Implementation of a Cervical Cancer Tumor Board to optimize patient care and follow-up at a rural hospital in Malawi

Abstract

Abstract Cervical cancer is Malawi's most diagnosed and highest mortality cancer. Due to a lack of screening, it is often diagnosed at an advanced stage. It has poor survival outcomes because treatment is not always available, patients are not quickly engaged in care and follow-up can be challenging for patients, especially those living far from a secondary facility. We set up a multidisciplinary team-based cervical cancer tumor board (CCTB) to better capture and care for clients at risk for cervical cancer and those with a new diagnosis. In February 2019, we initiated a monthly cervical cancer CCTB to enroll, review and discuss management for clients with suspected cervical cancer lesions. Specifically, we developed a cervical cancer registry to log suspects at Neno District Hospital. Our CCTB team members included cervical cancer screening providers, obstetrics and gynecology clinicians, and palliative care, laboratory, and community health workers representative. Any client with findings that required confirmation of cervical cancer diagnosis through a biopsy following cervical cancer screening was enrolled. Once enrolled, patients were followed continuously for final pathology results, treatment planning, and outcomes including referrals for surgeries and death. Between 1 February 2019, and 30 April 2021, an estimated 4,822 Visual Inspections with Acetic Acid (VIAs) were performed in the district. We enrolled 72 clients from those initial screenings with suspected cervical cancer. We found a high linkage to care for clients of 97%. All women enrolled in the CCTB had their results for biopsies available (100%). Total loss to care was very minimal at 2% for premalignant lesions. Out of the clients enrolled in CCTB, 39.8% (n = 37) had cervical cancer and among them, 73.0% were successfully staged. Cervical cancer-focused CCTB is an effective way to follow clients with suspected and diagnosed cervical cancer to ensure appropriate treatment and subsequent follow-up. We demonstrated that CCTB could be successfully implemented in rural Malawi at the district hospital level.