Academic journal article Bulletin of the World Health Organization

A Training Programme to Build Cancer Research Capacity in Low- and Middle-Income Countries: Findings from Guatemala/Un Programme De Formation Pour Renforcer la Capacite De Recherche Sur le Cancer Dans Les Pays a Revenu Faible et Intermediaire: Resultats Du Guatemala

Academic journal article Bulletin of the World Health Organization

A Training Programme to Build Cancer Research Capacity in Low- and Middle-Income Countries: Findings from Guatemala/Un Programme De Formation Pour Renforcer la Capacite De Recherche Sur le Cancer Dans Les Pays a Revenu Faible et Intermediaire: Resultats Du Guatemala

Article excerpt

Introduction

A disproportionate burden of the recent global increase seen in cancer incidence and mortality is shouldered by low- and middle-income countries (LMICs). This is due in part to population ageing in LMICs, but shifts in the prevalences of modifiable risk factors--such as smoking and obesity--have also played a role. (1) The United Nations and the Pan American Health Organization (PAHO) cite cancer surveillance, research and capacity building in LMICs as critical elements in the prevention and control of cancer worldwide. (2-4) The World Health Organization (WHO) has emphasized the importance of capacity building that reaches beyond the development of infrastructure and resources to include the strengthening of in-country competence for conducting high-quality research. (5) Potter & Brough developed a "capacity model" that addressed the building of infrastructures, systems, skills and tools, particularly in LMICs. (6) In this article, we illustrate one application of this "Potter-Brough" model that is responsive to the cancer needs of Guatemala--a lower-middle-income country in Latin America.

Guatemala: context for capacity building

Although cancer is the third leading cause of mortality in the country, (7) Guatemala lacks a population-based surveillance system (7) and only has limited services for cancer prevention and control. According to WHO--which has used Guatemala as an example of a country with a critical need to incentivize health research--the retention of "clinician researchers", research that informs policy and systems changes, and institutional commitment are all key to building cancer research capacity in the country and addressing the country's cancer needs. (8)

The Instituto de Cancerologia (INCAN) in Guatemala City serves as the point of referral and service for Guatemala's cancer patients. Access to adequate medical care in general--and oncological care in particular--is so poor in many areas of Guatemala that most cancers are not diagnosed until they are advanced. More than 70% of INCAN's patients present with late-stage disease. The country's oncologists are keen to develop strategies to reduce the late-stage diagnoses and improve outcomes. Although INCAN focuses on diagnosis and treatment and collects no population-based data, its medical records currently provide the best data available for estimating the national cancer burden in Guatemala. (5) Recently, INCAN's administration expressed an interest in collecting better, population-based data on which more accurate estimates of the country's cancer burden - and more effective initiatives for cancer prevention and control - could be based. INCAN is slowly developing into a resource for the development of agendas for the future prevention and control of cancer in Guatemala.

Training programme

In a partnership between INCAN and the School of Medicine of Washington University in Saint Louis (Saint Louis, United States of America), the Cancer Control Research Training Institute was developed at INCAN in September 2010. This was in response to Guatemala's increasing cancer burden and INCAN's recognition of the need to train clinician researchers in population health methods--so that such individuals can study and address Guatemala's cancer needs. The long-term goal is to establish a sustainable training programme to develop capacity for research that could improve cancer-related policy health systems and disease management. Key features of the year-long programme described here included multidisciplinary training, didactic sessions, a mentored dyadic experience and applied training through the development of research protocols that are responsive to Guatemala's needs (Fig. 1).

For the first, year-long training programme, 10 clinicians--five from the United States and five from Guatemala--were selected to participate, via a competitive application process. Participants engaged in training sessions--in English--in biostatistics, epidemiology, research methods, data collection and management, ethics and anthropology. …

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