Dec 21, 2015
Doctors and staff working as part of the non-profit Project Medishare teamed up with Hospital Bernard Mevs, in Port-au-Prince, Haiti, and the University of Florida, to launch a breast cancer treatment program in the span of three months. The study, “Development of a Breast Cancer Treatment Program in Port-au-Prince, Haiti: Experiences From the Field,” was published online, October 28, 2015, in the recently launched Journal of Global Oncology (JGO). The study highlights the four main activities that enabled the program to succeed: developing partnerships with local government and health care organizations, establishing strong links with pathology laboratories, training local doctors and nurses using chemotherapy treatment algorithms, and ensuring access to safe, low-cost chemotherapy drugs.
The study’s first author, Vincent DeGennaro, Jr., MD, MPH, explained the motivation behind the project. Dr. DeGennaro is an Assistant Professor in the College of Medicine at the University of Florida and has worked in global health for more than a dozen years.
“Really, what we’re trying to do with this study is to allow people to understand how to rapidly establish and scale up breast cancer treatment in low-resource settings,” said Dr. DeGennaro. “Working with the nonprofit Partners in Health, I helped build a similar program in Rwanda, and a lot of the lessons we learned there helped us scale up quite quickly in Haiti. We’re not the first to launch this kind of program, but what we think we have is a good template of scalability in developing countries, specifically low-income countries, which have less access to pathology and oncologists.”
Addressing a growing cancer burden
Low- and middle-income countries carry a disproportionate burden of global cancer incidence. According to the World Health Organization, more than 60% of the world’s total new annual cases of cancer occur in Africa, Asia, and Central and South America. When looking specifically at breast cancer, studies show that low- and middle-income countries have breast cancer mortality rates that are three times greater than high-income countries.
Similar to other low-income countries, Haiti faces a growing population of people with cancer, but lacks the resources to identify, diagnose, and treat the disease. Dr. DeGennaro described how partnerships between Project Medishare, the local government, and academic centers in the United States enabled the program to leverage the resources required to launch in such a short period of time. “Capitalizing on the existing expertise in a U.S. academic center and utilizing algorithmic treatment protocols for faster training of non-oncologists, we were able to start the whole program in less than three months. Literally, one day we had nothing, and the next day we had a cancer program.”
Increasing access to chemotherapy
From July 2013 to September 2014, the cancer treatment program in Port-au-Prince treated 139 patients with breast cancer, with 85% of them adhering to the treatment regimen. Chemotherapy was administered in 273 instances and did not lead to any reports of adverse safety events. Among the 94 patients who had complete data in their medical records, the mortality rate was 24%, with a median survival time of 53 months. This survival time likely stems from the fact that more than half of the patients in the study presented more than 12 months after first noticing a tumor, with nearly 80% presenting in stages III and IV.
According to the JGO report, future breast cancer efforts in Haiti might focus on programs to increase awareness and screening so that breast cancer can be diagnosed earlier. Clinically, the next steps include building local pathology capacity and training more providers, with the goal of making the cancer treatment program sustainable in the long-term.
Reflecting on the importance of improving cancer screening and treatment in low- and middle-income countries, Dr. DeGennaro said, “Treatment for cancer is a human right; it’s our mandate. No matter where any woman lives she deserves cancer care.”
Vincent DeGennaro, Jr., MD, MPH, is an Assistant Professor in the Division of Hospital Medicine at the College of Medicine at University of Florida, the Director of Internal Medicine at Project Medishare, and the Medical Director of Haiti Air Ambulance.
Abstract of the original JCO article.
PDF of the original JCO article.
DeGennaro V Jr, Libby R, Patberg E, et al. Development of a breast cancer treatment program in Port-au-Prince, Haiti: experiences from the field. J Glob Oncol. Epub 2015 Oct 28.
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@ 2015 American Society of Clinical Oncology