Swanson Megan, Ueda Stefanie, Chen Lee-May, Huchko Megan J, Nakisige Carol, Namugga Jane
Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of California at San Francisco, United States.
Department of Obstetrics and Gynecology, Duke Global Health Institute, United States.
Gynecol Oncol Rep. 2018 Jan 5;24:30-35. doi: 10.1016/j.gore.2017.12.005. eCollection 2018 May.
There is significant disparity in the prevalence of cervical cancer globally, with low- and middle-income countries (LMICs) shouldering a disproportionate share of disease incidence and an even greater proportion of morbidity and mortality. Available resources for diagnosis, treatment and palliation of cervical cancer are inversely related to per capita income. While prevention and screening remain public health priorities, given the large number of women affected by cervical cancer, expanding treatment capacity should be included in any evidence-based intervention plan. Uganda, a country with a high incidence of cervical cancer, serves as a representative case study in terms of the challenges of diagnosis and access to treatment in sub-Saharan Africa. Providers and patients in Uganda are challenged by late presentation to care, limited training opportunities, cost-prohibitive diagnostic studies, insufficient access to gold-standard treatment, and under-utilized palliative care services. This review highlights the ways in which Uganda's experience is typical of the continent at large, as well as areas where Uganda is unique. We describe the ways in which a small but dedicated group of gynecologists carefully use limited evidence and available resources creatively to provide the best possible care for their patients. We show that improvisation, albeit evidence-based, is central to the nature and success of oncology care in Africa (Livingston, 2012). We argue that a "recalibrated global response" (Farmer et al., 2010), particularly stressing the expansion of radiotherapy capabilities, could dramatically improve cancer care and outcomes for women in Uganda as well as in LMICs globally.
全球宫颈癌患病率存在显著差异，低收入和中等收入国家（LMICs）承担了不成比例的疾病发病率，以及更高比例的发病率和死亡率。用于宫颈癌诊断、治疗和缓解的可用资源与人均收入呈负相关。虽然预防和筛查仍然是公共卫生的重点，但鉴于受宫颈癌影响的女性数量众多，扩大治疗能力应纳入任何基于证据的干预计划。乌干达是一个宫颈癌发病率很高的国家，在撒哈拉以南非洲地区的诊断和治疗获取挑战方面是一个具有代表性的案例研究。乌干达的医疗服务提供者和患者面临着就诊延迟、培训机会有限、诊断研究费用高昂、难以获得金标准治疗以及姑息治疗服务利用不足等挑战。本综述强调了乌干达的经验在整个非洲大陆具有代表性的方面，以及乌干达独特的领域。我们描述了一小群敬业的妇科医生如何谨慎地运用有限的证据和可用资源，创造性地为患者提供尽可能好的护理。我们表明，尽管是基于证据的，但即兴发挥对于非洲肿瘤护理的性质和成功至关重要（利文斯顿，2012年）。我们认为，“重新校准的全球应对措施”（法默等人，2010年），特别是强调扩大放疗能力，能够显著改善乌干达以及全球低收入和中等收入国家女性的癌症护理和治疗结果。
