Evaluating breast cancer care in rural Rwanda

项目摘要 低收入和中等收入国家（LMIC）的乳腺癌负担正在上升，包括低于2000年的国家。 低收入国家与高收入国家乳腺癌死亡率之间的差距正在扩大。 然而，有关撒哈拉以南非洲乳腺癌护理质量和结果的数据非常有限， 现有证据表明，质量往往不够。减少乳腺癌的全球差异 结果，需要更好的数据来指导有效的乳腺癌治疗方案，这些方案具有成本效益， 这是可行的，撒哈拉以南非洲的普通民众也可以使用。 这个K 07职业发展奖的目标是促进莉迪亚佩斯博士成长为一个独立的 研究人员所需的技能进行严格的调查乳腺癌控制中的中低收入国家。佩斯医生 将受益于南希·基廷博士的指导，这是一家国际公认的癌症健康服务机构， 研究员和著名的导师，在癌症护理质量的专业知识，劳伦斯舒尔曼博士，一个 成功的乳腺肿瘤学家和全球癌症控制的领导者，以及成本专家Jane Kim博士， 在发展中国家的妇女癌症方面具有广泛经验。佩斯医生会继续 在哈佛T.H.的课程陈冯富珍公共卫生学院和哈佛额外的研究培训 大学、附属医院和国家癌症研究所。她将利用密切合作 卫生伙伴组织及其在执行科学、经济评价、 和癌症项目。她将与卢旺达外交部现有的同事网络密切合作， 健康和Butaro癌症卓越中心（BCCOE），卢旺达第一个公共癌症转诊中心。 我们将利用这种国际伙伴关系，现有的研究合作和强大的数据收集 评估BCCOE乳腺癌护理的系统。该项目的目的是1）识别相关乳腺癌 BCCOE和类似资源有限环境的癌症护理质量指标; 2）测量乳腺癌患者的 BCCOE的癌症护理，并评估影响质量的因素; 3）评估乳腺癌分期的时间趋势， BCCOE的生存率，确定质量、卫生系统和患者因素之间的关系，以及 结果; 4）量化BCCOE乳腺癌治疗的成本，并检查 采取措施，优化质量。对于目标1，我们将利用改进的德尔菲方法聘请专家 专家组在完善一套质量措施。对于目标2和3，我们将审查BCCOE医疗记录， 采用多变量logistic和考克斯比例风险回归分析数据。对于目标4，我们将执行 详细的成本分析，并比较最佳与当前护理的成本和有效性。 加上强大的导师，课程和丰富的全球合作，这个项目将促进博士。 成长为一名独立的研究者，并为R 01做好准备，以制定干预措施来改善乳腺癌 在BCCOE的癌症护理，最终目标是降低卢旺达及其他地区的乳腺癌死亡率。

PROJECT SUMMARY The burden of breast cancer is rising in low- and middle-income countries (LMICs), including in sub- Saharan Africa, and the gap between breast cancer mortality in low- versus high-income countries is widening. Data are highly limited about quality of and outcomes from breast cancer care in sub-Saharan Africa, though available evidence shows that quality is often inadequate. To reduce global disparities in breast cancer outcomes, better data are needed to guide effective breast cancer treatment programs that are cost-effective, feasible, and accessible to sub-Saharan Africa's general population. The goal of this K07 Career Development Award is to foster Dr. Lydia Pace's growth into an independent researcher with the skills needed to conduct rigorous investigation of breast cancer control in LMICs. Dr. Pace will benefit from mentorship by Dr. Nancy Keating, an internationally recognized cancer health services researcher and acclaimed mentor with expertise in cancer care quality, Dr. Lawrence Shulman, an accomplished breast oncologist and leader in global cancer control, and Dr. Jane Kim, an expert in cost- effectiveness with extensive experience in women's cancers in developing countries. Dr. Pace will pursue courses at the Harvard T.H. Chan School of Public Health and additional research training at Harvard University, affiliated hospitals, and the National Cancer Institute. She will take advantage of close collaboration with the organization Partners in Health and its experience in implementation science, economic evaluation, and cancer programs. She will work closely with her existing network of colleagues in Rwanda's Ministry of Health and Butaro Cancer Center of Excellence (BCCOE), Rwanda's first public cancer referral center. We will leverage this international partnership, existing research collaborations, and a robust data collection system to assess breast cancer care at BCCOE. The aims of this project are to 1) identify relevant breast cancer care quality measures for BCCOE and similarly resource-limited settings; 2) measure quality of breast cancer care at BCCOE and assess factors impacting quality; 3) assess time trends in breast cancer stage and survival at BCCOE, identifying the relationships between quality, health system and patient factors, and outcomes; 4) quantify costs of breast cancer treatment at BCCOE, and examine the cost-effectiveness of interventions to optimize quality. For Aim 1, we will utilize the modified Delphi method to engage an expert panel in refining a set of quality measures. For Aims 2 and 3 we will review BCCOE medical records and analyze the data using multivariate logistic and Cox proportional hazards regression. For Aim 4 we will perform detailed costing analysis and compare the costs and effectiveness of optimal versus current care. Together with strong mentorship, courses, and rich global collaboration, this project will facilitate Dr. Pace's growth into an independent investigator and prepare her for an R01 to develop interventions to improve breast cancer care at BCCOE, with the ultimate goal of reducing breast cancer mortality in Rwanda and beyond.