Research to improve surgical oncological care on the surgical department, Maputo Central Hospital

Objetivo: No sentido de avaliar e implementar um programa de qualidade nos cuidados especializados prestados aos doentes oncológicos, que necessitam de intervenções cirúrgicas no Departamento Cirúrgico do Hospital Central de Maputo (HCM), o maior hospital de Moçambique, conduzimos a presente investigação. Avaliámos os recursos cirúrgicos, habilidades da equipe de oncologia cirúrgica, identificamos e caracterizamos as neoplasias malignas prevalentes e o conhecimento global em oncologia e oncologia cirúrgica dos nossos proficionais. O objectivo ultimo era o de desenvolver um currículo abrangente e adequado para um prrograma de formação em oncologia cirúrgica para o Hospital e para Moçambique. Metodologia: O primeiro estudo, realizado em 2017, tinha como objectivo inventariar os recursos e incluiu o preenchimento por parte dos cirurgiões de um questionário (Avaliação das Unidades de oncologia para países africanos de baixa ou média renda – anexo II), foram visitadas as àreas hospitalares associadas aos cuidados oncológicos (serviço de oncologia, UTI, sala de operações, etc.)e coletadas informações de acordo com o questionário “Avaliação da Capacidade em Oncologia Cirúrgica dos Países Africanos de Língua Oficial Portuguesa” (PSAC-Cirurgia - anexo III). No segundo estudo, realizado em 2018, avaliou-se retrospectivamente os registros de doentes com cancro do HCM. As neoplasias malignas prevalentes foram identificadas e caracterizadas (anexo IV). O conhecimento global dos residentes em oncologia e oncologia cirúrgica, foi avaliado por meio de um teste de conhecimentos preenchido de forma anónima e sem prévio aviso (anexo V). Os domínios abordados foram: Bases da oncologia, Radioterapia, Patologia, Quimioterapia, Tratamento da dor, Oncologia cirúrgica e Percurso clínico. O terceiro estudo, feito realizado em 2019. Com recurso à metodologia Delphi modificada (3 etapas). Participaram 23 especialistas em oncologia que trabalham em Moçambique incluindo oncologistas cirúrgicos. Na primeira rodada, os participantes responderam a um questionário sobre o conteúdo do currículo, o momento e local do treinamento. E foi produzido um rascunho do curriculo. Na segunda etapa, o rascunho do curriculo foi apresentada a uma amostra selecionada de especialistas nacionalmente reconhecidos em oncologia e oncologia cirúrgica, incluindo membros do Colégio Moçambicano de Cirurgiões e líderes do Ministério da Saúde. Na etapa final, para um consenso mais amplo, foi exposto o curriculo a um grande numero de especialistas em Oncologia cirurgica presente na reuniao da Aortic que decorreu em Novembro de 2019 em Maputo. foi discutida a versão final do programa de treino em oncologia cirúrgica. Obteve-se consenso sobre o currículo de treinamento em oncologia cirúrgica para Moçambique. Resultados: O cancro da mama, do esófago e colorretal foram os tumores malignos mais comumente tratadas no HCM (departamento de Cirurgias). Uma série de necessidades técnicas e de recursos, bem como as lacunas de conhecimento e habilidades, foram identificadas. Todos os cirurgiões reconheceram a necessidade de criar um programa de treinamento em oncologia ao nível da graduação, e um treino específico para residentes e educação oncológica continuada para cirurgiões gerais, para aprimorar a prática da oncologia cirúrgica. Foi produzido o prgrama de formação em Oncologia Cirúrgica. Os princípios básicos de oncologia e princípios básicos de oncologia cirúrgica devem ser incluídos no currículo da residência cirúrgica em Moçambique. Uma sub-especialização de 24 meses em Oncologia Cirúrgica deve ocorrer após a residência na área cirúrgica e a ter lugar no Hospital Central de Maputo, devendo incluir estágios em centros oncológicos de renome e familiares. A proposta final do programa tem a seguinte estrutura: a - componentes teóricas; b - duração; c - localização; d - metodologia; e - habilidades técnicas em oncologia; e f - competência e atenção especial às doenças oncológicas prevalentes em Moçambique.Purpose: Regarding adequate care for oncological patients, requiring surgical interventions at the Surgical Department of Maputo Central Hospital (MCH), the largest hospital in Mozambique, the aim of those studies, was first to assess the surgical resources, surgical oncology team skills, identify and characterize prevalent cancers treated and general knowledge in oncology and surgical oncology, expecting the development of a comprehensive curriculum in surgical oncology fellowship fit for the Hospital and all Mozambique country. Methods: The study 1, done in 2017, was based on surgeons questionnaire (The Cancer Units Assessment Checklist for low- or middle-income African countries (annex I), visiting the unities (oncology service, ICU, operations room, etc.) collecting information according to the Portuguese-speaking African Countries Assessment of Surgical Oncology Capacity Survey (PSAC-Surgery – annex II). The study 2, done in 2018, by retrospective analysis of individual cancer patient registries of MCH, the prevalent cancers has been identified and characterized (annex IV). And the general knowledge in oncology and surgical oncology, this issue was evaluated by simple test administered anonymously and without prior notice to all surgeons and residents at the Surgical Department (annex V). The domains was about basis of Oncology, Radiotherapy, Pathology, Chemotherapy, Pain management, Surgical oncology and Clinical pathway. The study 3, done in 2019, a three-round modified-Delphi approach was implemented to obtain consensus on surgical oncology training curriculum. The participants were purposefully selected 23 experts in surgical oncology working in Mozambique. In round one, participants answered a questionnaire regarding the content of the curriculum and the timing and venue of training. Draft of the curriculum was produced. In round 2, answers from the first round and the curriculum draft were presented to a purposeful selected sample of nationally recognized experts in oncology and surgical oncology, including members of the Mozambican College of Surgeons and leadership of the Ministry of Health. A final round was carried out to discuss the final version of the training program in surgical oncology with extensive participation of majority of african experts in surgical oncology (Aortic, Maputo). Results: Breast, esophagus and colorectal cancers were the most commonly treated neoplasms in MCH (at Surgical department). A range of technical and resource needs as well as the gaps in knowledge and skills were identified. All surgeons recognized the need to create a training program in oncology at the undergraduate level, specific training for residents and continuing oncological education for general surgeons, to improve the practice of surgical oncology. Basic principles of oncology and basic principles of surgical oncology should be included in the curriculum of surgical residency in Mozambique, a 24-months fellowship in surgical oncology should take place after residency in the surgical field and should occur at Maputo Central Hospital and at comprehensive cancer centers. The final proposal for the program was divided into the following structure: a – theoretical components; b - duration; c - location; d - methodology; e - technical skills in oncology; and f - competency and paid particular attention to the oncological diseases prevalent in Mozambique

Identifying barriers and finding solutions to implement best practices for cancer surgery at Maputo Central Hospital, Mozambique

Purpose: The aim of this study was to assess the surgical resources and surgical oncology team skills at the Surgical Department of Maputo Central Hospital (MCH) in Mozambique in order to define an educational program to support surgical oncology practice. Methods: From January 2017 to December 2017, a general evaluation of the resources of MCH was carried out, as well as its offerings in oncological care in different services. Data were obtained by reviewing documents, visiting surgical services and interviewing key informants and others informally. In addition, a group of seven surgeons of the Surgical Department of MCH answered a questionnaire about the quality of the cancer units (The Cancer Units Assessment Checklist for low- or middle-income African countries). Subsequently, surgical, anaesthesiology and intensive care facilities were evaluated according to the Portuguese-speaking African Countries Assessment of Surgical Oncology Capacity Survey (PSAC-Surgery). All the data were triangulated in order to identify gaps, develop an action plan and define an educational program. Results: Breast, oesophagus and colorectal cancers were the most commonly treated neoplasms in MCH. A range of technical and resource needs as well as the gaps in knowledge and skills were identified. All surgeons recognised the need to create a training program in oncology at the undergraduate level, specific training for residents and continuing oncological education for general surgeons to improve the practice of surgical oncology. It was evident that all these interventions needed to be formalised, appropriately certified and count for professional career progression. Based on the local epidemiological data and on these study findings, oncology education programs were developed for surgeons. Conclusions: The findings of this study contributed to the development of an educational program in surgical oncology, considered essential to the training of surgeons at MCH. The cancer educational programs and the mobilisation of adequate resources will ensure the provision of adequate surgical oncology treatments for MCH. The training requirements should be tailored to suit the local needs based on the most prevalent malignancies diagnosed in the region. In our view, this methodology may apply to other countries with similar realities in the formation of surgical oncologists.publishersversionpublishe

Understanding the bricks to build better surgical oncology unit at Maputo Central Hospital: prevalent surgical cancers and residents knowledge

Introduction: cancer is a growing concern in Mozambique. However, the country has limited facilities and few oncologists. Surgical oncologists are an unmet need. The aim of this study was to assess residents' knowledge in prevalent cancer domains and to identify and characterize prevalent cancers treated by surgery at Maputo Central Hospital, the largest hospital in Mozambique. The expectations were that the findings shall inform the development of a comprehensive curriculum in surgical oncology fellowship fit for the Hospital. Methods: to identify and characterize prevalent cancers, we performed a retrospective analysis of individual cancer patient registries of Maputo Central Hospital (MCH), Mozambique. Information was recorded into data collection sheets and analyzed with SPSS® 21. To assess MCH residents oncologic knowledge, we invited Twenty-six junior residents (49% of all residents) of different specialties to take a 30 item multiple choice written test used elsewhere in previous studies. The test focused on the domains of Basis of oncology, Radiotherapy, Pathology, Chemotherapy, Pain management, Surgical oncology and Clinical Pathway. The test was administered anonymously and without prior notice. We analyzed the overall test and topic performance of residents. Results: the study covered a period of 3 years and 203 patients. The most prevalent malignant tumors treated by general and thoracic surgery in MCH cancer registry were esophageal (7%), female breast (6.5%) and colorectal cancer (2.8%). Globally these malignancies were diagnosed at an advanced stage of the disease and required a multimodal treatment. The mean percent correct score of residents was 37.3%. The dimension with the highest percent correct score were clinical management (46%) and surgical oncology (28%) showed the lowest correct score. Conclusion: in Maputo, Mozambique esophageal, breast and colorectal cancer were the most prevalent malignancies treated, with surgery, by thoracic or general surgery in MCH. The test scores suggest that, among residents, the knowledge in oncology needs to be improved, rendering support to the need of a surgical oncology training tailored to suit the local needs. Specific training should take into account local cancer prevalence, resources, their quality and the support of surgical oncology services with volume and experience

Understanding the bricks to build better surgical oncology unit at Maputo Central Hospital: prevalent surgical cancers and residents knowledge

Cancer is a growing concern in Mozambique. However, the country has limited facilities and few oncologists. Surgical oncologists are an unmet need. The aim of this study was to assess residents' knowledge in prevalent cancer domains and to identify and characterize prevalent cancers treated by surgery at Maputo Central Hospital, the largest hospital in Mozambique. The expectations were that the findings shall inform the development of a comprehensive curriculum in surgical oncology fellowship fit for the Hospital