Evaluating breast cancer care in rural Rwanda

项目总结 在低收入和中等收入国家(LMIC)，乳腺癌的负担正在上升，包括 在撒哈拉非洲，低收入国家和高收入国家的乳腺癌死亡率之间的差距正在扩大。 然而，关于撒哈拉以南非洲乳腺癌护理的质量和结果的数据非常有限 现有证据表明，质量往往是不够的。减少全球乳腺癌的差异 结果，需要更好的数据来指导有效的乳腺癌治疗计划，这些计划具有成本效益， 这是可行的，而且撒哈拉以南非洲的普通民众也能接触到。 本次K07职业发展奖的目标是促进Lydia Pace博士成长为一名独立的 具有在LMIC中进行乳腺癌控制的严格调查所需技能的研究人员。佩斯博士 将受益于国际公认的癌症健康服务机构南希·基廷博士的指导 在癌症护理质量方面拥有专业知识的研究员和备受赞誉的导师劳伦斯·舒尔曼博士 杰出的乳腺肿瘤学家和全球癌症控制领域的领导者，简·金博士，成本专家- 在发展中国家妇女癌症方面具有丰富经验的有效性。佩斯博士将继续 哈佛大学公共卫生学院的课程和哈佛大学的额外研究培训 大学、附属医院和国家癌症研究所。她将利用密切的合作 与健康伙伴组织及其在实施科学、经济评估、 和癌症项目。她将与她在卢旺达该部现有的同事网络密切合作 健康和布塔罗癌症卓越中心(BCCOE)，卢旺达第一个公共癌症转介中心。 我们将利用这一国际伙伴关系、现有的研究合作和强大的数据收集 在BCCOE评估乳腺癌护理的系统。这个项目的目的是1)识别相关的乳房 针对BCCOE和类似的资源受限环境的癌症护理质量测量；2)测量乳房质量 BCCOE的癌症护理并评估影响质量的因素；3)评估乳腺癌分期和 BCCOE的生存，确定质量、卫生系统和患者因素之间的关系，以及 结果；4)在BCCOE量化乳腺癌治疗成本，并检查 优化质量的干预措施。对于目标1，我们将使用改进的德尔菲法聘请专家 专家组在提炼出一套质量措施。对于目标2和目标3，我们将审查BCCOE的医疗记录并 采用多因素Logistic回归和COX比例风险回归进行分析。对于目标4，我们将表演 详细的成本分析，并比较最佳护理与当前护理的成本和效果。 加上强大的导师、课程和丰富的全球合作，该项目将促进佩斯博士的 成长为独立的调查员，并为R01做好准备，以开发改善乳房的干预措施 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.