Multidisciplinary team clinics in low- and middle-income countries are realistic and can help reduce delays in cervical cancer treatment, as demonstrated by a new model of cervical cancer care implemented in Botswana.
The study, “Multidisciplinary Gynecologic Oncology Clinic in Botswana: A Model for Multidisciplinary Oncology Care in Low- and Middle-Income Settings,” was conducted by a team from the University of Pennsylvania and was published in the Journal of Global Oncology.
Cervical cancer is the fourth most common cancer affecting women worldwide, with an estimated 528,000 new cases and 266,000 deaths annually. About 85 percent of these new cases and 87 percent of deaths occur in low- and middle-income countries (LMICs).
In Botswana, where a University of Pennsylvania team is based, cervical cancer is the leading cause of cancer deaths, mostly due to the limited screening programs and the high prevalence of HIV in the region.
Current treatment for cervical cancer in the country includes radiation therapy and cisplatin-based chemotherapy. However, radiotherapy is not available in public clinics, so patients who need radiation have to go to private hospitals, which can lead to wait times of up to five 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,” Surbhi Grover, MD, MPH, the study’s corresponding author, said in a news release.
“We saw an urgent need to develop a care program that gives cervical cancer patients the treatment they need as quickly as possible.”
Grover is the 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.
In a previous study, the researchers found that the median time from diagnosis to treatment is 108 days.
Grover and colleagues at Princess Marina Hospital have now developed a multidisciplinary team (MDT) model of cervical cancer care in Botswana to simplify care and communication between providers and get patients to treatment facilities faster.
The MDT clinic served as a forum for discussion and coordination of patients with gynecologic cancers and consisted of a gynecologist, a pathologist, a medical oncologist, a radiation oncologist, a palliative care specialist, and a nurse coordinator. The teams also worked together to submit paperwork and other documentation, further decreasing delays in treatment and streamlining the overall process.
“While this type of model might seem common in the United States or other developed countries, it’s actually a quite complicated process that lacks a global standard of guidelines,” Grover said. “We saw many different models across the world, but no published outcomes on how to successfully implement an MDT approach for cervical cancer care.”
Over a six-month period, 135 patients were seen in the multidisciplinary team clinic. Sixty percent of the patients were HIV positive. The most common diagnosis was cervical cancer (60 percent), and 42 percent had locally advanced cervical cancer that required chemotherapy and radiation.
Thanks to the MDT model, it was found that only 38 percent of patients needed more than one visit for care coordination before beginning treatment. Therefore, the program was found to cut the delay between diagnosis and treatment by more than 50 percent. For patients treated after multidisciplinary team initiation, the median delay from the date of biopsy to the start of radiation treatment was 39 days, compared with 108 days for patients treated before MDT was initiated.
“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 said. “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.”
Now, similar MDT models are being implemented in Botswana for head and neck cancer, breast cancer, and palliative care. In addition, a follow-up clinic is being created where all patients with gynecological cancer can be followed after treatment looking for recurrence or the emergence of treatment-related toxicities. The clinic will also see that patients receive regular reminders and phone calls for follow-up care.
“What this approach really shows is the importance of integrated care and treatment models,” Grover said. “We hope our MDT model will be applied on a broad scale across many different illnesses and clinics in resource-limited settings worldwide.”