Lopez Melissa S, Baker Ellen S, Milbourne Andrea M, Gowen Rose M, Rodriguez Ana M, Lorenzoni Cesaltina, Mwaba Catherine, Msadabwe Susan Citonje, Tavares José Humberto, Fontes-Cintra Georgia, Zucca-Matthes Gustavo, Callegaro-Filho Donato, Ramos-Martin Danielle, Thiago de Carvalho Icaro, Coelho Robson, Marques Renato Moretti, Chulam Thiago, Pontremoli-Salcedo Mila, Nozar Fernanda, Fiol Veronica, Maza Mauricio, Arora Sanjeev, Hawk Ernest T, Schmeler Kathleen M
, , , , and , The University of Texas MD Anderson Cancer Center, Houston; , Su Clinica Familiar, Brownsville; , The University of Texas Medical Branch, Galveston, TX; , Hospital Central de Maputo, Maputo, Mozambique; , , Cancer Diseases Hospital, Lusaka, Zambia; , , , and , Hospital de Cancer de Barretos, Barretos; , , , and , Hospital Israelita Albert Einstein; , A.C. Camargo Cancer Center, Sao Paulo; , Federal University of Health Sciences/Santa Casa de Misericordia, Porto Alegre, Brazil; and , Universidad de la Republica, Montevideo, Uruguay; , Basic Health International, San Salvador, El Salvador; and , University of New Mexico, Albuquerque, NM.
J Glob Oncol. 2016 Oct 5;3(5):658-665. doi: 10.1200/JGO.2016.005504. eCollection 2017 Oct.
Cervical cancer incidence and mortality rates are significantly higher in low- and middle-income countries compared with the United States and other developed countries. This disparity is caused by decreased access to screening, often coupled with low numbers of trained providers offering cancer prevention and treatment services. However, similar disparities are also found in underserved areas of the United States, such as the Texas-Mexico border, where cervical cancer mortality rates are 30% higher than in the rest of Texas. To address these issues, we have adopted the Project ECHO (Extension for Community Healthcare Outcomes) program, a low-cost telementoring model previously proven to be successful in increasing local capacity, improving patient management skills, and ultimately improving patient outcomes in rural and underserved areas. We use the Project ECHO model to educate local providers in the management of cervical dysplasia in a low-resource region of Texas and have adapted it to inform strategies for the management of advanced cervical and breast cancer in Latin America and sub-Saharan Africa. This innovative approach, using ECHO, is part of a larger strategy to enhance clinical skills and develop collaborative projects between academic centers and partners in low-resource regions.
与美国和其他发达国家相比,低收入和中等收入国家的宫颈癌发病率和死亡率显著更高。这种差异是由于筛查机会减少,往往还伴随着提供癌症预防和治疗服务的专业人员数量不足。然而,在美国一些服务不足的地区,如得克萨斯州与墨西哥边境地区,也发现了类似的差异,那里的宫颈癌死亡率比得克萨斯州其他地区高30%。为了解决这些问题,我们采用了“社区医疗成果拓展计划”(ECHO计划),这是一种低成本的远程指导模式,此前已被证明在提高当地能力、改善患者管理技能以及最终改善农村和服务不足地区的患者治疗效果方面取得了成功。我们利用ECHO计划模式在得克萨斯州资源匮乏地区培训当地医疗人员管理宫颈发育异常,并对其进行调整,为拉丁美洲和撒哈拉以南非洲地区晚期宫颈癌和乳腺癌的管理提供策略依据。这种使用ECHO计划的创新方法是一项更大战略的一部分,该战略旨在提高临床技能,并在资源匮乏地区的学术中心和合作伙伴之间开展合作项目。