{"title":"Abstract 40: Global Cancer Surgery in Low-Resource Settings: A Strengths, Weaknesses, Opportunities, and Threats Analysis","authors":"Samantha Sadler, Erick Torio, Alexandra Golby","doi":"10.1158/1538-7755.asgcr23-abstract-40","DOIUrl":"https://doi.org/10.1158/1538-7755.asgcr23-abstract-40","url":null,"abstract":"Abstract Background: Cancer surgery is a resource-intensive yet essential component of cancer care. In the face of projected increase in cancer burden, the present gap in cancer surgery care in low-resource settings with stressed healthcare and surgical infrastructure risks further exacerbation. Understanding the current state of global cancer surgery is essential to determining the best way forward. Purpose: The objectives of this report are to (1) describe the landscape of global cancer surgery literature and (2) characterize these findings through a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis. Methods: A literature review was performed of global cancer surgery studies involving low-resource settings published since the landmark 2015 Lancet Commission on Global Surgery and Global Cancer Surgery. Studies were summarized and evaluated for themes, which were further grouped into SWOT categories for analysis. Results: The online literature search yielded 123 articles, of which 46 articles met inclusion criteria for analysis. The majority of included studies were open access (n=34) and published between 2021 and 2022 (n=26). Conclusion: The body of published global cancer surgery literature is growing, perhaps reflecting increased research attention and valuation. From the reviewed literature, Strengths of the global cancer surgery field include a body of studies investigating important aspects of cancer surgery in low-resource settings: local cancer epidemiology, local surgical and technological innovation, quality-of-life as a key surgical outcome metric, and advancements in cancer surgery through interdisciplinary work. Weaknesses include systems-level limitations (i.e. resources, perioperative services, broader health system gaps) and a paucity of detailed economic analyses. Opportunities include diverse local cancer management strategies, successful inter-setting collaborations supporting research, education, and surgical skills training, and thoughtful research expansion for an inclusive future. Threats include large-scale stresses on local healthcare infrastructure (i.e. COVID-19) and the risk of widening disparities posed by unchecked technological. Conclusion: This SWOT analysis may inform local intervention strategies and action plans to help LMIC stakeholders achieve cancer surgery goals. Similar analyses are needed locally to help elucidate best practices that might be applied or tailored to similar settings globally. Citation Format: Samantha Sadler, Erick Torio, Alexandra Golby. Global Cancer Surgery in Low-Resource Settings: A Strengths, Weaknesses, Opportunities, and Threats Analysis [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 40.","PeriodicalId":9488,"journal":{"name":"Cancer Epidemiology, Biomarkers & Prevention","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135727421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Abstract 58: Leaving Cancer Patients Behind for Greener Pastures: The Clinical Oncology Workforce in Nigeria","authors":"Runcie C.W. Chidebe, Tochukwu C. Orjikor, Onyinye Balogun, Adedayo Joseph, Samantha Toland, Alison Simons","doi":"10.1158/1538-7755.asgcr23-abstract-58","DOIUrl":"https://doi.org/10.1158/1538-7755.asgcr23-abstract-58","url":null,"abstract":"Abstract Purpose: For a population of over 201 million, Nigeria has only 4 doctors per 10,000 patients and 16.1 nurses, midwives per 10,000 patients, and less than 100 clinical oncologists for over 100,000 cancer patients. While Nigeria has one of the worst disease burdens in the world and a workforce shortage; 9 in 10 Nigerian physicians are seeking opportunities to leave for the USA, UK, and Canada. To improve oncology care in Nigeria, it may be important to understand the push and pull factors contributing to the migration of the clinical oncology (CO) workforce. Mathew (2018), Vanderpuye, et al., (2019), Balogun, et al., (2017), and Adebayo, (2016) have done research on CO; however, their studies were vastly focused on the African continent and not country-specific nor focused on the CO workforce in Nigeria.The aim of this study is to explore the push and pull factors to stay or leave the clinical oncology workforce in Nigeria. Methods: Using a mixed-method research approach, 80 participants completed the questionnaire and 9 participants responded to semi-structured interviews. Multiple linear regression and Grounded theory were used for the data analysis. Results: The results show that CO workload and satisfaction were significantly related to turnover intention. The qualitative results showed that CO as a new area of specialization, mentorship, career growth, and attractiveness of radiation science are the pull factors. While, high CO workload, poor healthcare system, poor remuneration, corruption in the public sector, and a few other themes are push factors. Empathy for patients, patriotism and a sense of fulfillment unexpectedly emerged as retention factors in the study. Conclusion: Nigeria can improve patient treatment outcomes by the reduction of CO workload through the employment of more CO. More CO can be available for employment when they are attracted, and their training is optimized. Those employed can be retained by improving working conditions and introducing work benefits. Our recommendations are that health leaders should create more CO training and awareness of CO in Nigeria. Citation Format: Runcie C.W. Chidebe, Tochukwu C. Orjikor, Onyinye Balogun, Adedayo Joseph, Samantha Toland, Alison Simons. Leaving Cancer Patients Behind for Greener Pastures: The Clinical Oncology Workforce in Nigeria [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 58.","PeriodicalId":9488,"journal":{"name":"Cancer Epidemiology, Biomarkers & Prevention","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135728373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Abstract 36: Examining Policies and Guidelines to Improve the Cervical Cancer Prevention and Treatment Pathway for Patients and Health Providers in Tanzania: A Qualitative Study","authors":"Melinda Chelva, Sanchit Kaushal, Nicola West, Erica Erwin, Prisca Dominic Marandu, Safina Yuma, Donna Shelley, Karen Yeates","doi":"10.1158/1538-7755.asgcr23-abstract-36","DOIUrl":"https://doi.org/10.1158/1538-7755.asgcr23-abstract-36","url":null,"abstract":"Abstract Purpose: Cervical cancer is the fourth most common cancer in women around the globe. It has been identified as the most common cancer in Tanzania, resulting in about 9772 new cases and 6695 deaths each year. Several research studies have identified the importance of adequate and timely policies and guidelines to optimize the cervical cancer prevention and treatment pathway in the nation. However, there is scant literature on the perspectives of all stakeholders (e.g., patients, key informants, healthcare providers, and non-healthcare providers). Our study aims to better understand the recommendations from important stakeholders to inform current and upcoming policies and guidelines, and overall, improve the cervical cancer screening and treatment cascade in rural Tanzania and other African countries. Methods: We leveraged a framework for conducting a health systems assessment to identify healthcare providers’ perspectives on effective cervical cancer screening, prevention and control in Tanzania. We adapted interview topic guides for cervical cancer screening using the health systems assessment framework conceptualized by Risso-Gill and colleagues designed initially for evaluating hypertension control. Study participants (71) were interviewed between 2014-2018. This included key stakeholders, patients, healthcare providers and non-healthcare providers. Results: Through the interviews and focus group discussions that were conducted, three major themes emerged: 1) policies and guidelines, 2) burden of disease in relation to policies, and 3) treatment and follow-up. Sub-themes relating to policies and guidelines included health policies, governmental influence, data collection, and revision of HPV vaccination guidelines. Sub-themes for burden of disease included the rise in overall cases of cervical cancer. Subthemes for treatment and follow-up included quality of care, dissatisfaction with care, and patient safety and well-being. Conclusion: It is evident that significant changes must be made to existing policies and guidelines to improve many aspects of the cervical cancer screening and treatment pathway, to benefit healthcare providers and patients alike in rural Tanzania. There is also a critical need to implement new initiatives and programs to increase uptake and allow for informed-decision making among women. Citation Format: Melinda Chelva, Sanchit Kaushal, Nicola West, Erica Erwin, Prisca Dominic Marandu, Safina Yuma, Donna Shelley, Karen Yeates. Examining Policies and Guidelines to Improve the Cervical Cancer Prevention and Treatment Pathway for Patients and Health Providers in Tanzania: A Qualitative Study [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 36.","PeriodicalId":9488,"journal":{"name":"Cancer Epidemiology, Biomarkers & Prevention","volume":"56 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135728171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Leith León-Maldonado, Raul U. Hernández-Ramírez, Leticia Torres-Ibarra, Donna Spiegelman, Sangini S Sheth, Eduardo Lazcano-Ponce, José Damián Cadena-Fiscal, Jorge Salmerón
{"title":"Abstract 39: Factors Associated With Receiving Results and Attending Colposcopy in Patients With Positive HPV Screens in Mexico City","authors":"Leith León-Maldonado, Raul U. Hernández-Ramírez, Leticia Torres-Ibarra, Donna Spiegelman, Sangini S Sheth, Eduardo Lazcano-Ponce, José Damián Cadena-Fiscal, Jorge Salmerón","doi":"10.1158/1538-7755.asgcr23-abstract-39","DOIUrl":"https://doi.org/10.1158/1538-7755.asgcr23-abstract-39","url":null,"abstract":"Abstract Purpose: Unlike in high-income countries, where cervical cancer (CC) screening programs have resulted in a dramatic decrease in incidence and mortality of this nearly fully preventable disease, in low- and middle-income countries, the impact of these programs has been limited. Poor follow-up to abnormal cancer screening tests lessens the benefit of CC screening. We sought to identify multilevel factors at the level of patient, provider, and healthcare system related to receipt of screening results and attendance to colposcopy among patients with positive screening results in a CC screening program in Mexico. Methods: We studied 1,351 patients who were scheduled for colposcopy after testing positive for high-risk human papillomavirus in two screening demonstration studies conducted in Mexico City’s Tlalpan District (2017-2018). Multilevel factors associated with receipt of screening results and with adherence to a colposcopy appointment were identified using multivariable logistic regression. Results: Participants had a median age of 40 years, 58% had less than high school education, and 74% had a Pap screening recently (i.e., in the last 5 years). Fifty-five percent of participants retrieved their screening results at the healthcare facility before being reminded to do so. Greater adherence to obtaining screening test results was associated with providing an email address as contact information (Odds Ratio 1.35 [95% Confidence Interval 1.03-1.77]), attending a facility with family medicine (1.54 [1.07-2.21]), and receiving care from experienced nurses (1.85 [1.30-2.70]). Fifty-seven percent of participants attended their first scheduled colposcopy appointment. Providing a phone number as contact information was linked to improved adherence to colposcopy (1.27 [1.01-1.59]), whereas longer travel time between the healthcare facility and the colposcopy clinic was associated with a decrease in colposcopy adherence (0.68 [0.49-0.94]). Having a Pap recently was positively associated with better compliance with both outcomes (1.36 [0.96-1.94] for receiving results; 1.59 [1.10-2.29] for colposcopy adherence). Conclusion: We identified multilevel factors associated with abnormal test follow-up in patients in Mexico City. Additional research is necessary to design and test components for a multilevel intervention to address these factors and enable successful implementation of the follow-up process for abnormal screens from screening to diagnosis and treatment. Citation Format: Leith León-Maldonado, Raul U. Hernández-Ramírez, Leticia Torres-Ibarra, Donna Spiegelman, Sangini S Sheth, Eduardo Lazcano-Ponce, José Damián Cadena-Fiscal, Jorge Salmerón. Factors Associated With Receiving Results and Attending Colposcopy in Patients With Positive HPV Screens in Mexico City [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol B","PeriodicalId":9488,"journal":{"name":"Cancer Epidemiology, Biomarkers & Prevention","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135727417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}