sub-Saharan Africa. This innovative approach, using ECHO, is part of a larger strategy to enhance clinical skills and develop collaborative projects between academic centers and partners in low-resource regions.

The burden of cancers and their variations across the states of India: the Global Burden of Disease Study 1990–2016

“…Shortage of appropriately educated and trained medical officers for treatment, management, and palliative care for cancer patients, particularly outside metropolitan cities, remains a challenge across the country 10 . Recent attempts to address this gap include training through the Extension of Community Healthcare Outcomes tele-mentoring model for primary health-care providers and specialists on cancer screening and management by the National Institute of Cancer Prevention and Research 52 . Attempts are also being made to strengthen tertiary cancer management by developing evidence-based guidelines through the knowledge exchange platform of the National Cancer Grid of India 12 .…”

Identifying barriers and finding solutions to implement best practices for cancer surgery at Maputo Central Hospital, Mozambique

“…Despite different interventions to train Mozambique oncologists involving Brazilian hospitals, the Calouste Gulbenkian foundation from Portugal, MD Anderson Cancer Center from USA and others, according to the respondents, there were no substantial changes in the practice of surgical oncology at MCH. It seems clear that without integrating these training efforts into an official and formal CEP at different levels (namely, pre-graduate and continuing medical education), the results will continue to be fragile and these activities will be erratic [ 21 , 22 ].…”

Cervical cancer prevention and treatment in Latin America

“…Clinicians in underserved areas learn from the specialists and from each other, and specialists learn from the community providers. This is a many‐to‐many approach, as opposed to the approach of traditional telemedicine . The ECHO telementoring program is complemented by hands on training for diagnostic and therapeutic surgical procedures in the low resource areas such as colposcopy and LEEP courses held locally.…”

“…This is a many-to-many approach, as opposed to the approach of traditional telemedicine. 14 Argentina) is currently performing a prospective, multicenter study (the ConCerv trial) to evaluate the feasibility and safety of performing more conservative surgery in women with early stage cervical cancer. 19 Patients with stage IA2-IB1 cervical cancer undergo cone biopsy or simple hysterectomy with lymphadenectomy depending on their desire for future fertility.…”