Evaluating breast cancer care in rural Rwanda

评估卢旺达农村地区的乳腺癌护理

基本信息

批准号：
10655128
负责人：
Lydia Pace
金额：
$ 17.39万
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：
2018
资助国家：
美国
起止时间：
2018-02-01 至 2024-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10655128
关键词：
Africa South of the Sahara African Breast Breast Cancer Treatment Cancer Center Cancer Control Caring Collaborations Cost Analysis Country Data Data Collection Developing Countries Diagnosis Disparity Effectiveness Effectiveness of Interventions Fostering General Population Goals Growth Health Health Services Health Services Accessibility Health system Hospitals Income International Intervention Investigation K-Series Research Career Programs Logistics Malignant Neoplasms Measures Medical Records Mentors Mentorship Methods National Cancer Institute Oncologist Outcome Patients Public Health Public Health Schools Quality of Care Research Research Personnel Research Training Resource Allocation Resource Development Resource-limited setting Rural Rwanda System Time trend Universities Woman Work access disparities cancer care cancer referral center cost cost comparison cost effective cost effectiveness economic evaluation experience hazard implementation science improved international partnership low and middle-income countries malignant breast neoplasm mortality program costs programs skills treatment program

项目摘要

PROJECT SUMMARY The burden of breast cancer is rising in low- and middle-income countries (LMICs), including in sub- Saharan Africa, and the gap between breast cancer mortality in low- versus high-income countries is widening. Data are highly limited about quality of and outcomes from breast cancer care in sub-Saharan Africa, though available evidence shows that quality is often inadequate. To reduce global disparities in breast cancer outcomes, better data are needed to guide effective breast cancer treatment programs that are cost-effective, feasible, and accessible to sub-Saharan Africa’s general population. The goal of this K07 Career Development Award is to foster Dr. Lydia Pace’s growth into an independent researcher with the skills needed to conduct rigorous investigation of breast cancer control in LMICs. Dr. Pace will benefit from mentorship by Dr. Nancy Keating, an internationally recognized cancer health services researcher and acclaimed mentor with expertise in cancer care quality, Dr. Lawrence Shulman, an accomplished breast oncologist and leader in global cancer control, and Dr. Jane Kim, an expert in cost- effectiveness with extensive experience in women’s cancers in developing countries. Dr. Pace will pursue courses at the Harvard T.H. Chan School of Public Health and additional research training at Harvard University, affiliated hospitals, and the National Cancer Institute. She will take advantage of close collaboration with the organization Partners in Health and its experience in implementation science, economic evaluation, and cancer programs. She will work closely with her existing network of colleagues in Rwanda’s Ministry of Health and Butaro Cancer Center of Excellence (BCCOE), Rwanda’s first public cancer referral center. We will leverage this international partnership, existing research collaborations, and a robust data collection system to assess breast cancer care at BCCOE. The aims of this project are to 1) identify relevant breast cancer care quality measures for BCCOE and similarly resource-limited settings; 2) measure quality of breast cancer care at BCCOE and assess factors impacting quality; 3) assess time trends in breast cancer stage and survival at BCCOE, identifying the relationships between quality, health system and patient factors, and outcomes; 4) quantify costs of breast cancer treatment at BCCOE, and examine the cost-effectiveness of interventions to optimize quality. For Aim 1, we will utilize the modified Delphi method to engage an expert panel in refining a set of quality measures. For Aims 2 and 3 we will review BCCOE medical records and analyze the data using multivariate logistic and Cox proportional hazards regression. For Aim 4 we will perform detailed costing analysis and compare the costs and effectiveness of optimal versus current care. Together with strong mentorship, courses, and rich global collaboration, this project will facilitate Dr. Pace’s growth into an independent investigator and prepare her for an R01 to develop interventions to improve breast cancer care at BCCOE, with the ultimate goal of reducing breast cancer mortality in Rwanda and beyond.

项目概要低收入和中等收入国家 (LMIC) 的乳腺癌负担正在上升，包括亚低收入国家撒哈拉非洲地区，低收入国家与高收入国家乳腺癌死亡率之间的差距正在扩大。不过，有关撒哈拉以南非洲地区乳腺癌护理质量和结果的数据非常有限现有证据表明，减少乳腺癌的全球差异的质量往往不够。结果，需要更好的数据来指导具有成本效益的有效乳腺癌治疗计划，可行，并且可供撒哈拉以南非洲地区的普通民众使用。 K07 职业发展奖的目标是促进 Lydia Pace 博士成长为独立的 Pace 博士是一位具有对中低收入国家乳腺癌控制进行严格调查所需技能的研究人员。将受益于国际公认的癌症健康服务机构 Nancy Keating 博士的指导 Lawrence Shulman 博士是一位研究员和著名导师，在癌症护理质量方面具有专业知识成就卓著的乳腺肿瘤学家和全球癌症控制领域的领导者，以及成本专家 Jane Kim 博士佩斯博士将凭借在发展中国家女性癌症方面的丰富经验来追求有效性。哈佛大学陈曾熙公共卫生学院的课程和哈佛大学的额外研究培训她将利用大学、附属医院和国家癌症研究所的密切合作。与健康合作伙伴组织及其在实施科学、经济评估方面的经验，她将与卢旺达卫生部现有的同事网络密切合作。健康与布塔罗癌症卓越中心 (BCCOE)，卢旺达第一个公共癌症转诊中心。我们将利用这种国际合作伙伴关系、现有的研究合作和强大的数据收集 BCCOE 评估乳腺癌护理的系统该项目的目的是 1) 确定相关的乳腺癌。 BCCOE 和类似资源有限环境的癌症护理质量测量 2) 测量乳房质量； BCCOE 的癌症护理并评估影响质量的因素；3) 评估乳腺癌分期的时间趋势和 BCCOE 的生存，确定质量、卫生系统和患者因素之间的关系，以及 4) 量化 BCCOE 乳腺癌治疗的成本，并检查成本效益对于目标 1，我们将利用改进的德尔菲法聘请专家。对于目标 2 和 3，我们将审查 BCCOE 医疗记录和对于目标 4，我们将使用多元逻辑回归和 Cox 比例风险回归分析数据。详细的成本分析并比较最佳护理与当前护理的成本和有效性。加上强有力的指导、课程和丰富的全球合作，该项目将促进佩斯博士的成长为一名独立调查员，并为 R01 做好准备，制定改善乳房的干预措施 BCCOE 的癌症护理，最终目标是降低卢旺达及其他地区的乳腺癌死亡率。

项目成果

期刊论文数量（10）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Cost of breast cancer care in low- and middle-income countries: a scoping review protocol.

低收入和中等收入国家乳腺癌护理成本：范围界定审查方案。

DOI：
发表时间：
2021-10
期刊：
影响因子：
2.7
作者：
Erfani, Parsa;Bhangdia, Kayleigh;Mugunga, Jean Claude;Pace, Lydia E;Fadelu, Temidayo
通讯作者：
Fadelu, Temidayo

Integrating Breast Cancer Early Detection Into a Resource-Constrained Primary Health Care System: Health Care Workers' Experiences in Rwanda.

将乳腺癌早期检测纳入资源有限的初级卫生保健系统：卢旺达卫生保健工作者的经验。

DOI：
发表时间：
2022-12
期刊：
影响因子：
4.5
作者：
Uwimana, Aimable;Dessalegn, Sosina;Vianney Dusengimana, Jean;Stauber, Catherine;Fata, Amanda;Hagenimana, Marc;Uwinkindi, Francois;Balinda, Jean Paul;Shulman, Lawrence N;Revette, Anna;Rwamuza, Enock;Pace, Lydia E
通讯作者：
Pace, Lydia E

Comparing Diagnostic Evaluations for Rectal Bleeding and Breast Lumps in Primary Care: a Retrospective Cohort Study.

比较初级保健中直肠出血和乳房肿块的诊断评估：一项回顾性队列研究。

DOI：
发表时间：
2019-07
期刊：
影响因子：
5.7
作者：
Pace, Lydia E;Percac;Nguyen, Kevin H;Crofton, Charis N;Normandin, Katharine A;Singer, Sara J;Rosenthal, Meredith B;Chien, Alyna T
通讯作者：
Chien, Alyna T

Barriers to timely surgery for breast cancer in Rwanda.

卢旺达乳腺癌及时手术的障碍。

DOI：
发表时间：
2019-12
期刊：
影响因子：
3.8
作者：
Schleimer, Lauren E;Vianney Dusengimana, Jean;Butonzi, John;Kigonya, Catherine;Natarajan, Abirami;Umwizerwa, Aline;O'Neil, Daniel S;Costas;Majyambere, Jean;Shulman, Lawrence N;Keating, Nancy L;Shyirambere, Cyprien;M
通讯作者：
M

The Impact of Breast Density Notification Laws on Supplemental Breast Imaging and Breast Biopsy.

乳房密度通知法对补充乳房成像和乳房活检的影响。