By the time you have finished reading this, another woman will have died from cervical cancer.
Yet cervical cancer is not only preventable, it is also curable if detected early and adequately treated. But this devastating condition remains one of the most common cancers and causes of cancer-related deaths among women across the globe.
Furthermore, without intervention, cases of cervical cancer are predicted to increase from 570,000 in 2018 to 700,000 by 2030. These increases are disproportionately impacting women living in low-and middle-income countries (LMICs), where between 85% and 90% of new cervical cancer cases occur.
How C/Can produced its guide on how to develop resource-appropriate cervical cancer management guidelines
As C/Can’s Global Technical Lead, Dr Rolando Camacho, points out: “C/Can is the first organisation to take a city-led approach to improving access to quality cancer care.”
The needs assessments conducted in C/Can cities by its technical groups show that among the main barriers to increasing access to quality cancer care is the lack of multidisciplinary teams (MDT) and a multidisciplinary cancer management (MCM) approach – which means cancer care specialists (diagnostic, treatment and supportive care) working together to decide the best treatment option to be proposed to each patient.
At the same time, local stakeholders also highlight the urgent need for resource-appropriate guidelines to manage patients with invasive cancer.
As Dr Shylasree TS from the Tata Memorial Hospital in Mumbai explains: “The lack of guidance on how best to incorporate this approach into the cancer care continuum of a particular city and/or country is an issue. Most of the times, international guidelines cannot be implemented uniformly across populations in LMICs because of sparse resources, competing health priorities and non-existent cancer networks”.
In response, C/Can is coordinating partners to provide tailored training on Multidisciplinary Care Management (e.g. ASCO, MCMC) and how best to implement this approach, whilst developing cancer management guidelines adapted to the local context and resource availability.
“Local experts in C/Can cities know what needs to be done, but how to adapt evidence-based guidelines to the scarcely available resources is difficult”, adds Dr Camacho
Which is why C/Can supported cities when they developed projects such as Increasing Access to Quality Cancer Care, focused precisely on a multidisciplinary approach and standardising the management of breast and cervical cancer patients.
Working from the ground up
One of the most common problems local experts identified when they began drafting resource-appropriate guidelines was the lack of clear information and guidance on the steps and processes for drafting them. There was no material to guide the technical working groups on how to develop resource-appropriate guidelines nor on how to organise the creative process. It was also necessary to decide what should be considered and included, which professionals should be involved, and the specific structure and contents.
To overcome this, C/Can requested assistance from its partners to prepare a series of “How to Guides” to address city-specific needs.
The result is the ground-breaking Guide for Developing Resource-appropriate Invasive Cervical Cancer Management Guidelines, drawn up in collaboration with the Tata Memorial Hospital in Mumbai.
The guide was inspired by and follows the same methodology as the Guide for Developing Resource-appropriate Breast Cancer Management Guidelines developed by C/Can in collaboration with the Breast Health Global Initiative (BHGI). It outlines the steps and procedures for designing resource-appropriate invasive cervical cancer management guidelines in LMIC cities and improving access to cervical cancer diagnosis (clinical evaluation, imaging, tissue sampling), multimodality treatment (surgery, radiotherapy, systemic therapy) and palliative care services.
Setting up multidisciplinary teams and cancer networks will improve communication and care pathways, as well as successful implementation of guidelines.
The first step in creating resource-appropriate invasive cervical cancer management guidelines is an accurate understanding of resources (infrastructure, human resources, equipment, and renewable supplies) for cervical cancer healthcare, so as to avoid creating guidelines that are scientifically sound but financially unsustainable.
The document focuses on establishing effective cervical cancer diagnosis and treatment services, a necessary prerequisite for cancer downstaging efforts to be effective, even when the majority of cervical cancer cases are diagnosed as locally advanced or metastatic disease.
The guide has been prepared in collaboration with Professor Shylasree Surappa TS, MD, FRCOG, consultant gynaecological oncologist at the Tata Memorial Hospital in Mumbai, to support stakeholders in cities as they prioritise the development of cervical cancer management guidelines.
City stakeholders will now be able to interpret, analyse, and tailor the guide’s recommendations, taking into account the local context and the need to build a multisectoral consultative process within their cities.
Driving Quality Cancer Care in Asia Discussion Series
Join C/Can and international cancer care experts in a new discussion series providing healthcare professionals with the knowledge and support to strengthen a MDT approach as well as the development of resource-appropriate guidelines for priority cancers.