Cluster Randomized Trial to Facilitate Breast Cancer Early Diagnosis in a Rural District of Rwanda
Cluster Randomized Trial to Facilitate Breast Cancer Early Diagnosis in a Rural District of Rwanda
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DOI：
10.1200/jgo.19.00209
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发表时间：
2019-11-27
影响因子：
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通讯作者：
Mpunga, Tharcisse
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文献类型：
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作者：
Pace, Lydia E.;Dusengimana, Jean Marie Vianney;Mpunga, Tharcisse
目的需要采取可行且有效的策略来促进低收入国家乳腺癌的早期诊断。本研究的目的是调查卢旺达农村地区卫生工作者乳房健康培训对卫生保健利用、患者诊断和癌症分期的影响。 方法 我们分两个阶段在卢旺达布雷拉区 19 个卫生中心 (HC) 中的 12 个开展了一项整群随机试验，对培训干预进行了研究。我们使用双重差分模型评估了培训对因乳房问题就诊的患者数量的影响。我们使用广义估计方程来评估 HC 的发生率以及干预性 HC 与对照 HC 所服务的服务区域中因乳腺问题、活检、良性乳腺诊断、乳腺癌和早期疾病而就诊的情况。 结果 从 2015 年 4 月到 2017 年 4 月，1,484 名患者就诊于干预 HC ，308 名患者因乳腺问题就诊于对照 HC。与对照 HC 相比，干预措施导致 1 期 HC 的就诊次数增加了 4.7 次/月 (P = .001)，2 期 HC 的就诊次数增加了 7.9 次/月 (P = .007)。接受干预 HC 服务的人群的就诊次数较多（115.1 vs 20.5/100,000 人年，P < .001），活检次数较多（36.6 vs 8.9/100,000 人年，P < .001），乳腺癌发病率较高（6.9 vs 3.3/100,000 人年；P = .28）。干预地区早期乳腺癌的发病率为每 100,000 人 3.3 例，对照地区为每 100,000 人 0.7 例 (P = .048)。 结论 在卢旺达农村地区的这项整群随机试验中，卫生工作者的培训和定期乳腺诊所的建立与在医疗机构就诊乳腺问题的患者数量增加、更多的乳腺活检以及良性乳腺诊断和早期乳腺癌的发生率更高相关。癌症。 (C) 2019 年美国临床肿瘤学会
PURPOSE Feasible and effective strategies are needed to facilitate earlier diagnosis of breast cancer in low-income countries. The goal of this study was to examine the impact of health worker breast health training on health care utilization, patient diagnoses, and cancer stage in a rural Rwandan district.METHODS We conducted a cluster randomized trial of a training intervention at 12 of the 19 health centers (HCs) in Burera District, Rwanda, in 2 phases. We evaluated the trainings' impact on the volume of patient visits for breast concerns using difference-in-difference models. We used generalized estimating equations to evaluate incidence of HC and hospital visits for breast concerns, biopsies, benign breast diagnoses, breast cancer, and early-stage disease in catchment areas served by intervention versus control HCs.RESULTS From April 2015 to April 2017, 1,484 patients visited intervention HCs, and 308 visited control HCs for breast concerns. The intervention led to an increase of 4.7 visits/month for phase 1 HCs (P = .001) and 7.9 visits/month for phase 2 HCs (P = .007) compared with control HCs. The population served by intervention HCs had more hospital visits (115.1 v 20.5/100,000 person-years, P < .001) and biopsies (36.6 v 8.9/100,000 person-years, P < .001) and higher breast cancer incidence (6.9 v 3.3/100,000 person-years; P = .28). The incidence of early-stage breast cancer was 3.3 per 100,000 in intervention areas and 0.7 per 100,000 in control areas (P = .048).CONCLUSION In this cluster randomized trial in rural Rwanda, the training of health workers and establishment of regular breast clinics were associated with increased numbers of patients who presented with breast concerns at health facilities, more breast biopsies, and a higher incidence of benign breast diagnoses and early-stage breast cancers. (C) 2019 by American Society of Clinical Oncology