- The document was prepared within the C/Can initiative by a multidisciplinary and multi-sectoral technical team made up of leading professionals from scientific societies and institutions that provide cancer care.
Last week in Asuncion, Paraguay, the “Guidelines for Diagnosis and Treatment of Breast Cancer” was launched, a document created by a multidisciplinary team of experienced healthcare professionals in the city. The event was attended by Dr Hernán Martínez, Paraguay’s Deputy Minister of Health and Dr Marcia Erazo of the Pan American Health Organization, along with representatives of other authorities, scientific societies and civil associations.
The guide is the result of the City Cancer Challenge (C/Can) initiative dating back to 2017—when Asuncion joined C/Can—that brought together a multidisciplinary and multi-sectoral technical team made up of leading professionals from scientific societies and institutions that provide cancer care, including Paraguay’s Ministry of Public Health and Social Welfare and the Faculty of Medical Sciences of the National University of Asuncion, with the subsequent involvement of the Social Security Institute and the San Roque Group, among others.
That year, supported by C/Can’s network of local, regional and global partners and experts, the city embarked on a Needs Assessment, part of the City Engagement Process that all C/Can cities undergo to identify, design and develop sustainable cancer care solutions that respond to local needs.
Among the key priorities that were identified was the need to standardise treatment and ensure comprehensive cancer care by creating and strengthening multidisciplinary teams to enable them to inform and make decisions and manage patients.
Furthermore, the City Engagement Process accelerated discussions between private and public sectors within the C/Can City Executive Committee. These identified the fragmented nature of Paraguay’s national healthcare system, which hampers the provision of quality and effective care for cancer patients. In turn, this analysis was the starting point of work to implement legal changes to the landscape of cancer services in the country and create a system where equity, collaboration and cost-effectiveness were central; The national Cancer Law was a catalytic effect of this process.
The Cancer Law was promulgated in January 2019 and frames an integrated approach for quality cancer services, along with the establishment of a multisectoral National Cancer Advisory Board including the Ministry of Health, the National Council for Research and Technologies, public and private hospitals, the City Cancer Challenge Executive Committee, and Pharmaceutical companies.
Speaking at last week’s event, Dr Valeria Sanabria, who coordinated the drafting of the guide, highlighted the benefits of working with players from the public and private sectors in preparing the guide: “In Paraguay, not all our specialists work in the same institutions, so this collaborative approach allowed us to have more experts in the team, which will lead to better treatments and decisions for patients.”
The clinical practice guidelines for the diagnosis and treatment of breast cancer was created in response to the need for recommendations based on scientific evidence, but adapted to the reality on the availability of resources at the ground in Paraguay,” explained Dr Sanabria, adding: “Our goal is to raise the quality of patient care by unifying the criteria of all the physicians involved.”
Dr María F. Navarro, C/Can’s Regional Director for Latin America, said: “All the research shows that a multidisciplinary approach to managing breast cancer significantly increase patients’ survival and the quality of life. Breast cancer patients benefit when diagnostic and care decisions are agreed upon by all the specialists involved in the treatment process.” She added: “The guidelines are a milestone, both for Asuncion and Paraguay, because they respond to a need identified locally and that has now been elevated to the national level.”
About the guide’s development process
C/Can’s “Guidelines for Diagnosis and Treatment of Breast Cancer” was developed by a multidisciplinary team made up of health professionals from the following areas: mastology, radiation and medical oncology, medical imaging, pathology, and professionals in palliative medicine and supportive care.
The team began preparing the guide in 2019. After six months of intensive research, they presented the first draft to a panel of experts nominated by the American Society of Clinical Oncology (ASCO), the American Society of Clinical Pathology (ASCP), the International Atomic Energy Agency (IAEA), Latin American Society of Palliative Care (ALCP) and the Oncology Nursing Society (ONS) in a process coordinated by ASCO and C/Can
Later in the year, representatives of the group travelled to Barcelona to meet with professionals from the Breast Pathology Unit of the city’s Hospital del Mar and the Catalan Institute of Oncology, where they drafted a second version. This was unveiled at the end of the year at a validation workshop with the Paraguayan Ministry of Public Health and Social Welfare and was approved, with minor corrections.
Due to the pandemic, the project was stalled throughout 2020, but in 2021 the final modifications were incorporated with the collaboration of the international reviewer (C/Can – ASCO expert), Dr Lucía Delgado of Uruguay’s University of the Republic, and the team refined the content to produce the definitive version of the “Guide for Diagnosis and Treatment of Breast Cancer”.
“This guide is aimed at health professionals managing breast cancer patients in order to have better management with medical recommendations. It is important that patients, their families, the different associations and foundations know that it exists and empower them to guarantee that they are being offered the best”, said Dr Sanabria.
Dr Alicia Pomata, the Director of Paraguay’s National Cancer Control Program said guidelines and protocols for the treatment of certain pathologies are key and mandatory in all health systems, “because they unify the criteria to narrow the gaps in providing quality care for patients, so that all health facilities follow the same procedures, ensuring quality and humanized treatment.
How and where can I download the guide?
The “Guidelines for Diagnosis and Treatment of Breast Cancer” is aimed exclusively at doctors and is available on the Paraguayan Ministry of Health’s website in the “Health Campaigns” section. To download it, it is first necessary to register by providing an ID number, professional registration, and other information.
Paraguay’s Ministry of Public Health and Welfare approves creation of multidisciplinary Tumour Committees
In addition to approving the breast cancer guidelines, the Ministry of Health and Social Welfare of Paraguay has sanctioned the mandatory evaluation of cancer cases in a multidisciplinary manner, obliging the heads of hospitals and institutions that provide services or treatment to patients with cancer to set up multidisciplinary Tumour Committees.