Increasing Cervical Cancer Prevention and Care in Nepal

Feb 26, 2021

By Katherine H. Crawford, MA, PMP, ASCO Communications

A new JCO Global Oncology special article details the process and results of a Multidisciplinary Cervical Cancer Prevention Course that ASCO volunteers led in Nepal, where cervical cancer remains the most common cancer among women, and most patients present with an advanced stage of the disease. The article, “American Society of Clinical Oncology (ASCO) Cervical Cancer Prevention Program: A Hands-On Training Course in Nepal,” was published in JCO Global Oncology on February 8.

The course—one of several courses per year ASCO manages around the world—was aimed at addressing the significant inequity in the cervical cancer burden between high-income countries and low- and middle-income countries. In Nepal, the World Health Organization set a goal of screening 50% of the target population for cervical cancer by 2015. However, screening remains lower than the target due to challenges with implementation.

“Cervical cancer, a preventable and potentially curable disease still stands as a major contributor of cancer morbidity and mortality among women of Nepal,” said author Jitendra Pariyar MD, of Nepal’s Civil Service Hospital, a 2018 IDEA recipient who participated in the course. “It is important to sensitize the health professionals on this fact and make them able to identify and treat the preinvasive states of cervix: the ASCO cervical cancer course has successfully done that!”

U.S.-based faculty from The University of Texas MD Anderson Cancer Center and Rice University and Nepalese faculty—including gynecologic oncologists, gynecologists, and radiation oncologists from the National Academy of Medical Sciences, Bir Hospital; Civil Service Hospital; and Bhaktapur Cancer Hospital—taught the course, which consisted of lectures and a hands-on workshop.

The curriculum was developed using guidelines from the American Society for Colposcopy and Cervical Pathology and ASCO resource-stratified guidelines, taking into consideration local resources and Nepal’s standards of care. The lectures covered the epidemiology of cervical cancer globally and locally; cervical cancer screening guidelines; human papillomavirus vaccination; colposcopy and visual inspection; and cervical cancer treatment. The hands-on workshop had four stations at which participants could practice various aspects of clinical practice. Materials for the stations, including Low-cost Universal Cervical Cancer Instructional Apparatus (LUCIA) models, were donated by Rice University.

“The ASCO Hands-on Cervical Cancer Prevention Training Course helped the providers have more confidence in performing the procedures related to cervical cancer prevention, as they had the opportunity to do it many times under our supervision,” said lead author and faculty member for the course Natacha Phoolcharoen, MD, of the Department of Gynecologic Oncology and Reproductive Medicine at The University of Texas MD Anderson Cancer Center. “I believe this course is one of the practical tools to decrease the inequity in the cervical cancer burden between high-income countries and low- and middle-income countries."

The course had 42 attendees, and in a 6-month follow-up survey, all respondents reported they had made practice changes based on what they learned and had implemented or tried to implement the cervical cancer screening guidelines presented with some starting to perform procedures. This suggests that the training course helped to build local capacity for cervical cancer screening, diagnosis, and treatment in the country.

Eliza Shrestha, MD, of Patan Hospital, who was both a course organizer and participant, felt that the curriculum’s train-the-trainer model “increased familiarity with instruments, procedures, and models among the participants; this will definitely help to strengthen the knowledge of cervical cancer screening.” She added, “The practical approach following theoretical knowledge helped to make connections. I strongly feel the necessity for these trainings in the future, as well, to improve capabilities and skills among the health professionals.”

Read the full JCO Global Oncology special article.

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