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

Project Information

EquityCancer-LA

Grant agreement ID: 965226

DOI

10.3030/965226

EC signature date 25 January 2021

Start date 1 May 2021

End date 31 October 2026

Funded under

• SOCIETAL CHALLENGES - Health, demographic change and well-being

Total cost

€ 2 998 688,75

EU contribution

€ 2 998 688,75

Coordinated by

CONSORCI DE SALUT I D'ATENCIO SOCIAL DE CATALUNYA
Spain

Periodic Reporting for period 3 - EquityCancer-LA (Improving equity in access to early diagnosis of cancer: implementation research in different healthcare systems of Latin America (EquityCancer-LA))

Reporting period: 2024-05-01 to 2025-10-31

Summary of the context and overall objectives of the project

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.

Work performed from the beginning of the project to the end of the period covered by the report and main results achieved so far

To prepare the onset of EquityCancer-LA, the research plan and tools for both the qualitative and quantitative base-line studies were elaborated, and study areas were selected in Chile, Colombia and Ecuador. Country research teams were set up, as well as Local Steering and National Scientific Committees. At a project level, both the Scientific and Ethics International Committees were formed.

At the end of the first reporting period, data collection tools for the base-line study had been already adapted to each context, and qualitative and quantitative fieldwork started in Latin American (LA) countries after obtaining the ethical approval. However, difficulties to complete the patients’ survey arose in the three countries due to context-related factors. This fact required a higher dedication of the research teams and delayed the completion of the quantitative base-line study until well into the second reporting period for Chile and Ecuador, while it could not be completed in Colombia; delaying the implementation of the intervention in the three contexts. Despite this situation, results of the qualitative study informed the analysis of conditions for the adaptation and implementation of the EquityCancer-LA multi-component intervention in participant healthcare settings. The process followed a participatory strategy with healthcare professionals and relevant stakeholders from healthcare networks, who engaged in discussions on how to improve cancer diagnosis in their networks. At the end of the second reporting period, different components of the EquityCancer-LA intervention had been already implemented in the three LA countries, and its monitoring was underway. The plan of analysis and tools for the intra-country evaluation and monitoring of the interventions were elaborated and adapted to each context, and data collection started. Progress was also made regarding the analysis of the implementation costs and cost-effectiveness. Finally, the cross-country comparative analysis of preliminary results was developed, and its conclusions shared and discussed among research teams and with different stakeholders during public dissemination events.

To date, EquityCancer-LA presentations to policy makers and relevant stakeholders of the health sector in LA countries have been conducted, where the organization of public seminars in Chile, Colombia and Ecuador stand out. Moreover, EquityCancer-LA has been present in national and international scientific conferences, while the study protocol has been published in a scientific journal. The EquityCancer-LA consortium has attended most of the networking activities organized by the Global Alliance of Chronic Diseases (GACD). Capacity building needs has been 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, and continuous exchange between project partners. Biannual project workshops in Latin America stand out as one of the most important spaces for discussion within the EquityCancer-LA consortium. Since the start of the project, the coordinator has provided support and supervised scientific and management tasks, ensuring a good implementation and the fulfilment of project goals.

Progress beyond the state of the art and expected potential impact (including the socio-economic impact and the wider societal implications of the project so far)

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.

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