In Mali, the oncology project, dedicated to cervical and breast cancers (representing 30% of cancers of both sexes), built in partnership with Malian colleagues and Ministry of Health, started at the end of 2018 with palliative care, then support for screening, histopathology laboratory and specific treatments (surgery, chemotherapy, radiotherapy). In 2020, MSF provided specific care for 542 patients (366 breast cancers and 176 cervical cancers) and performed 2828 palliative consultations and 3260 tumor wounds care.
This experience confirmed the lack of financial and geographical access to screening and care facilities leading to diagnoses at very advanced stages and the complexity of management and multidisciplinary care pathways. This type of project implies new ways of working for MSF: the development of a holistic and patient-centered approach, long-term projection and working in partnership with national actors and international experts. Research, an essential element, needs to be developed around several axes: epidemiological, therapeutic trials and the introduction and evaluation of technological tools to improve diagnosis and management such as telemedicine and artificial intelligence. Finally, the issues of access not only to treatment but also to diagnosis and prevention are one of the major added values that MSF could bring to the fight against cancer.
KEY MESSAGE: Cancer is one of the new challenges that MSF has decided to tackle and for which new ways of working and research are needed.
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INTRODUCTION
MSF is providing cervical cancer screening in Blantyre and Chiradzulu districts in Southern Malawi in the catchment area of 10 health centres. Improved screening strategies under diverse recruitment models are introduced to increase HPV screening coverage at health centres and with outreach activities.
METHODS
Under PAVE study, self-collected vaginal swabs are tested by an isothermal amplification PCR assay followed byvisual inspection, imaging, and histological assessment for HPV +ve women. Women living <5km from health centers are recruited opportunistically during routine visits. After HPV test, they are advised either to wait onsite (test-and-wait model) or called back in two days’ time (test-and-call model) for triage and treatment visit.Women living>10km from health centers are offered HPV test, triage, and treatment in community settings by outreach teams (mobile-clinic model). A fourth model for women living 5-10km from a health center with HPV testing in their communities followed by a triage and treatment visit at respective health centers (mobile-lab model) is not yet implemented.
RESULTS
As of April 2024, over 2000 women have undergone HPV screening across all active sites. Key insights from the experience are focused at: i)streamlining patient flow during opportunistic recruitment at health centers,ii)improving HPV results communication, iii)effectively tracing women back for triage and treatment visits using phone and community based tracing, iv)ensuring provision of stable internet for effective and real time data collection and synchronization, v)reducing gaps in logistics and quality assurances at HPV lab particularly in mobile lab setup, vi)ensuring real-time quality histopathology review of cervical biopsies for case management,and vii)continuous monitoring of patients and data flow to ensure quality of screening, compliance, and effective case management.
CONCLUSIONS
Diverse HPV-based screening strategies are key to achieve good screening coverage, and subsequently reducethe cervical cancer morbidity and mortality in southern Malawi.
Since the outbreak of the Russian Federation invasion, the border city of Kharkiv has come under bombardments leading to disruptions of the medical supply chain. Mission Kharkiv (MK) is a non-governmental organization (NGO) created in 2022 by Ukrainian volunteers to organize a consistent supply of chronic medications, especially anticancer drugs, in the area of Kharkiv.
METHODS
A partnership was created between MK and MSF in June 2022. MSF decided a donation of 12 anticancer drugs, all registered on the World Health Organization list of essential medicines. The supplies were dispensed to MK by MSF teams in Ukraine. MK was in charge of the storage and the distribution of the drugs to patients meeting eligibility criteria determined with Ukrainian oncologists. Digital database was created to allow traceability of every medication from its donation to its dispensation.
RESULTS
From October 2022 to April 2023, platinum compounds, taxanes, fluorouracil, trastuzumab, doxorubicin and hormone therapies were given to MK. Drugs were stocked in a warehouse unit equipped with cold chain facilities. 749 patients met eligibility criteria and were registered on the database to receive a whole course of treatment prescribed by Ukrainian oncologists. >99% of patients were ECOG 0-2. The largest types of cancers were digestive cancers (200 patients with gastrointestinal cancer, 21 with pancreatic cancer and 2 with biliary tract cancer representing 29.7% of all patients), breast cancers (206 women – 27.5%), gynaecologic cancers (151 women – 20.2%) followed by lung cancers (49 patients – 6.5%), hematologic malignancies (44 patients – 5.7%) and head and neck cancers (44 patients – 5.4%). Disease stage was reported in 723 patients. 32% were diagnosed with stage I-II, 33% with stage III and 35% with stage IV. Included patients received an average of 4.5 cycles of chemotherapy.
CONCLUSIONS
This model of humanitarian cancer medication release, coupled with cooperation between NGOs and a high level of digital traceability, has proven to be efficient. This approach could be scaled up in the future, enabling more cancer patients suffering from the consequences of war to benefit from this humanitarian program.