Grover Surbhi, Chiyapo Sebathu Philip, Puri Priya, Narasimhamurthy Mohan, Gaolebale Babe Eunice, Tapela Neo, Ramogola-Masire Doreen, Kayembe Mukendi K A, Moloi Thabo, Gaolebale Ponatshego Andrew
, , and , University of Pennsylvania, Philadelphia, PA; and , Botswana-University of Pennsylvania Partnership, , , and , University of Botswana, , , , , and , Princess Marina Hospital, , Ministry of Health and Botswana Harvard AIDS Institute Partnership, and , National Health Laboratory, Gaborone, Botswana; and , Brigham and Women's Hospital, Boston, MA.
J Glob Oncol. 2017 Feb 8;3(5):666-670. doi: 10.1200/JGO.2016.006353. eCollection 2017 Oct.
Cervical cancer is a major cause of mortality in low- and middle-income countries (LMICs) and the most common cancer diagnosed in women in Botswana. Most women present with locally advanced disease, requiring chemotherapy and radiation. Care co-ordination requires input from a multidisciplinary team (MDT) to deliver appropriate, timely treatment. However, there are limited published examples of MDT implementation in LMICs.
In May 2015, a weekly MDT clinic for gynecologic cancer care was initiated at Botswana's national referral facility. The MDT clinic served as a forum for discussion and coordination of patients with gynecologic cancer and consisted of a gynecologist, pathologist, medical oncologist, radiation oncologist, palliative care specialist, and nurse coordinator.
Between May 2015 and December 2015, 135 patients were seen in the MDT clinic. The mean age of the patients was 49 years. Most (60%) of the patients were HIV positive. The most common diagnosis was cervical cancer (60%), followed by high-grade cervical intraepithelial neoplastic lesions (12%) and vulvar cancer (11%). Only data up to September 2015 were assessed for treatment delays. It was found that only 38% of patients needed more than one visit for care coordination before treatment initiation. Among patients with cervical cancer, the median delay from date of biopsy to start of radiation treatment was 39 days (interquartile range, 34 to 57 days) for patients treated after MDT initiation, compared with 108 days (interquartile range, 71 to 147 days) for patients treated before MDT initiation ( < .001).
Implementation of MDT clinics in LMICs is feasible and can help reduce delays in treatment initiation, as demonstrated by a gynecologic MDT clinic in Botswana. Streamlining care through MDT clinics can enhance care coordination and improve clinical outcomes. This model can apply to cancer care in other LMICs.
宫颈癌是低收入和中等收入国家（LMICs）女性死亡的主要原因，也是博茨瓦纳女性中最常被诊断出的癌症。大多数女性就诊时已处于局部晚期疾病阶段，需要化疗和放疗。护理协调需要多学科团队（MDT）的参与，以提供适当、及时的治疗。然而，在低收入和中等收入国家，关于多学科团队实施情况的公开实例有限。
2015年5月，博茨瓦纳国家转诊机构开设了每周一次的妇科癌症护理多学科团队诊所。该多学科团队诊所作为讨论和协调妇科癌症患者的平台，由妇科医生、病理学家、医学肿瘤学家、放射肿瘤学家、姑息治疗专家和护士协调员组成。
2015年5月至2015年12月期间，多学科团队诊所共诊治了135名患者。患者的平均年龄为49岁。大多数（60%）患者为艾滋病毒阳性。最常见的诊断是宫颈癌（60%），其次是高级别宫颈上皮内瘤变（12%）和外阴癌（11%）。仅对2015年9月之前的数据进行了治疗延迟评估。结果发现，只有38%的患者在开始治疗前需要不止一次就诊进行护理协调。在宫颈癌患者中，多学科团队启动后接受治疗的患者从活检日期到开始放疗的中位延迟时间为39天（四分位间距，34至57天），而多学科团队启动前接受治疗的患者为108天（四分位间距，71至147天）（P< .001）。
正如博茨瓦纳的一个妇科多学科团队诊所所证明的那样，在低收入和中等收入国家实施多学科团队诊所是可行的，并且有助于减少治疗开始的延迟。通过多学科团队诊所简化护理可以加强护理协调并改善临床结果。该模式可应用于其他低收入和中等收入国家的癌症护理。
