Resource-Stratified Guidelines for Cancer Management: Correction and Commentary

Anderson, Benjamin O.; Duggan, Catherine

doi:10.1200/jgo.2016.006213

Cited by 18 publications

(22 citation statements)

References 24 publications

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“…The guidelines describe approaches for managing breast cancer early detection and diagnostic imaging; tissue sampling and pathology; multimodality treatment; health care systems; and supportive and palliative care within a 4‐tiered resource‐stratification framework—basic, limited, enhanced, and maximal—through which breast cancer control strategies are prioritized within the context of available health care resources 5‐8 . This resource‐stratification approach has now been adopted or adapted by other groups, including the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN), for additional cancer guideline development 9 . The NCCN has now developed 19 resource‐stratified frameworks that cover approximately 75% of cancers worldwide 10,11 …”

Section: Introductionmentioning

confidence: 99%

The Breast Health Global Initiative 2018 Global Summit on Improving Breast Healthcare Through Resource‐Stratified Phased Implementation: Methods and overview

Duggan

Dvaladze

Rositch

et al. 2020

Cancer

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BACKGROUND:The Breast Health Global Initiative (BHGI) established a series of resource-stratified, evidence-based guidelines to address breast cancer control in the context of available resources. Here, the authors describe methodologies and health system prerequisites to support the translation and implementation of these guidelines into practice. METHODS: In October 2018, the BHGI convened the Sixth Global Summit on Improving Breast Healthcare Through Resource-Stratified Phased Implementation. The purpose of the summit was to define a stepwise methodology (phased implementation) for guiding the translation of resource-appropriate breast cancer control guidelines into real-world practice. Three expert consensus panels developed stepwise, resource-appropriate recommendations for implementing these guidelines in low-income and middle-income countries as well as underserved communities in high-income countries. Each panel focused on 1 of 3 specific aspects of breast cancer care: 1) early detection, 2) treatment, and 3) health system strengthening. RESULTS: Key findings from the summit and subsequent article preparation included the identification of phased-implementation prerequisites that were explored during consensus debates. These core issues and concepts are key components for implementing breast health care that consider real-world resource constraints. Communication and engagement across all levels of care is vital to any effectively operating health care system, including effective communication with ministries of health and of finance, to demonstrate needs, outcomes, and cost benefits. CONCLUSIONS: Underserved communities at all economic levels require effective strategies to deploy scarce resources to ensure access to timely, effective, and affordable health care. Systematically strategic approaches translating guidelines into practice are needed to build health system capacity to meet the current and anticipated global breast cancer burden. Cancer 2020;126:2339-2352.

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Section: Introductionmentioning

confidence: 99%

The Breast Health Global Initiative 2018 Global Summit on Improving Breast Healthcare Through Resource‐Stratified Phased Implementation: Methods and overview

Duggan

Dvaladze

Rositch

et al. 2020

Cancer

Self Cite

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“…To be effective, guidelines must be relevant to the setting and resources available. Resource‐appropriate, evidence‐based guidelines for breast cancer detection, diagnosis, and treatment at different resource levels have been developed by a variety of organizations, including the Breast Health Global Initiative (BHGI) and the National Comprehensive Cancer Network 1 . The effective translation of this evidence into practice in low‐resource settings requires strategies to identify and optimize existing infrastructure, personnel, and funding.…”

Section: Introductionmentioning

confidence: 99%

Situational analysis of breast health care systems: Why context matters

Duggan

Dvaladze

Stevens

et al. 2020

Cancer

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BACKGROUND: Implementation of evidence-based, resource-appropriate guidelines for breast cancer control should be preceded by a baseline assessment or situational analysis to assess breast health infrastructure, workforce capacity, patient pathways, existing practices, accessibility, and costs. METHODS: To support the assessment of breast health care systems within the broader context in which they exist, the Breast Health Global Initiative (BHGI) developed, tested, and refined a set of situational analysis tools with which to guide the assessment of breast health care capacity, identify the relative strengths and weaknesses of the health system, and support stakeholders in prioritizing actionable items to advance breast cancer care using evidence-based strategies tailored to their setting. The tools address 6 domains of breast health care delivery: 1) breast cancer early detection practices; 2) breast cancer awareness programs; 3) the availability of breast cancer surgery; 4) the availability of pathology; 5) the availability of radiotherapy, and 6) the availability of systemic therapy services. The current study also describes the more comprehensive International Atomic Energy Agency Programme of Action for Cancer Therapy (PACT) integrated missions for PACT (imPACT) review. RESULTS: As of 2020, 5 formal BHGI situational analyses have been performed in India, Brazil, Panama, Tanzania, and Uganda. As of August 2019, a total of 100 imPACT reviews have been conducted in 91 countries. These assessments can contribute to more informed policymaking. CONCLUSIONS: Situational analyses are a prerequisite for the development of resource-appropriate strategies with which to advance breast cancer control in any setting and should assess services across the entire breast health care continuum as well as the broader structural, sociocultural, personal, and financial contexts within which they operate. Cancer 2020;126:2405-2415.

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“…(105) Future directions will hinge on identifying individualized approaches based upon building functional systems that provide effective early detection, diagnosis and treatment approaches based upon the implementation of existing resources. (106)…”

Section: Disparities Around the Globementioning

confidence: 99%

Breast Cancer Disparities at Home and Abroad: A Review of the Challenges and Opportunities for System-Level Change

Reeder‐Hayes

Anderson

2017

Clinical Cancer Research

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Sizeable disparities exist in breast cancer outcomes, both between Black and White patients in the United States, and between patients in the US and other high-income countries compared to low- and middle-income countries (LMICs). In both settings, health system factors are key drivers of disparities. In the US, Black women are more likely to die of breast cancer than Whites, and have poorer outcomes even among patients with similar stage and tumor subtype. Over-representation of higher-risk “triple negative” breast cancers contributes to breast cancer mortality in Black women; however, the greatest survival disparities occur within the good-prognosis hormone-receptor positive (HR+) subtypes. Disparities in access to treatment within the complex US health system may be responsible for a substantial portion of these differences in survival. In LMICs, breast cancer mortality rates are substantially higher than in the US, while incidence continues to rise. This mortality burden is largely attributable to health system factors, including late-stage presentation at diagnosis and lack of availability of systemic therapy. This article will review the existing evidence for how health-system factors in the United States contribute to breast cancer disparities, discuss methods for studying the relationship of health system factors to racial disparities, and provide examples of health system interventions that show promise for mitigating breast cancer disparities. We will then review evidence of global breast cancer disparities in low and middle income countries, the treatment factors that contribute to these disparities, and actions being taken to combat breast cancer disparities around the world.

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Resource-Stratified Guidelines for Cancer Management: Correction and Commentary

Cited by 18 publications

References 24 publications

The Breast Health Global Initiative 2018 Global Summit on Improving Breast Healthcare Through Resource‐Stratified Phased Implementation: Methods and overview

The Breast Health Global Initiative 2018 Global Summit on Improving Breast Healthcare Through Resource‐Stratified Phased Implementation: Methods and overview

Situational analysis of breast health care systems: Why context matters

Breast Cancer Disparities at Home and Abroad: A Review of the Challenges and Opportunities for System-Level Change

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