RCPHO_Rwanda

Strengthening advanced breast cancer care in Rwanda through improved care coordination

Themes: 
Policy and health system gaps

Context

As published by O’Neil et. al (2017), the majority of individuals diagnosed with breast cancer in Rwanda present with advanced and metastatic disease and 14% of patients have been found to be lost to follow up.[1]  As the country continues to develop, significant advancements have been made in cancer prevention diagnosis and treatment and care. Despite this, there is concern that as options for treatment and care are provided by different hospitals, many patients are lost to follow-up due to the need to navigate between facilities. In response to this, Rwanda’s Ministry of Health (MoH), through the Rwanda Biomedical Centre and in collaboration with Rwanda Palliative Care and Hospice Organisation (RPCHO), have developed an innovative, cross-cutting breast cancer care coordination system paying particular attention to the most high-risk, advanced stage breast cancer patients.

The Rwanda Biomedical Centre promotes high quality, affordable, and sustainable health care services to the population through the delivery of evidence-based interventions. RPCHO is a multidisciplinary, non-governmental organisation whose aim is to promote access to high-quality palliative care for all those living in Rwanda. Together, these organisations are partnering to implement a new SPARC project aiming at improving the coordination of care in the country. 

RCPHO_Rwanda_Quote

"In LMICs, addressing the issue of metastatic breast cancer requires a health care system-wide approach centred to the patient, a prompt referral system from primary health care level combined with an effective coordination system at the tertiary care level are equally important as medical treatments to improve the survival rates of patients."

Dr François Uwinkindi, Director of Cancer Diseases Unit

Project description

In 2019, RPCHO received a SPARC MBC Challenge grant to improve the national model of care for breast cancer in Rwanda, in partnership with the Rwanda Biomedical Centre. This project sought to create a national breast cancer care coordination system to harmonise care across Rwanda’s five health facilities where breast cancer patients are treated. In order to achieve this goal, the RPCHO set four main objectives: 

  • To design and implement a National Breast Cancer Care Coordination System (NBCCC system) to facilitate standardised, documented, multidisciplinary and multi-site coordination of care across Rwanda’s five facilities where breast cancer patients are treated. 
  • To identify patients with advanced breast cancer who have been lost to follow-up from across Rwanda’s five identified treatment centres and reintegrate them into care.
  • To decrease loss to follow-up for patients living with stage III or IV breast across Rwanda’s five identified treatment centres through the NBCCC system.
  • To create a comprehensive National Care Model for Breast Cancer, minimising loss to follow-up of patients living with, or at risk of, advanced and metastatic disease through standardised, intra and inter-facility care coordination.

In the first stage of this project a national technical working group was established, composed of key clinicians from each of the five cancer hospitals in Rwanda, representatives from Rwanda Biomedical Centre, RPCHO, Ministry of Health, a breast cancer survivors association, and the Director of Oncology from the organisation, ‘Partners in Health’. Breast cancer care coordination forms and standard operating procedures were developed, approved by the Ministry of Health, and are now being used by hospitals. 

At each of the five cancer referral facilities namely: Butaro Cancer Center of Excellence, Kigali University Teaching Hospital, Rwanda Military Hospital, King Faisal Hospital and Butare University Teaching Hospital, retrospective data collection was carried out to identify MBC patients that had ceased follow up care and the patients were contacted to support them to re-engage in care. 

Breast cancer care nurses were trained to act as a focal person to help in organising the care of patients with the support of key clinicians at the hospital. On top of these focal points, additional breast cancer coordinators within each of these hospitals were trained to improve patient coordination. 

The centre has also integrated into the national cancer registry by developing electronic medical records, including a unique identifier for each patient, to help harmonise the care provided to patients as well as enable the sharing of information between clinicians treating these individuals with breast cancer. 

Impact

The national breast cancer care coordination system has been specifically designed to be a low-cost intervention with the aim to be integrated into Rwanda’s existing health system and human resource structure. 

A breast cancer registry has been created, using the software of Rwanda’s National Cancer Registry, links project’s hospitals and facilitating the navigation of patients across different health facilities to allow communication between clinicians from the five hospitals. Multidisciplinary boards in the five project hospitals have been established and meet on regular basis and have designed a harmonized treatment plan based on the national treatment guidelines. Furthermore, Rwanda Biomedical Centre has trained five breast cancer focal points in each of the hospitals, and additional breast cancer care coordinators to support patients through their treatment journey and prevent patients from dropping out of treatment. A breast cancer care coordinator was hired full time as a patient navigator that connects all participating hospitals.

After identifying patients who had been lost to follow-up the team was able to reach out to 103 patients who had stopped care and reintegrate them into treatment. 

Additionally, during the implementation period of the project RPCHO reached a total of 832 patients who have benefitted from the support of patient navigators and the improved treatment plans developed as a result of the NBCCC. The project has also achieved the goal of having over 90% of MBC patients continue their treatment. 

Through this project the breast cancer care coordination system has been fully integrated into the five project hospitals and is in the approval process by the Ministry of Health as a standard of care that will also be adopted as a national care model for other cancers.

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References

(Information from the project description and context is compiled from the final SPARC report) 

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Last update: 
Tuesday 3 May 2022
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