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Guideline implementation for breast healthcare in low‐ and middle‐Income countries: Treatment resource allocation
Author(s) -
Eniu Alexandru,
Carlson Robert W.,
El Saghir Nagi S.,
Bines Jose,
Bese Nuran Senel,
Vorobiof Daniel,
Masetti Riccardo,
Anderson Benjamin O.
Publication year - 2008
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.23843
Subject(s) - medicine , guideline , low and middle income countries , health care , breast cancer , resource allocation , intensive care medicine , developing country , cancer , economic growth , economics , pathology , market economy
A key determinant of breast cancer outcome is the degree to which newly diagnosed cancers are treated correctly in a timely fashion. Available resources must be applied in a rational manner to optimize population‐based outcomes. A multidisciplinary international panel of experts addressed the implementation of treatment guidelines and developed process checklists for breast surgery, radiation treatment, and systemic therapy. The needed resources for stage I, stage II, locally advanced, and metastatic breast cancer were outlined, and process metrics were developed. The ability to perform modified radical mastectomy is the mainstay of locoregional treatment at the basic level of breast healthcare. Radiation therapy allows for consideration of breast‐conserving therapy, postmastectomy chest wall irradiation, and palliation of painful or symptomatic metastases. Systemic therapy with cytotoxic chemotherapy is effective in the treatment of all biologic subtypes of breast cancer, but its provision is resource intensive. Although endocrine therapy requires few specialized resources, it requires knowledge of hormone receptor status. Targeted therapy against human epidermal growth factor receptor 2 (anti‐HER‐2) is very effective in tumors that overexpress HER‐2/ neu receptors, but cost largely prevents its use in resource‐limited environments. Incremental allocation of resources can help address economic disparities and ensure equity in access to care. Checklists and allocation tables can support the objective of offering optimal care for all patients. The use of process metrics can facilitate the development of multidisciplinary, integrated, fiscally responsible, continuously improving, and flexible approaches to the global enhancement of breast cancer treatment. Cancer 2008;113(8 suppl):2269–81. © 2008 American Cancer Society.