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Improving equity in access to early diagnosis of cancer: implementation research in different healthcare systems of Latin America (EquityCancer-LA)

Periodic Reporting for period 1 - EquityCancer-LA (Improving equity in access to early diagnosis of cancer: implementation research in different healthcare systems of Latin America (EquityCancer-LA))

Reporting period: 2021-05-01 to 2022-10-31

High mortality rates due to delayed cancer diagnosis and treatment in Latin America are the lethal consequences of limited access to health care in fragmented healthcare system. A comprehensive approach is needed to address this challenge, which particularly affects disadvantaged population groups.

The EU-funded EquityCancer-LA is a research project that aims at evaluating the contextual effectiveness of scaling-up a multicomponent integrated care intervention to improve early diagnosis of cancer, taking a participatory approach, in healthcare networks of Chile, Colombia and Ecuador. The project will focus on the contextual- and cost- effectiveness of an affordable, tailored solution to reduce diagnostic delays, developing a strategy for its implementation in different contexts. It will provide novel data on inequity in access to healthcare and contribute to clinical practice and research on early diagnosis through an innovative use of digital tools.

EquityCancer-LA objectives are:

a) To analyse delays in cancer diagnosis, associated factors, and key access barriers and facilitators of early diagnosis related to the context and population characteristics of the most frequent cancers in public healthcare networks in Chile, Colombia and Ecuador.
b) To adapt and scale-up, through a participatory approach, a multi-component integrated care intervention to improve early diagnosis of the most frequent cancers in each particular context based on three core components – training of PC teams, a fast-track referral pathway, and a patient information strategy to navigate the services.
c) To evaluate the contextual effectiveness and the implementation process to identify the factors related to the context, process and intervention content that determine their sustainability and applicability in other contexts.
d) To evaluate the cost of the intervention and its implementation and estimate the cost-effectiveness of the intervention, to inform the scaling-up and rollout of the intervention in other settings.
e) To develop a strategy and tools for the sustainable large-scale implementation of the multi-component integrated care intervention to translate the evidence into innovative and effective policies for cancer control in Latin America and beyond.
To prepare the onset of EquityCancer-LA, the research plan and draft versions of research tools for both the qualitative and quantitative studies were elaborated, and study areas were selected in participant Latin American (LA) countries. Country research teams were set up, as well as the Local Steering Committees and National Scientific Committees. At a project level, both the International Scientific Committee and the International Ethics Committee were formed. Data collection tools were finalised and fieldwork for both the quantitative and qualitative studies started in Chile, Colombia and Ecuador. Before that, the patients’ questionnaire for the patients survey (quantitative study) and the topic guides for the individual interviews and focus groups of main stakeholders (qualitative study) were adapted to each local context, and agreements with participant institutions were concluded. Ethical approvals were sought and granted by the reference ethics committee of each beneficiary, according to national laws. A number of difficulties during fieldwork arose in the three intervention countries, which required higher dedication of the research teams and delayed the finalization of the base-line studies (particularly, regarding the patients’ questionnaire survey). However, at the end of the reporting period, relevant progress had been made in LA countries towards the finalization of the fieldwork of the quantitative study, and preliminary results were already available. Results of the qualitative study obtained informed the analysis of conditions for the adaptation and implementation of the interventions in each context, a process started in May 2022.

The plan for the dissemination and exploitation of results was finalised and its implementation started. Presentations to policy makers and relevant stakeholders of the health sector in LA countries were conducted, as well as the public launching of the project in Spain, Ecuador, and Colombia. Activities intended to disseminate EquityCancer-LA at a national and international level, as well as secure the participation of healthcare networks in LA countries. The construction of the website stands out during this period. Capacity building needs were identified and addressed by a learning by doing strategy towards junior researchers and members of the Local Steering Committees, in situ scientific support to research teams, continuous exchange between project partners, and the organization of different courses and presentations on the subject and methods of the study.

The project coordinator (CSC) provided support and supervised scientific and management tasks, ensuring communication between partners via e-mail, website, monthly teleconferences and biannual workshops. During the reporting period, 3 international workshops were held: kick-off meeting in May-June 2021 (on-line due to pandemic restrictions); the Principal Investigator’s meeting I in Ecuador (Quito, October 2021) and Workshop II in Colombia (Bogota, April 2022). The latter two were held in hybrid format, so they could be also attended on-line. The project intranet was built and regularly updated, containing all relevant documents, acting as a communication platform for project beneficiaries.
The major ground-breaking perspective of EquityCancer-LA is to comprehensively evaluate the contextual effectiveness of scaling up an innovative multi-component integrated care intervention for early diagnosis of cancer, based on improving primary care diagnostic capacity and care coordination across levels in Latin America (LA). Available evidence, mostly from high income countries, highlights the opportunity that this kind of intervention presents for improving early diagnosis of cancer. However, these initiatives have been limitedly implemented and evaluated in the region.

The EquityCancer-LA research project will generate: 1) robust evidence on contextual effectiveness and costs-effectiveness of an affordable, tailored intervention to reduce diagnostic delays; and a validated strategy for its large-scale implementation in LA and low and middle-income countries; 2) novel data on delays and key barriers and facilitators to early diagnosis and inequalities in access; 3) e-tools to improve clinical practice and research on early diagnosis.

As potential impact, the contribution of EquityCancer-LA to advance local and regional cancer health policies stands out. The project tailored intervention to reduce delays in cancer diagnosis will promote sustainable and efficient cancer care, contributing to the sustainability of health systems in the long run. By focusing on the contextual and individual factors other than need that are currently influencing early cancer diagnosis in participant countries, it will contribute to reduce health inequalities and inequities in cancer diagnosis in LA. Another key potential impact relates to the advance in healthcare delivery research on cancer control at national and international levels, providing tools, methods and building research capacity.