A tailored approach to building specialized surgical oncology capacity: Early experiences and outcomes in Malawi

Chinula, Lameck; Hicks, Michael L.; Chiudzu, Grace; Tang, Jennifer H.; Gopal, Satish; Tomoka, Tamiwe; Kachingwe, James; Pinder, Leeya; Hicks, Maya M; Sahasrabuddhe, Vikrant V.; Parham, Groesbeck P.

doi:10.1016/j.gore.2018.10.001

Cited by 16 publications

(23 citation statements)

References 13 publications

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“…A similar approach has been used to increase gynecologic oncology surgical capacity in SSA. 14 The University of Witwatersrand breast cancer curriculum focused on 4 major areas: surgery, oncoplasty, imaging, and the multidisciplinary team approach to cancer care. One of the surgeons led the establishment of MBCSC, the subject of this report.…”

Section: Methodsmentioning

confidence: 99%

Minimizing Delays in the Breast Cancer Pathway by Integrating Breast Specialty Care Services at the Primary Health Care Level in Zambia

Mutumba¹,

Pinder

Munalula³

et al. 2020

JCO Global Oncology

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PURPOSE In Zambia, more than two-thirds of female patients with breast cancer present with late-stage disease, leading to high mortality rates. Most of the underlying causes are associated with delays in symptom recognition and diagnosis. By implementing breast care specialty services at the primary health care level, we hypothesized that some of the delays could be minimized. METHODS In March 2018, we established a breast care specialty clinic for women with symptomatic disease within 1 of the 5 district hospitals in Lusaka. The clinic offers breast self-awareness education, clinical breast examination, breast ultrasound, ultrasound-guided breast biopsy, surgery, referral for chemoradiation, follow-up care, and electronic medical records. RESULTS Between March 2018 and April 2019, of 1,790 symptomatic women who presented to the clinic, 176 (10%) had clinical and/or ultrasound indications for histologic evaluation. Biopsy specimens were obtained using ultrasound-guided core-needle procedures, all of which were performed on the same day as the initial visit. Of the 176 women who underwent biopsy, 112 (64%) had pathologic findings compatible with a primary breast cancer, and of these, 42 (37%) were early-stage (stage I/II) disease. Surgery for early-stage cancers was performed at the district hospital within 2 weeks of the time of definitive pathologic diagnosis. Patients with advanced disease were referred to the national cancer center for multimodality therapy, within a similar time frame. CONCLUSION Breast care specialty services for symptomatic women were established in a district-level hospital in a resource-constrained setting in Africa. As a result, the following time intervals were minimized: initial presentation and performance of clinical diagnostics; receipt of a definitive pathologic diagnosis and initiation of surgery; receipt of a definitive pathologic diagnosis and referral.

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Section: Methodsmentioning

confidence: 99%

Minimizing Delays in the Breast Cancer Pathway by Integrating Breast Specialty Care Services at the Primary Health Care Level in Zambia

Mutumba¹,

Pinder

Munalula³

et al. 2020

JCO Global Oncology

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“…As of early 2019, there are six trained gynaecology surgeons providing radical hysterectomy surgery across Malawi, totally inadequate to meet current need. A tailored, but resource-intensive approach for rapid building of surgical capacity for radical hysterectomy through a competency-based curriculum and use of master trainers and clinical mentoring has proved effective in Malawi 62 , a model also adopted by others in sub-Saharan Africa. 63…”

Section: Complete Pathways Of Care For Detected Abnormalitiesmentioning

confidence: 99%

Cervical cancer screening – The challenges of complete pathways of care in low-income countries: Focus on Malawi

Cubie

Campbell

2020

Womens Health (Lond Engl)

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Cervical cancer is the fourth most common cancer among women globally, with approximately 580,000 new diagnoses in 2018. Approximately, 90% of deaths from this disease occur in low- and middle-income countries, especially in areas of high HIV prevalence, and largely due to limited prevention and screening opportunities and scarce treatment options. In this overview, we describe the opportunities and challenges faced in many low- and middle-income countries in delivery of cervical cancer detection, treatment and complete pathways of care. In particular, drawing on our experience and that of colleagues, we describe cervical screening and pathways of care provision in Malawi, as a case study of a low-resource country with high incidence and mortality rates of cervical cancer. Screening methods such as cytology – although widely used in high-income countries – have limited relevance in many low-resource settings. The World Health Organization recommends screening using human papillomavirus testing wherever possible; however, although human papillomavirus primary testing is more sensitive and detects precancers and cancers earlier than cytology, there are currently costs, infrastructure considerations and specificity issues that limit its use in low- and middle-income countries. The World Health Organization accepts the alternative screening approach of visual inspection with acetic acid as part of ‘screen and treat’ programmes as a simple and inexpensive test that can be undertaken by trained health workers and hence give wider screening coverage; however, subjectivity and variability in interpretation of findings between providers raise issues of false positives and overtreatment. Cryotherapy using either nitrous oxide or carbon dioxide is an established treatment for precancerous lesions within ‘screen and treat’ programmes; more recently, thermal ablation has been recognized as suitable to low-resource settings due to lightweight equipment, short treatment times, and hand-held battery-operated and solar-powered models. For larger lesions and cancers, complete clinical pathways (including loop excision, surgery, radiotherapy, chemotherapy and palliative care) are required for optimal care of women. However, provision of each of these components of cancer control is often limited due to limited infrastructure and lack of trained personnel. Hence, global initiatives to reduce cervical mortality need to adopt a holistic approach to health systems strengthening.

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“…The primary objective of our initiative was to build surgical oncologic capacity through the implementation and further validation of a training approach designed for rapid surgical skills transfer [10]. Using a non-traditional approach to surgical training that takes advantage of high volumes of disease, we accelerated the usual time required for a trainee to master the skills necessary to perform potential curative cervical cancer surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Both are professors of gynaecologic oncology at the University of Zambia School of Medicine, where they have established an international training programme in gynaecologic oncology. They previously implemented this novel approach to rapid surgical skills transfer in Zambia and Malawi [10].…”

Section: Personnelmentioning

confidence: 99%

Building workforce capacity for the surgical management of cervical cancer in a fragile, low-income African nation—Democratic Republic of the Congo

Hicks

YouYou

Anaclet

et al. 2021

ecancer

Self Cite

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Objectives: Surgery is a cornerstone of the management of cervical cancer. Women diagnosed with cervical cancer in sub-Saharan Africa have very little access to specialised (gynaecologic oncology) surgical services. We describe our experiences and challenges of training local general gynaecologists to surgically treat early stage invasive cervical cancer at a private sector healthcare facility in a fragile, low-income African nation.Methods: Implementation of the training curriculum began with assigned self-directed learning. It continued with on-site training which consisted of preoperative surgical video reviews, pre-and intra-operative assessment of disease status, deconstruction of the designated surgical procedure into its critical subcomponents and trainees orally communicating the steps of the surgical procedure with the master trainers. High-volume repetition of a single surgical procedure over a short time interval, intra-operative bedside mentoring, post-operative case review and mental narration were critical to the process of surgical skills transfer.Results: Nineteen radical abdominal hysterectomies were successfully performed over four training visits; trainees were able to perform the procedure alone after eight cases; surgical complications decreased over time. The trainees have continued to perform the surgical procedures independently. Research

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A tailored approach to building specialized surgical oncology capacity: Early experiences and outcomes in Malawi

Cited by 16 publications

References 13 publications

Minimizing Delays in the Breast Cancer Pathway by Integrating Breast Specialty Care Services at the Primary Health Care Level in Zambia

Minimizing Delays in the Breast Cancer Pathway by Integrating Breast Specialty Care Services at the Primary Health Care Level in Zambia

Cervical cancer screening – The challenges of complete pathways of care in low-income countries: Focus on Malawi

Building workforce capacity for the surgical management of cervical cancer in a fragile, low-income African nation—Democratic Republic of the Congo

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