Williams Victoria L, Narasimhamurthy Mohan, Rodriguez Olaf, Mosojane Karen, Bale Thapelo, Kesalopa Koorileng, Kayembe Mukendi A, Grover Surbhi
University of Botswana, Gaborone, Botswana.
Princess Marina Hospital, Gaborone, Botswana.
J Glob Oncol. 2019 Nov;5:1-7. doi: 10.1200/JGO.19.00181.
Kaposi sarcoma (KS) is an HIV-associated skin cancer that is highly prevalent in Botswana and associated with significant morbidity and mortality. Histopathology-confirmed diagnosis is required for chemotherapeutic interventions in Botswana, which creates barriers to care because of limited biopsy and pathology services. We sought to understand the role a dermatology specialist can play in improving KS care through quality improvement (QI) initiatives to reduce histologic turnaround times (TATs) for KS.
Employment of a dermatology specialist within a public health care system that previously lacked a local dermatologist generated quality improvements in KS care. Retrospective review identified patients diagnosed with KS by skin biopsy in the predermatology QI interval (January 1, 2015, to December 31, 2015) versus the postdermatology QI interval (January 1, 2016, to November 31, 2017). Histology TATs and clinical characteristics were recorded. A test compared the median histology TATs in the pre- and post-QI intervals.
A total of 192 cases of KS were diagnosed by skin biopsy. Nearly all (98.4%) were HIV-positive; and 52.8% of patients were male with a median age of 39 years. Median TAT in the postdermatology QI interval was 11 days (interquartile range, 12-23 days) compared with 32 days in the predermatology QI interval (interquartile range, 24-56 days; < .00).
Dermatology-led QI initiatives to improve multispecialty care coordination can significantly decrease histology TATs for KS. The reduction of diagnostic delays is a key first step to decreasing the morbidity and mortality associated with this cancer in resource-limited settings.
卡波西肉瘤（KS）是一种与HIV相关的皮肤癌，在博茨瓦纳高度流行，且与显著的发病率和死亡率相关。在博茨瓦纳，化疗干预需要组织病理学确诊，由于活检和病理服务有限，这给治疗带来了障碍。我们试图了解皮肤科专家通过质量改进（QI）举措在改善KS治疗中所起的作用，以缩短KS组织学周转时间（TAT）。
在一个先前缺乏当地皮肤科医生的公共卫生保健系统中聘用一名皮肤科专家，使KS治疗的质量得到了改善。回顾性研究确定了在皮肤科QI干预前阶段（2015年1月1日至2015年12月31日）与皮肤科QI干预后阶段（2016年1月1日至2017年11月31日）通过皮肤活检诊断为KS的患者。记录组织学TAT和临床特征。采用检验比较QI干预前后阶段的组织学TAT中位数。
共通过皮肤活检诊断出192例KS病例。几乎所有患者（98.4%）HIV呈阳性；52.8%的患者为男性，中位年龄为39岁。皮肤科QI干预后阶段的TAT中位数为11天（四分位间距，12 - 23天），而皮肤科QI干预前阶段为32天（四分位间距，24 - 56天；<0.00）。
由皮肤科主导的QI举措以改善多专科护理协调，可显著缩短KS的组织学TAT。减少诊断延迟是在资源有限环境中降低与这种癌症相关的发病率和死亡率的关键第一步。
