Multipronged Training to Improve Screening and Management of Cervical Cancer in Nepal

PURPOSE According to GLOBOCAN estimates, cervical cancer is the most common cancer among women in Nepal, with nearly 3,000 new cases and approximately 1,900 deaths in 2018. Trained health care providers are needed to prevent cervical cancer and diagnose and treat cervical cancer earlier to achieve better clinical outcomes. To address this need, ASCO used a 3-pronged approach to improve multidisciplinary cervical cancer care in Nepal, including 3 in-person training courses on cervical cancer screening and treatment, a 6-month tele-education Project ECHO program that included didactic and case presentations, and supplemental volunteer visits to provide additional clinical skills training. METHODS ASCO collected data from program participants via surveys and observational methods. In-person trainings and Project ECHO sessions were evaluated via surveys. Survey instruments included questions about practice changes and learning objectives. Surveys were conducted on-site and 6 months later for live trainings, and after each Project ECHO session, with a final survey to assess the program. Volunteer physicians provided observational data on physicians’ skills at the hospital site. RESULTS Results are available for 2 in-person trainings and the Project ECHO program. Seventy-nine percent of respondents from the in-person trainings reported making changes to their practice that included team-based care for patients with cervical cancer, increased screening for cervical cancer, and newly established or increased participation in tumor boards. All Project ECHO respondents reported incorporating changes into their work on the basis of their participation. Volunteers at the hospital site reported observing improvements in knot tying and holding of instruments, lymphadenectomy, and colposcopy. CONCLUSION Preliminary results of the project are positive according to self-reported outcomes and observed behaviors. They include improvements in multidisciplinary care, screening, and the ability to perform essential surgical procedures. The 3-pronged approach described here can be considered for other geographies and cancer types.