A multilevel intervention (Potlako+) to improve timely cancer detection and treatment initiation

多层次干预（Potlako）可改善及时的癌症检测和治疗启动

基本信息

批准号：
10242834
负责人：
Scott Dryden-Peterson
金额：
$ 47.91万
依托单位：
BRIGHAM AND WOMEN'S HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-19 至 2024-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10242834
关键词：
Accounting Adult Advanced Malignant Neoplasm Advocacy Affect Africa South of the Sahara Age Anus Awareness Botswana Breast Breast Cancer Cell Breast Cancer Early Detection Cancer Burden Cancer Detection Cancer Patient Caring Cause of Death Cervix Uteri Cessation of life Clinic Communities Complex Counseling Country Diagnosis Diagnostic Disease Early Diagnosis Education Effectiveness Environment Family Geography HIV HIV diagnosis Head and Neck Squamous Cell Carcinoma Head and neck structure Health system Healthcare Incidence Income Individual International Intervention Knowledge Limited Stage Malignant Neoplasms Medical Mentors Modeling Oncology Pathology Pathway interactions Patients Persons Phase Physicians Population Prevalence Primary Health Care Printed Media Probability Provider Qualitative Research Randomized Reach, Effectiveness, Adoption, Implementation, and Maintenance Records Research Resources Rural Community Schedule Self Efficacy Social Workers Speed Suggestion Symptoms Syndrome Team Nursing Time Transportation Vagina Viral Vital Status Vulva aged cancer care cancer diagnosis cancer initiation cancer risk cancer survival cancer therapy cohort common symptom community clinic curative treatments effectiveness evaluation effectiveness implementation study effectiveness implementation trial effectiveness testing family support implementation intervention improved innovation low and middle-income countries medical care fees mortality multidisciplinary pandemic disease penis pilot trial programs response rural dwellers self help theories treatment duration

项目摘要

Project Summary/Abstract The HIV pandemic has intensified the growing burden of cancer in low- and middle-income countries (LMICs), where nearly three-quarters of all cancer deaths occur. The majority of patients in LMICs have advanced cancer stage and limited opportunity for survival. Meaningful improvements in cancer mortality in LMICs will require prompt diagnosis and efficient linkage to care, however research identifying effective strategies has not been conducted. Botswana has key resources in place— free-of-charge medical care including comprehensive cancer care, accessible primary clinics, and an internationally-emulated ART program— yet large gaps in timely cancer care and thus provides a key opportunity to innovate strategies to detect cancer earlier and engage patients in care. The Potlako pilot trial (ORBIT phase IIa), evaluating an intervention targeting diagnostic and pre-treatment intervals in a single district (27 communities) in Botswana, has successfully increased the number of patients entering cancer care and number treated with curative intent compared to historical controls. As a next step, the Potlako+ trial— a community-randomized (26 geographically diverse rural communities, 1:1), pragmatic, ORBIT phase IIb, type 1 hybrid effectiveness-implementation trial— will assess a complex, theory-informed intervention to promote earlier clinic presentation with symptoms suggestive of cancer, enable efficient diagnosis, and facilitate prompt initiation of oncologic treatment. The Potlako+ trial targets high burden cancers accounting for 60% of cancer deaths (breast, cervix, anus, penis, vulva, and head and neck) which are typically curable with early detection of symptoms. We utilize cancer stage at time of treatment initiation, incidence of curative intent treatment, and the duration of Models of Pathways to Treatment intervals as primary effectiveness endpoints. Implementation will be evaluated using the RE-AIM framework. The project will achieve three aims: 1) Assess the effectiveness of cancer symptom awareness intervention with rural residents (persons living with HIV and HIV-uninfected) aged 30 years and older in decreasing time to presentation with moderate and high probability cancer syndromes, 2) Assess impact of a comprehensive cancer patient navigation platform on reducing time to diagnosis and initiation of cancer treatment (diagnostic and pre-treatment intervals), and 3) Evaluate whether the combined multilevel intervention improves early stage treatment and cumulative incidence of curative intent treatment. Understanding the impact and implementation of these interventions will inform strategies of care for LMIC populations at increasing risk of cancer death and contribute to developing models of primary care in resource- constrained environments.

项目概要/摘要艾滋病毒大流行加剧了低收入和中等收入国家（LMIC）日益增长的癌症负担，近四分之三的癌症死亡发生在中低收入国家，大多数患者患有晚期癌症。中低收入国家的癌症死亡率需要显着改善。及时诊断和与护理的有效联系，但尚未开展确定有效策略的研究博茨瓦纳拥有关键资源——包括综合癌症在内的免费医疗服务。护理、可及的初级诊所以及国际效仿的 ART 计划——但在及时性方面存在巨大差距癌症护理，从而提供了一个关键的机会来创新战略，以早期发现癌症并参与 Potlako 试点试验（ORBIT IIa 期），评估针对诊断和治疗的干预措施。博茨瓦纳单个地区（27 个社区）的预处理间隔已成功提高与历史相比，进入癌症治疗的患者人数和接受治疗的人数下一步，Potlako+ 试验是一项社区随机试验（26 个不同地理位置的农村地区）。社区，1:1），务实的，ORBIT IIb 期，1 类混合有效性实施试验——将评估复杂的、以理论为依据的干预措施，以促进早期出现提示症状的临床表现癌症，实现有效诊断，并促进迅速启动肿瘤治疗。针对占癌症死亡人数 60% 的高负担癌症（乳腺癌、子宫颈癌、肛门癌、阴茎癌、外阴癌和头部癌症）和颈部），通常可以通过早期发现症状来治愈。治疗开始、治疗意图治疗的发生率以及路径模型的持续时间治疗间隔作为主要有效性终点将使用 RE-AIM 进行评估。该项目将实现三个目标：1）评估癌症症状意识的有效性。对 30 岁及以上农村居民（艾滋病毒感染者和未感染艾滋病毒者）的干预减少出现中度和高概率癌症综合征的时间，2) 评估综合癌症患者导航平台，可缩短癌症诊断和起始时间治疗（诊断和治疗前间隔），以及 3) 评估组合的多水平是否干预可改善早期治疗和治愈性治疗的累积发生率。了解这些干预措施的影响和实施将为中低收入国家的护理策略提供信息癌症死亡风险增加的人群，并有助于发展资源领域的初级保健模式环境受限。