1/13/15 Building and Evalua,ng Cancer Registry Capacity in Moshi and Mwanza, Tanzania Leah Zullig, PhD, MPH S. Yousuf Zafar, MD, MHS Kris<n Schroeder, MD Cancer Diagnosis Developed Developing Countries Countries 54 % Cancer Deaths Developed Developing Countries Countries 64 % 1 1/13/15 Cancer Registry Coverage U.S. and Canada Western Europe 94 % 100 % 6 South America % % 4 Southeast Asia % 80 Australia % 1 Africa Source: Interna<onal Agency for Research on Cancer Implica<ons Underes<mate cancer incidence and mortality % 1 Africa Develop reliable popula<on-‐based registries Understand cancer trends and leverage resources Source: Interna<onal Agency for Research on Cancer 2 1/13/15 Tanzania Mwanza Moshi Dodoma Dar es Salaam 3 1/13/15 Moshi Dar es Salaam Mwanza Moshi Dar es Salaam 4 1/13/15 Objec<ve Aim 1: Evaluate quality of exis<ng KCMC hospital-‐based cancer registry Aim 2: Expand data collec<on to include Bugando Medical Center Kilimanjaro Chris<an Medical Center • Ter<ary referral hospital • Serves an es<mated 11 million people • Ac<ve hospital-‐based cancer registry began in August 2013 5 1/13/15 KCMC Cancer Registry • Began in August 2013 • Uses CanReg5 • Contains 1,200 unique pa<ents Bugando Medical Center • Serves an es<mated 13 million people • Offers pathology services, chemotherapy administra<on, and radia<on therapy 6 1/13/15 Project Team @ Duke Leah Zullig, PhD, MPH Health Services Researcher Yousuf Zafar, MD, MHS Medical Oncologist Kris,n Schroeder, MD Pediatric Oncologist Project Team @ KCMC Venance Maro, MD Head of Internal Medicine Michael Oresto Munishi, MD, MPH Lecturer in Community Health 7 1/13/15 Project Team @ BMC Beda Likonda, MD Radia,on Oncology Director Kris,n Schroeder, MD Pediatric Oncologist BMC KCMC Duke 8 1/13/15 Significance Popula<on-‐based cancer registries are an essen<al component of a fully developed cancer control program. Assessment of KCMC’s registry now provides early opportunity to strengthen data quality. Exchanging informa<on between KCMC and BMC registry will allow for more comprehensive understanding of cancer burden. Previous and Ongoing Work HIV-‐associated Malignancies Research Training Program (Bartle[) Medical Educa,on Partnership Ini,a,ve (Bartle[) Research with Kampala Cancer Registry (Schroeder) Cancer Registra,on Training (Oresto) 9 1/13/15 KCMC Two-‐Phased Needs Assessment Paper-‐Based Survey June 2012 • Organiza,onal Readiness to Change • Organiza,onal Needs Semi-‐Structured Qualita,ve Interviews March 2013 • Organiza,onal Readiness to Change • Percep,ons about Registry Sustainability Zullig LL, Vanderburg SB, Muiruri C, Abernethy A, Weiner BJ, Bartleg JA, Oneko O, Lisasi E, Oresto M, Zafar SY. “Sustainability of Cancer Registra<on in the Kilimanjaro Region of Tanzania -‐ A Qualita<ve Assessment.” World Health & Popula0on. 2014;15(1):21-‐30. PMID: 24702763 Zullig LL, Muiruri C, Abernethy A, Weiner BJ, Bartleg JA, Oneko O, Zafar SY. “Cancer Registra<on Needs Assessment at a Ter<ary Medical Center in Kilimanjaro, Tanzania.” World Health & Popula0on. 2013;14(2):12-‐23. PMID: 23713208 Needs Assessment Findings KCMC Clinicians and Administrators were Confident and Commi[ed to Registry Implementa<on Stakeholders Iden<fied Interna,onal Partners as Key Ingredients for Sustainability 10 1/13/15 Aim 1 Evaluate the quality of exis,ng data in the KCMC hospital-‐based cancer registry • Retrospec<ve analysis of data collected in the KCMC registry from August 1, 2013 through December 31, 2013 Data Quality Completeness: Percentage of variables completed within a case Accuracy: Internal consistency within a registry record and medical record 11 1/13/15 Aim 1 Methods • Sample 10% of the registry cases from first year • Compare the electronic cancer registry case file with paper-‐based medical record • Review discrepancies and adjust cancer registry • Conduct a root cause analysis to iden<fy possible sources of error • Apply lessons learned for training Aim 1 Sta<s<cal Considera<ons • Pilot study • Frequency distribu<ons • Cancer frequency trends compared to similar African cancer registries 12 1/13/15 KCMC Registry Contents Pa,ent Informa,on Full Name Sex Birth Date Tribe Occupa<on Address Follow Up Date of Last Contact Vital Status Tumor Diagnosis Date Topography Morphology Behavior Basis of Diagnosis ICD 10 Source Hospital Unit Pathology Number Case Number Cancer Registry Medical Records Major Clinical Wards Pathology Results 13 1/13/15 Aim 1 Products • Report to KCMC leaders • Apply lessons learned to expansion at BMC • Submit abstract to AORTIC annual mee<ng • Prepare publishable manuscript Aim 2 Expand data collec,on to include a second site, BMC, in Mwanza • Build cancer registra<on capacity at BMC and collect data for 3 months as part of a feasibility study 14 1/13/15 BMC Cancer Registry • Prospec<ve registry • 30-‐120 pa<ents expected monthly • Using CanReg5 BMC Cancer Registry Cancer Registrar Pathology Cancer Registry Medical Records Oncology 15 1/13/15 KCMC-‐BMC Collabora<on • Weekly communica<on • BMC staff visit KCMC – Observe registry case finding and data collec<on – Plan for BMC set-‐up • KCMC staff visit BMC – Facilitate equipment set-‐up – Provide on-‐site registra<on training Aim 2 Methods • Pilot, Feasibility Study • Program Evalua<on – Number of cases – Completeness of cases – Cost of data collec<on 16 1/13/15 Aim 2 Products • Cul<vate a cancer registry team • Develop standard opera<ng procedures • Report to BMC leaders of collected cases 1 % Africa Source: Interna<onal Agency for Research on Cancer 17 1/13/15 Timeline 2015 Dec Jan Feb Mar Apr May Jun Obtain ethics approval at Duke, KCMC, & Bugando Jul Aug Sept Oct Nov Dec AIM 1 Audit exis<ng registry cases Create registry quality report Conduct KCMC staff training based on audit findings Iden<fy cancer registrar Purchase equipment BMC staff visit KCMC KCMC staff visit BMC Train cancer registrar Collect registry data AIM 2 PRODUCTS Retrospec<ve registry analysis: stakeholder report Updated scope of prac<ce Seek addi<onal funding for data Present at AORTIC Research Team Leah Zullig, PhD, MPH S. Yousuf Zafar, MD, MHS Michael Oresto, MD, MPH Venance Maro, MD Kris<n Schroeder, MD Beda Likonda, MD Special Thanks Charles Muiruri, MPH John Bartleg, MD 18 1/13/15 Leah L. Zullig, PhD, MPH [email protected] 919.286.0411 ext. 7586 19
© Copyright 2024 ExpyDoc
