The central role of provider training in implementing resource‐stratified guidelines for palliative care in low‐income and middle‐income countries: Lessons from the Jamaica Cancer Care and Research Institute in the Caribbean and Universidad Católica in Latin America

Abstract

Individuals in low‐income and middle‐income countries (LMICs) account for approximately two‐thirds of cancer deaths worldwide, and the vast majority of these deaths occur without access to essential palliative care (PC). Although resource‐stratified guidelines are being developed that take into account the actual resources available within a given country, and several components of PC are available within health care systems, PC will never improve without a trained workforce. The design and implementation of PC provider training programs is the lynchpin for ensuring that all seriously ill patients have access to quality PC services. Building on the Breast Health Global Initiative's resource‐stratified recommendations for provider education in PC, the authors report on efforts by the Jamaica Cancer Care and Research Institute in the Caribbean and the Universidad Católica in successfully developing and implementing PC training programs in the Caribbean and Latin America, respectively. Key aspects of this approach include: 1) fostering strategic academic partnerships to bring additional expertise and support to the effort; 2) careful adaptation of the curriculum to the local context and culture; 3) early identification of feasible metrics to facilitate program evaluation and future outcomes research; and 4) designing PC training programs to meet local health system needs.

PredTAD: A machine learning framework that models 3D chromatin organization alterations leading to oncogene dysregulation in breast cancer cell lines

“…Breast cancer is a highly prevalent disease, with more than 7.8 million cases worldwide [33] . Fortunately, the overall death rate has been steadily decreasing due to advances in early detection and treatments [36] , [37] , [38] , [39] , [40] .…”

“…Breast cancer is a globally prevalent disease. The 5-year survival rate for people diagnosed with breast cancer ranges from 90% in high-income countries to about 66% in India and 40% in South Africa [31] , [32] , [33] , [34] . In the U.S., about 1 in 8 women will develop breast cancer in her lifetime [35] .…”

“…It is estimated that there will be more than 280,000 new cases of invasive breast cancer and 49,000 new cases of non-invasive (in situ) breast cancer in 2021 [32] . There are currently more than 3.8 million women with a history of breast cancer in the U.S and more than 7.8 million women worldwide who were diagnosed with breast cancer in the past 5 years [33] . Although the overall death rate from breast cancer is decreasing by about 1% per year due to advances in treatment and early detection through screening [36] , [37] , [38] , [39] , [40] , there is still an estimated 43,600 breast cancer related deaths in U.S. women in 2021 [35] .…”

Breast cancer treatment: A phased approach to implementation

“…Today, the definition of palliative care has expanded to include supportive care provisions that should be introduced soon after a breast cancer diagnosis to address symptomatic treatment, including pain management, as well as psychosocial and spiritual support 12 . Because supportive care is fundamental to symptom management, the establishment of palliative and supportive care is a prerequisite for establishing both early‐stage and metastatic treatment programs and should not be overlooked in the development of a comprehensive cancer treatment plan 13 …”

Breast Cancer in the Caribbean

“…The WHO estimates 78% of 40 million people who need palliative care live in low- and middle-income (LMIC) countries, which includes 30% to 50% of patients presenting with advanced-stage BC diagnosis (III-IV) in LAC [ 112 ]. High mortality is largely due to insufficient access to treatment and patients presenting with incurable advanced stages of the disease [ 112 ], as presented by this review.…”