Conducting Global Oncology Research, Mentoring a New Generation of Investigators
The Center for Global Cancer Medicine (CGCM) collaborates with partner sites in Haiti and Rwanda to promote innovative and relevant global oncology research projects. Faculty and trainees from Dana-Farber Cancer Institute, as well as from across collaborating
institutions — including Brigham and Women's Hospital, T.H. Chan School of Public Health, and external foundation partners — engage in research activities that promote local research capacity. CGCM's U.S.-based and in-country clinicians are sharing
their research through papers and abstracts published in high-impact, peer-reviewed journals and through participation in cancer conferences around the world.
Breast Cancer Early Detection in Rwanda
CGCM works with the Butaro Cancer Center of Excellence and the Rwanda Ministry of Health to examine ways to promote earlier detection of breast cancer. Our previous work examined patient and health system factors associated with diagnostic delays.
With the financial support of the Breast Cancer Research Foundation (BCRF), an intervention was subsequently piloted that teaches community health workers to build breast awareness; trains health center nurses to recognize high-risk breast lumps;
establishes a referral pathway; and trains district hospital-based nurses and doctors to perform ultrasound evaluations. This intervention is now being scaled to other districts in Rwanda.
Breast Cancer Outcomes in Haiti
CGCM is now engaging with the local oncology team at the University Hospital of Mirebalais on a project to comprehensively assess breast cancer outcomes since the program's launch in 2013. The study seeks to evaluate the influence of concomitant co-morbid
conditions, such as obesity and metabolic syndrome and care delays, on treatment outcomes and survival.
Accurate and timely pathologic evaluation is paramount for quality cancer care. In collaboration with researchers at Brigham and Women's Hospital and the American Society of Clinical Pathology (ASCP), we have evaluated novel resource-appropriate ways
of providing pathology services in Rwanda, including sophisticated tissue-processing systems, whole-slide imaging and telepathology.
Other Disease Initiatives
Adult and pediatric research programs in Rwanda have empowered local clinicians to engage in disease-specific outcome projects. So far, they have evaluated clinical outcomes and determinants in chronic myelogenous leukemia (CML), acute lymphoblastic leukemia, gestational trophoblastic disease, and Hodgkin's lymphoma and Wilms tumor (WT).
With many possible arenas of research engagement opportunities in global oncology, CGCM will utilize a multi-pronged approach to expand our research activities. The Center seeks to:
- Foster deeper engagement within Dana-Farber itself to draw upon the considerable intellectual resources of the Institute.
- Establish health services and population science research initiatives to systematically evaluate elements of the current care delivery models, with the goal of maximizing efficiency and improving outcomes.
- Evaluate molecular diagnostic technologies that would potentially leapfrog current existing pathologic techniques and provide affordable timely diagnosis.
- Work toward building and supporting local research capacity by establishing research training programs at our sites.
Publications and Abstracts
Sharma K, Costas A, Damuse R, Pierre JH, Pyda J, Ong C, Shulman LN, Meara J. The Haiti Breast Cancer Initiative (HBCI): initial findings and analysis of barriers-to-care delaying patient presentation. J Oncol 2013;2013:1-6. doi:10.1155/2013/206367.
Mubiligi JM, Hedt-Gauthier B, Mpunga T, Tapela N, Okao P, Harries AD, Edginton ME, Driscoll C, Mugabo L, Riviello R, Shulman LN. Caring for patients with surgically resectable cancers: experience from a specialized center in rural Rwanda. Public Health Action 2014;4(2):128-32. doi:10.5588/pha.14.0002.
Mpunga T, Tapela N, Hedt-Gauthier BL, Milner D, Nshimiyimana I, Muvugabigwi G, Moore M, Shulman DS, Pepoon JR, Shulman LN. Diagnosis of cancer in rural Rwanda: early outcomes of a phased approach to implement anatomical pathology services in resource-limited settings. Am J Clin Pathol 2014;142(4):541-5. doi:10.1309/AJCPYPDES6Z8ELEY.
Shulman LN, Mpunga T, Tapela N, Wagner C, Fadelu T, Binagwaho A. Bringing cancer care to the poor: experiences from Rwanda. Nature Rev Cancer 2014;14:815-21. doi:10.1038/nrc3848.
Pace LE, Mpunga T, Hategekimana V, Dusengimana JMV, Habineza H, Bigirimana JB, Mutumbira C, Mpanumusingo E, Ngiruwera JP, Tapela N, Amoroso C, Shulman LN, Keating NL. Delays in breast cancer presentation and diagnosis at two rural referral centers in Rwanda. The Oncologist 2015;20:1-9. doi:10.1634/theoncologist.2014-0493.
Challinor JM, Galassi AL, Al-Ruzzieh MA, Bigirimana JB, Buswell L, So KW, Steinberg AB, Williams M. Nursing's potential to address the growing cancer burden in low- and middle-income countries. J Global Oncol 2016;3:154-163. doi:10.1200/JGO.2015.001974.
Stulac S, Binagwaho A, Tapela N, Wagner C, Muhimpundu M, Ngabo F, Nsanzimana S, Kayonde L, Bigirimana J, Lessard A, Lehmann L, Shulman LN, Nutt C, Drobac P, Mpunga T, Farmer P. Capacity building for oncology programs in sub-Saharan Africa: the Rwanda experience. Lancet Oncol 2015;16:e405-13. doi:10.1016/S1470-2045(15)00161-8.
Shulman LN, Wagner CM, Barr R, Lopes G, Longo G, Robertson J, Forte G, Torode J, Magrini N. Proposing essential medicines to treat cancer: methodologies, processes, and outcomes. J Clin Oncol 2016;34(1):69-75. doi:10.1200/JCO.2015.61.8736.
Buswell L, Umuhizi D, Hategekimana V, Muhayimana C, Kennell-Heiling S. Voices of hope from rural Rwanda: three oncology nurse leaders emerge. Oncol Nurs Forum. 2016;43(5):661-4. doi:10.1188/16.ONF.661-664.
Tapela N, Mpunga T, Karema N, Nzayisenga I, Fadelu T, Uwizeye F, Hirschhorn L, Muhimpundu M, Balinda J, Amoroso C, Wagner C, Binagwaho A, Shulman LN. Implementation science for global oncology: the imperative to evaluate safety and efficacy of cancer care delivery. J Clin Oncol 2016;34(1):43-52. doi:10.1200/JCO.2015.61.7738.
Mpunga T, Hedt B, Tapela N, Nshimiyimana I, Muvugabigwi G, Pritchett N, Greenberg L, Benewe O, Shulman D, Pepoon J, Shulman L, Milner D. Implementation and validation of telepathology triage at cancer referral center in rural Rwanda. J Global Oncol 2016;2(2):76-82. doi:10.1200/JGO.2015.002162.
Nzayisenga I, Segal R, Pritchett N, Xu MJ, Park PH, Mpanumusingo EV, Umuhizi DG, Goldstein DP, Berkowitz RS, Hategekimana V, Muhayimana C, Rubagumya F, Fadelu T, Tapela N, Mpunga T, Ghebre RG. Gestational trophoblastic neoplasia treatment at the Butaro Cancer Center of Excellence in Rwanda. J Glob Oncol 2016;2(6):365-374. doi:10.1200/JGO.2015.002568.
Stulac S, Munyaneza RB, Chai J, Bigirimana JB, Nyishime M, Tapela N, Chaffee S, Lehmann L, Shulman LN. Initiating childhood cancer treatment in rural Rwanda: a partnership-based approach. Pediatr Blood Cancer 2016;63(5):813-7. doi:10.1002/pbc.25903.
Shyirambere C, Xu MJ, Elmore SN, Fadelu T, May L, Umuhizi DG, Uwizeye FR, Driscoll C, Muhayimana V, Hategekimana V, Rubagumya F, Nzayisenga I, Shulman LN, Mpunga T, Lehmann LE. Treating nephroblastoma in Rwanda: using International Society of Pediatric Oncology guidelines in a novel oncologic care model. J Global Oncol 2016;2(3)105-113. doi:10.1200/JGO.2015.000067.
Tapela N, Nzayisenga I, Sethi R, Bigirimana JB, Habineza H, Hategekimana V, Mantini N, Mpunga T, Shulman LN, Lehmann L. Treatment of chronic myeloid leukemia in rural Rwanda: promising early outcomes. J Global Oncol 2016;2(3):129-137. doi:10.1200/JGO.2015.001727.
Tapela NM, Mpunga T, Hedt-Gauthier B, Moore M, Mpanumusingo E, Xu MJ, Nzayisenga I, Hategekimana V, Umuhizi DG, Pace LE, Bigirimana JB, Wang J, Driscoll C, Uwizeye FR, Drobac PC, Ngoga G, Shyirambere C, Muhayimana C, Lehmann L, Shulman LN. Pursuing equity in cancer care: implementation, challenges and preliminary findings of a public cancer referral center in rural Rwanda. BMC Cancer 2016;16:237. doi:10.1186/s12885-016-2256-7.
Pace LE, Dusengimana JMV, Hategekimana V, Habineza H, Bigirimana JB, Tapela N, Mutumbira C, Mpanumusingo E, Brock J, Meserve E, Uwumugambi A, Dillon D, Keating NL, Shulman LN, Mpunga T. Benign and malignant breast disease at Rwanda's first public cancer referral center. The Oncologist 2016;21:1-5. doi:10.1634/theoncologist.2015-0388.
Pace LE, Shulman LN. Breast cancer in Sub-Saharan Africa: Challenges and opportunities to reduce mortality. The Oncologist 2016;21(6):739-44. doi:10.1634/theoncologist.2015-0429.
Rubagumya F, Greenberg L, Manirakiza A, DeBoer R, Park PH, Mpunga T, Shulman LN. Increasing global access to cancer care: models of care with non-oncologists as primary providers. Lancet Oncol 2017;18(8):1000-2. doi:10.1016/S1470-2045(17)30519-3.
Neal C, Rusangwa C, Borg R, Tapela N, Mugunga JC, Shyirambere C, Ntakirutimana E, Park PH, Shulman LN, Mpunga T. Cost of providing quality cancer care at the Butaro Cancer Center of Excellence in Rwanda. J Global Oncol 2017. doi:10.1200/JGO.17.00003.
Muvugabigwi G, Nshimiyimana I, Greenberg L, Hakizimana E, Ruhangaza D, Benewe O, Bhai K, Pepoon JR, Fehr AE, Park PH, Butonzi J, Shyirambere C, Manirakiza A, Rusangwa C, Milner D, Mpunga T, Shulman LN. Decreasing histology turnaround time through stepwise innovation and capacity building in Rwanda. J Global Oncol 2018;4:1-6. doi:10.1200/JGO.17.00081.
Davey S, Mpanumusingo E, Fehr A, Butonzi J, Shyirambere C, Hategekimana V, Bigirimana JB, Borg R, Uwizeye R, Tapela N, Randall T, Shulman L, Park P, Mpunga T. Characteristics and early outcomes of cervical cancer patients at Butaro District Hospital, Rwanda: a retrospective review. The Lancet Global Health. 2017;5. doi:10.1016/s2214-109x(17)30135-3.
Pace LE, Dusengimana JV, Keating NL, Hategekimana V, Rugema V, Bigirimana JB, Costas-Chavarri A, Umwizera A, Park PH, Shulman LN, Mpunga T. Impact of breast cancer early detection training on Rwandan health workers' knowledge and skills. J Glob Oncol 2018. doi:10.1200/JGO.17.00098.
O'Neil DS, Keating NL, Dusengimana JM, Hategekimana V, Umwizera A, Mpunga T, Shulman LN, Pace LE. Quality of breast cancer treatment at a rural cancer center in Rwanda. J Global Oncol 2018;4:1-11. doi:10.1200/JGO.2016.008672.
Rubagumya F, Xu MJ, May L, Driscoll C, Uwizeye FR, Shyirambere C, Larrabee K, Gilbert UD, Muhayimana C, Hategekimana V, Elmore S, Mpunga T, Moore M, Shulman LN, Lehmann L. Outcomes of a low intensity treatment for acute lymphoblastic leukemia (ALL) at the Butaro Cancer Center of Excellence in Rwanda. J Global Oncol 2018;4:1-11. doi:10.1200/JGO.2017.009290.
Dusengimana JV, Hategekimana V, Borg R, Hedt-Gauthier B, Gupta N, Troyan S, Shulman LN, Nzayisenga I, Fadelu T, Mpunga T, Pace LE. Pregnancy-associated breast cancer in rural Rwanda: the experience of the Butaro Cancer Center of Excellence. BMC Cancer 2018;18:634. doi:10.1186/s12885-018-4535-y.
Garcia-Gonzalez P, Lopes G, Schwartz E, Shulman LN. The role of humanitarian donations in decreasing preventable mortality from cancer in low-income countries: models to improve access to life-saving medicines. J Glob Oncol 2018;4:1-3. doi: 10.1200/JGO.18.00096.
Buswell L, Elperin A, Houlahan K, St. Croix M, Virchick B, Bigirimana JB, Hategekimana, V, Umuhizi D. Answering the call: US oncology nurses train and mentor nurses in Rwanda. Proc of 18th International Conference on Cancer Nursing, September 2014, Panama City, Panama, 44.
DeBoer RJ, Driscoll CD, Butera Y, Bigirimana JB, Muhayimana C, Fadelu T, Park PH, Shyirambere C, Uwizeye FR, Mpunga T, Lehmann LE, Shulman LN. Report on the Treatment of Hodgkin Lymphoma with ABVD Chemotherapy at Two Rural District Hospitals in Rwanda. J Global Oncol 2016;2(3_suppl):67s-67s. doi:10.1200/JGO.2016.003764.
Lansigan F, Costa C, Mpanumusingo E, Kigonya C, Butonzi J, Sebahungu F, Shyirambere C, Mpunga T, Haley J, Figueroa K, Park P, Davis T, Chamberlin M. A novel global health fellowship elective in oncology in Rwanda: a multi-faceted model in education. J Global Oncol 2017;35:15 suppl:e18086-e18086.
Davey S. Characteristics and Early Outcomes of Cervical Cancer of Patients at Butaro District Hospital, Rwanda. Lancet Glob Health 2017;5:S28-S28. doi:10.1016/S2214-109X(17)30135-3.
Anglade F, Mompremier M, Bhangdia K, Greenberg L, Orozco JD, Brock J, Pepoon J, Milner D. Implementation of Anatomic Pathology Services in Mirebalais, Haiti. J Glob Oncol 2018;4_suppl:31s-31s.