Multidisciplinary Team Approach Reduces Cervical Cancer Treatment Delays in Low-Resource Areas

Long delays between diagnosis and treatment can contribute to cervical cancer mortality in lower income countries, such as many in Africa.
Long delays between diagnosis and treatment can contribute to cervical cancer mortality in lower income countries, such as many in Africa.

A new approach to address the delay between diagnosis of cervical cancer and treatment in Botswana decreased the delay by more than 50%. This multidisciplinary model could be used around the world in health clinics with limited resources.1

In low-income and middle-income countries, cervical cancer is the leading cause of cancer deaths in women due to long delays between diagnosis and treatment, during which the disease advances.

The HIV epidemic and limited preventive screenings drive high rates of cervical cancer in Botswana. In addition, 75% of patients with cervical cancer have advanced disease at treatment. Because public clinics do not offer radiation therapy, patients must seek treatment at private hospitals, where the wait for therapy can extend as long as 5 months.

"With so many women suffering from advanced cervical cancer in Botswana, long delays between treatment and diagnosis can mean the difference between life and death," said Surbhi Grover, MD, MPH, director of Global Radiation Oncology in the Perelman School of Medicine at the University of Pennsylvania and head of Oncology at Princess Marina Hospital in Botswana.

"We saw an urgent need to develop a care program that gives cervical cancer patients the treatment they need as quickly as possible."

The researchers developed a multidisciplinary team approach to improve communication among health care providers and initiate patients' treatment sooner.

Weekly meetings across multidisciplinary clinicians enabled discussions on patient cases and the development of treatment plans. These teams also submitted paperwork and documentation together, which further decreased treatment delays.

Although this care model may be common in the United States or other developed countries, it is a complicated process that lacks a global standard of guidelines, Grover explained.

This team treated 135 patients over 6 months. Of these patients, 60% were found to have cervical cancer, and 42% had locally advanced disease requiring chemoradiotherapy.

Because of the multidisciplinary team (MDT) approach, 62% of patients needed only 1 visit to the clinic to coordinate care. This reduced the time from diagnosis to treatment by more than 50%. The median delay from biopsy to treatment was 39 days, compared with an average of 108 days prior to the MDT team model.

"With this model, we've shown that the MDT approach works in a resource-limited setting and actually helps address several challenges providers face," Grover stated.

"Many of our patients must travel long distances or face other barriers that prevent them from returning to the clinic for multiple visits. Offering patients a comprehensive treatment plan during one clinic visit is a game-changer."

Reference

1. Grover S, Chiyapo S, Puri P, et al. Multidisciplinary gynecologic oncology clinic in Botswana: a model for multidisciplinary oncology care in low- and middle-income settings. J Glob Oncol. 2017 Feb 8. doi: 10.1200/JGO.2016.006353 [Epub ahead of print]

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