HOPEXCHANGE GHANA HEALTH PROJECT Ghana Breast Cancer Specialty Training Course Accra: August 23-27, 2010

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1 ecourse Sponsors: Course Coordination: In-Country Partnership: Programme of Action for Cancer Therapy (PACT) of the International Atomic Energy Agency (IAEA) Breast Health Global Initiative HopeXchange The Breast Health Global Initiative (international program) The Korle-Bu Teaching Hospital (local program) Susan G. Komen for the Cure (advocacy training) Oncology Nursing Society (nursing education) HopeXchange / The Ghana Breast Cancer Alliance Overview: As part of its educational and clinical endeavors in Ghana, the HopeXchange Ghana Health Project has established a pilot program for breast cancer education and training. As a collaboration of local and global partners that brings together regional and international experts, this program is designed to improve breast cancer outcomes in Ghana by creating and pilot testing education modules that once tested and verified, can be expanded in Ghana and extended to other African countries. Organization: In recognition of the importance of international collaborative partnerships, SUSAN G. KOMEN FOR THE CURE in 2008 funded HOPEXCHANGE to establish a multiorganizational collaboration now known as the GHANA BREAST CANCER ALLIANCE (GBCA), coordinating the several partners within and outside the country that share the goal of improving breast cancer and women s health outcomes in Ghana. Educational Approach: As an organizational partner of the GBCA and HopeXchange, the BREAST HEALTH GLOBAL INITIATIVE (BHGI) established its first international Learning Laboratory to design, implement and test education and training modules based on the BHGI clinical breast health and cancer control guidelines that can be adapted and used by diverse communities to expand their existing breast health programs. Challenges: Two obstacles to improving breast cancer outcomes in limited resource countries are 1) late presentation of disease and 2) disorganized or incomplete cancer diagnosis and treatment. To improve outcome, linked efforts are necessary to improve breast cancer awareness in the community through the mobilization of civil society groups at the same time that multidisciplinary hospital teams are organized such that patients are correctly diagnosed and then receive adequate, comprehensive cancer care: Page 1

2 Project goals: A central goal of the HopeXchange Ghana Health Project is to increase healthcare capacity in Ghana. Professional education should focus on assessing the optimal methods by which tailored educational programs may most effectively translate into IMPROVEMENT OF CARE. Because breast cancer diagnosis and treatment requires the coordinated efforts of multidisciplinary teams, the medical education and training must assist hospitals build or reinforce multidisciplinary teams, and these educational opportunities need to be matched with the deployment of proper equipment and technical training. Target medical audience: In order to develop and test this model of intervention, the next course could be offered to multidisciplinary teams from hospitals in the greater Accra region (either the regional hospitals of neighboring regions or district hospitals). Training will focus of multidisciplinary organization and coordination, developing the Korle-Bu multidisciplinary program as a model for other hospital-based diagnosis and treatment programs in Ghana. Advocacy participation: In parallel with the medical training course, general breast education will be provided to civil society groups. The Ghana Breast Cancer Alliance in collaboration with Susan G. Komen for the Cure will provide a one-training course for advocacy. Course assessments: A survey of each participating hospital will be applied to evaluate services currently provided in these facilities and to determine the composition and needs of the current teams. Follow-up surveys will also be applied to assess the degree to which the education and training influenced health care delivery in the hospitals for which training was provided. This course will cover the following general curriculum: Epidemiology International and Ghanaian statistics regarding breast disease Endocrine biology of the breast Fetal development, puberty, lactation, post-menopausal changes Non-malignant breast conditions Pain, cysts, fibroadenomas and phyllodes tumors, mastitis Malignant pathology In situ disease, invasive cancer (ductal and lobular), cancer staging Breast cancer risk factors Family history, reproductive factors, environmental factors, BRCA1 / 2 genes Diagnostic work-up Pt history, CBE, mammography / ultrasound, metastatic work-up Breast imaging Breast ultrasound, diagnostic mammography, BIRADS classification Tissue sampling Surgical biopsy, percutaneous needle sampling, image guided sampling Breast cancer surgery Modified radical mastectomy, axillary staging, breast conservation therapy Breast cancer adjuvant treatment Radiation therapy, systemic therapy Locally advanced and inflammatory breast cancer Etiology, diagnosis and treatment Multidisciplinary care Breast conservation therapy, neoadjuvant therapy Nursing Primary breast evaluation, patient triage, oncology nursing Palliative care Management of treatment symptoms, pain management, end-of-life care Page 2

3 DAY 1 (Monday August 23) General Plenary Sessions: The general plenary session on breast cancer for all participants: including a series of comprehensive lectures to provide teams and individual participants (physicians, nurses, social workers, and advocates) with an update on epidemiology, early detection, diagnosis and treatment of breast cancer: 7:30-8:30 AM BREAKFAST 8:30-8:45 AM Conference opening welcome of distinguished guests COURSE CHAIRS: Joe-Nat Clegg-Lamptey / Riccardo Masetti / Ben Anderson 8:45-9:00 AM ADVOCATE PRESENTATION Personal experience of breast cancer MORNING SESSION I: Didactic MODERATOR: Dr. Joel Yarney 9:00-9:30 AM LECTURE: Breast cancer epidemiology, physiology and common breast problems Global and Ghanaian cancer statistics, endocrine biology of the breast and benign breast conditions Fetal development, puberty, lactation, post-menopausal changes, breast pain, cysts, fibroadenomas and phyllodes tumors, mastitis INTL. SPEAKER: Ben Anderson LOCAL FACULTY: Dr. Adu-Aryee 9:30-10:00 AM LECTURE: Breast cancer risk factors and critical role of early cancer detection Epidemiology of breast cancer and risk factors International and Ghanaian statistics regarding breast cancer, family history, reproductive factors, environmental factors, BRCA1 / 2 genes INTL. SPEAKER: Lisa Newman LOCAL FACULTY: Dr. K.O. Dako 10:00-11:00 PM Small group break out session Questions & answers about breast cancer presentation, risk factors and early detection 11:00-11:30 AM TEA BREAK MORNING SESSION II: Didactic MODERATOR: Prof. E.A. Badoe 11:30-12:00 PM LECTURE: Breast diagnosis and the role of clinical breast examination (CBE) Pt history, self examination, clinical breast examination, use of breast ultrasound INTL. SPEAKER: Riccardo Masetti LOCAL FACULTY: Dr. Ben Baako 12:00-12:30 PM LECTURE: Breast pathology (micro) benign vs. malignant Malignant pathology In situ and invasive cancer (ductal v lobular), cancer staging, needle sampling for diagnosis (FNA vs core needle biopsy vs surgical excision) INTL. SPEAKER: Britt-Marie Ljung LOCAL FACULTY: Dr. Edusei 12:30-1:30 PM Small group break out session Questions & answers about breast cancer diagnosis and pathology 1:30-2:30 PM LUNCH Page 3

4 DAY 1 (Monday August 23) Continued: HOPEXCHANGE GHANA HEALTH PROJECT AFTERNOON SESSION III: Cancer Treatment and Patient Navigation General plenary session on breast cancer for all participants to review cancer management strategies MODERATOR: Prof E Q Archampong 2:30-3:00 PM LECTURE: General principles of breast cancer treatment Overview of surgery (mastectomy v. breast conservation, axillary staging), radiation treatment and systemic therapies (endocrine therapy, systemic chemotherapy) INTL. SPEAKER: Bob Carlson LOCAL FACULTY: Dr. Verna Vanderpuye 3:00-3:30 PM LECTURE: Patient navigation to improve patient access to care Lay navigation, nurse navigation, problem-solving to improve patient access INTL. SPEAKER: Rosemary Clement LOCAL FACULTY: Ms. Julie Tagoe 3:30-4:30 PM Small group break out session Questions & answers about breast cancer treatment and patient navigation 4:30-5:00 PM Summary of breakout group findings Group review of findings from breakout sessions CYTOPATHOLOGY TRAINING: FINE NEEDLE ASPIRATION TRAINING (Korle Bu Hospital) Hands-on training for pathologists and clinicians interested in hands-on FNA sampling techniques. This will be offered every afternoon Monday through Thursday in a clinical setting. 2:00-5:00 PM Applications of FNA sampling and cytology for diagnosis Fine-needle aspiration training on clinic patients set up during morning INTL. FACULTY: Britt-Marie Ljung LOCAL FACULTY: Prof. Anim Practicum topic: Educational goals: Outcome: Practical training session for pathologists and clinicians in FNA technique Training of FNA technique Basic technical skills for diagnosis In Kumasi, Dr. Britt-Marie Ljung provided training every day Monday through Friday to pathologists and surgeons interested in learning FNA technique. Several cancers (breast, lymphoma) and infections (bacterial and fungal) were diagnosed. This experience will serve as the basis for future training and implementation projects related to improved diagnosis techniques and capacity building in Ghana. This training has never previously been provided or tested in Sub-Saharan Africa and will serve as the basis for future feasibility and implementation science projects. Page 4

5 DAY 2 (Tuesday August 24): The second morning will begin with all groups combined for announcements and an advocate presentation. Following this, the group will break into 3 parallel training sessions: Civil Society (Advocacy), Nursing and Physicians. The Civil Society and nursing groups will be meeting separately in the morning and will then be combined in the afternoon. 7:30-8:30 AM BREAKFAST 8:30-8:45 AM Conference announcements COURSE CHAIRS: Joe-Nat Clegg-Lamptey / Riccardo Masetti / Ben Anderson 8:45-9:00 AM ADVOCATE PRESENTATION Personal experience of breast cancer DAY 2 MORNING PARALLEL BREAKOUT SESSIONS A. TRACK A - Advocacy and Civil Society groups Organizers: Susan G. Komen for the Cure Local advisor: Ghana Breast Cancer Alliance advocacy groups Local Facilitator: Naomi Ohene-Oti Attendees: Membership of civil society and advocacy groups MORNING SESSION IV (TRACK A) 9:00-9:30 AM LECTURE: Early detection Public beliefs about breast cancer early detection 9:30-10:00 AM Small group break out session Strategies for addressing barriers to early breast cancer detection in Ghana 10:00-10:30 AM LECTURE: Treatment Public beliefs about breast cancer treatment 10:30-11:00 AM Small group break out session Strategies for addressing barriers to breast cancer treatment in Ghana 11:00-11:30 AM TEA BREAK MORNING SESSION V (TRACK A) 11:30-12:00 PM LECTURE: Education Educational needs for the public what works? 12:00-12:30 PM Small group break out session Development of educational materials targeting the Ghanaian population 1:30-2:30 PM LUNCH Page 5

6 B. TRACK B Nursing, Breast Health and Cancer Care Organizers: Local advisor: Attendees: Topics: Oncology Nursing Society curriculum (selected modules) Beatrice Wiafe, MD Clinic and community nurses Nursing knowledge assessment (Q&A) Nursing care for post-surgery, chemotherapy and radiation therapy Breast self-examination with live clinical demonstration Breast prosthetics, post-mastectomy camisole MORNING SESSION IV (TRACK B) 9:00-9:30 AM LECTURE: Identifying Risk Factors in Breast Cancer INTL. SPEAKER: Mary Gullatte 9:30-10:00 AM LECTURE: Breast Cancer Prevention and Early Detection INTL. SPEAKER: Mary Gullatte 10:00-10:30 AM Techniques of Clinical and Self-Breast Examination INTL. SPEAKER: Mary Gullatte 10:30-11:00 AM GROUP DISCUSSION: Patient education strategies risk reduction and early detection 11:00-11:30 AM TEA BREAK MORNING SESSION V (TRACK B) 11:30-12:15 PM LECTURE: Breast Cancer Treatment Modalities INTL. SPEAKER: Mary Gullatte 12:15-12:30 PM Stretch Break 12:30-1:30 PM LECTURE & DISCUSSION: Breast Cancer Treatment: Side Effect Management INTL. SPEAKER: Mary Gullatte 1:30-2:30 PM LUNCH Page 6

7 AFTERNOON SESSION VI (TRACKS A and B) HOPEXCHANGE GHANA HEALTH PROJECT Combined afternoon session for Civil Society and Nursing 2:30-3:00 PM LECTURE: Empowerment How advocates and nurses become empowered to implement change 3:00-3:30 PM Small group break out session What are the obstacles to empowerment and how can we overcome them? 3:30-4:00 PM LECTURE: Public and Nursing Education What are the most important educational needs for the public and for health care professionals in breast cancer 4:00-4:30 PM Small group break out session Educational materials needed to help Ghanaian women understand breast cancer 4:30-5:00 PM Summary of breakout group findings C. DAY 2, TRACK 3 - Breast Cancer Treatment - Surgeons, Radiation/Medical Oncologists Organizers: Local advisor: Attendees: Breast Health Global Initiative HopeXchange Surgeons, oncology specialists, primary care providers MORNING SESSION IV (TRACK C) MODERATOR: Prof. R. Darko 9:00-9:30 AM LECTURE: Tissue sampling options INTL. SPEAKER: Lisa Newman LOCAL FACULTY: Dr. Florence Jackson 9:30-10:00 AM LECTURE: Pathology services Cytology vs. histology INTL. SPEAKER: Britt-Marie Ljung LOCAL FACULTY: Prof. Tettey 10:00-11:00 AM Small group break out session Questions & answers about breast pathology and tissue sampling 11:00-11:30 AM TEA BREAK Page 7

8 MORNING SESSION V (TRACK C) MODERATOR: Dr. Asiamah 11:30-12:00 PM LECTURE: Role of imaging in breast cancer management Role of Mammography reading and interpretation Quality control and organization of imaging INTL. SPEAKER: Louise Miller LOCAL FACULTY: Dr. Hewlett 12:00-12:30 PM LECTURE: Breast ultrasound to assist the surgeon in diagnosis and treatment Role of ultrasound for diagnosis, sampling and surgical management INTL. SPEAKER: Jay Harness LOCAL FACULTY: Dr. Yaw Mensah 12:30-1:30 PM Panel Discussion: Questions and Answers (Q & A) 1:30-2:30 PM LUNCH AFTERNOON SESSION VI (TRACK C) MODERATOR: Dr. Baffour Awuah 2:30-3:00 PM LECTURE: Surgical therapy for local control of disease Basic: Mastectomy, lumpectomy, axillary lymph node dissection Advanced: Sentinel node biopsy, oncoplastic procedures INTL. SPEAKER: Ben Anderson LOCAL FACULTY: Dr. J.N.A Clegg-Lamptey 3:00-3:30 PM LECTURE: Radiation therapy for local control of disease Principles of radiation therapy; Cobalt XRT vs LINAC XRT; Patient planning INTL. SPEAKER: Krys Kiel LOCAL FACULTY: Dr. Joel Yarney 3:30-4:00 PM LECTURE: Systemic therapy for prevention or control of metastatic disease Principles of systemic therapy decision making and practical considerations Systemic therapy overview, infusion, chemotherapy preparation, patient monitoring INTL. SPEAKER: Bob Carlson LOCAL FACULTY: Dr. Verna Vanderpuye 4:00-4:30 PM Small group break out session Questions & answers about adjuvant breast cancer treatment 4:30-5:00 PM Summary of breakout group findings Group review of findings from breakout sessions Page 8

9 DAY 3 (Wednesday August 25) Multidisciplinary care and institutional teamwork The third day will reunite the groups to discuss how coordinated teamwork can create organized systems for patient intake, diagnosis and treatment. 7:30-8:30 AM BREAKFAST 8:30-8:45 AM Conference announcements COURSE CHAIRS: Joe-Nat Clegg-Lamptey / Riccardo Masetti / Ben Anderson 8:45-9:00 AM ADVOCATE PRESENTATION Personal experience of breast cancer: Madam Gladys Boateng, Reach for Recovery, Ghana MORNING SESSION VII: Roundtable Discussion 9:00-11:00 AM ROUNDTABLE: A 2-hour discussion with all participants (nurses, advocates, and physicians) on the state of women s cancers in Ghana FACILITATOR: Christine Florez (Susan G. Komen for the Cure ) Welcome Remarks - Liz Thompson, SVP, Susan G. Komen for the Cure Conference Overview Remarks - Ben Anderson Overview of Komen s Global Health Alliance - Christine Florez Discussion Moderator Open Physician s Discussion State of Breast Cancer in Ghana Christine Florez Discussion Moderator Self introduction of physicians and brief discussion on topic Open Nurse s Discussion How to better communicate patient needs Christine Florez Discussion Moderator Self introduction of nurses and brief discussion on topic Open Advocate s Discussion How to better advocate in Ghana Christine Florez Discussion Moderator Advocacy speakers: Dr. Beatrice Wiafe Peace and Love Hospital Gladys Boateng Reach for Recovery Mary Agyapong - Sisters Support Network/KATH Riccardo Masetti HopeXchange 11:00-11:30 AM TEA BREAK Followed by Q & A if time allows Closing remarks - Liz Thompson, SVP, Susan G. Komen for the Cure Page 9

10 MORNING SESSION VII: CASE REVIEWS HOPEXCHANGE GHANA HEALTH PROJECT 11:30-12:00 PM MULTIDISCIPLINARY CASES: Clinical breast diagnosis Panel: Clinician (surgeon or primary care clinician), radiologist, pathologist, nurse, patient advocate / navigator FACILITATOR: Riccardo Masetti 12:00-12:30 PM MULTIDISCIPLINARY CASES: Breast cancer treatment Panel: Surgeon, radiologist, radiation oncologist, medical oncologist, pathologist, nurse, patient advocate / navigator FACILITATOR: Ben Anderson 12:30-1:30 PM Small group break out session Questions & answers about breast cancer diagnosis and pathology 1:30-2:30 PM LUNCH AFTERNOON SESSION VIII: SURGICAL CASE PRESENTATIONS FOR THURSDAY O.R. 2:30-5:00 PM TUMOR BOARD: A 2-hour review of surgical cases FACILITATOR: Dr. Verna Vanderpuye PRESENTERS: Local surgical faculty TOPICS: Wound care, clinical decision making, planning for Day #4 Page 10

11 DAY 4: Surgery Practicum topic: Educational goals: Outcome: Separate Practicum/hands-on training sessions, including: Live surgical demonstrations of cases discussed in the tumor board Breast cancer surgical cases (O.R.) Surgical demonstration of mastectomy, partial mastectomy and axillary staging In Kumasi, three international surgeons (Masetti, Newman and Anderson) operated on 5 surgical patients together with local faculty, demonstrating techniques for modified radical mastectomy and reexcision lumpectomy. Approximately 20 surgeons observed the surgical cases that took place over two days. Tissue sampling: Training on FNA techniques and percutaneous needle sampling Breast imaging: Nursing Training on breast ultrasound and/or diagnostic mammography Primary breast evaluation, patient triage, oncology nursing care for post-surgery, chemotherapy and radiation therapy Breast self-examination with live clinical demonstration Breast prosthetics, post-mastectomy camisole Lymphedema and wound care (presented by Rosemary Clement & Mary Gullatte) DAY 5: Course wrap-up, debriefing, and visit to district hospital and rural services and/or participation in an outreach mission. 10:00 am: All faculty to meet at 10 am at Korle-Bu Teaching Hospital prior to sightseeing trips to either Kakum National Park, Cape Coast Coast, or Akosombo. Page 11