Challenges of Cancer Challenges of Cancer Diagnosis in Resource Diagnosis in Resource Limited SettingsLimited Settings

Challenges of Cancer Challenges of Cancer Diagnosis in Resource Diagnosis in Resource Limited SettingsLimited Settings

Optimizing Pathology SupportOptimizing Pathology Support

Ann Marie Nelson, M.D.AIDS and Infectious Disease Pathology

Joint Pathology Center, USA

Sub-Saharan Africa CFAR May 2011 Kampala,Uganda

What Are the Goals What Are the Goals of Pathology?of Pathology?

What Are the Goals What Are the Goals of Pathology?of Pathology?

Provide consistently high quality diagnoses linked to Capacity to interpret and utilize information forTreatmentFollow-upEstablishment of registries and biorepositories

What is Required?What is Required?What is Required?What is Required?

Health workforce Infrastructure Reliable source of supplies

Quality assurance program Interdisciplinary training and communication

Health Work ForceHealth Work ForceHealth Work ForceHealth Work Force

Primary Care Knowledge of cancer epidemiology/ddx Information on when and where to refer

Oncologists Surgeons Radiologists/Clinical Laboratories Pathologists Technicians and clerical staff

Infrastructure and Supplies -Surgery

Infrastructure and Supplies -Surgery

Materials and SOPs for collection, documentation, fixation, and hand off of specimens Clinical and surgical information Specimen description and margins Appropriate fixation for routine and special procedures - tissue fixation must be rapid and documented

Efficient transfer of material to pathology

Infrastructure and Supplies

-Pathology

Infrastructure and Supplies

-Pathology Standardized system for receipt and documentation of specimens, case tracking, reporting and archiving

Basic working equipment for tissue evaluation and processing

Adequate supply of good quality reagents

Quality AssuranceQuality Assurance

Standard operating procedures and training of personnel at all levels

Quality control of specimen collection, fixation, processing, tissue sections and staining

Quality assurance of diagnosis - internal and external review

Documentation of errors with remediation

Interdisciplinary Training and

Communication

Interdisciplinary Training and

Communication Tumor Boards

Oncology, surgery, radiology, pathology etc

Before and after definitive procedures

Cancer Registries and Repositories Data sharing and dissemination

Cross-training at post-graduate level Surgeons, oncologists, pathologists and radiologists should rotate in each specialty

ChallengesChallenges

What requirements does your institution lack?

How to implement change? How to get buy-in from all parties including government and funding agencies?

When and how to introduce new technologies?