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 supported the local oncology team at the University Hospital of Mirebalais on a project to comprehensively assess breast cancer outcomes. Initial analysis in a retrospective cohort of nearly 350 patients revealed the preponderance of younger patients with more advanced disease and other poor risk features, such as higher-grade disease. This analysis also highlighted significant delays that occur prior to treatment initiation, as well as along the treatment care continuum. We are currently working on an analysis evaluating geospatial accessibility of cancer care and quantifying the impact of travel distance on cancer stage at presentation and on treatment outcomes. We are also evaluating patient communication preferences, and plan to explore the utility of mobile health interventions to improve communication between patient and providers, as well as other future interventions that may improve outcomes.
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). In addition, CGCM received support from the Sanofi Espoir Foundation to establish a pediatric patient navigation program in Rwanda for WT to address barriers to pediatric cancer care completion, increase timeliness of diagnosis and treatment, and reduce non-compliance with treatment recommendations.
Quality Improvement Initiatives
Quality improvement (QI) initiatives are an important component of building capacity and competency in low-resource settings. With a grant from Celgene, CGCM is engaged in research to evaluate a new, tailored curriculum and coaching program in cancer care quality improvement at the Butaro Cancer Center of Excellence in Rwanda. The goal of this project is to understand barriers and facilitators of QI initiatives and, ultimately, to foster QI culture and mentor leaders that will sustain ongoing QI efforts into the future.
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.
Recent Publications, Abstracts, and Meetings
Morgan J, DeBoer RJ, Bigirimana JB, Nguyen C, Ruhangaza D, Paciorek A, Mugabo F, Villaverde C, Nsabimana N, Bihizimana P, Umwizerwa A, Lehmann L E, Shulman LN, Shyirambere C. A ten-year experience of treating chronic myeloid leukemia in rural Rwanda: outcomes and insights for a changing landscape. JCO Glob Oncol. 2022; 8: e2200131. doi:10.1200/GO.22.00131