Transcript MBCG Project Primary Results

MBCG Project
Primary Results
MEDICALSURVEYS-17 RESEARCH GROUP IN COLLABORATION WITH THE
EASO
Introduction

Breast cancer represents a major health care problem in the MENA
region.
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In a population of about 500 million, the political and
socioeconomic factors had created a variety of health care
systems with different standards and different abilities. But non of
them had worked together to create a regional guidelines for this
part of the world.
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Most of the breast cancer international guidelines came from USA
(NCCN, ASCO) and from Europe (ESMO, NICE). These parts of the
world have a different health care system and different facilities
than those in the MENA region.
MBCG Project

Through a collaborative work between MedicalSurveys-17 Research
Group and the EASO, we have created the MBCG project.

Through 3 online web based surveys, we tried to collect as much
data as we can regarding the real clinical practice and the
availability of different facilities as well as the obstacles that face
the oncologist in the MENA region to apply the best clinical
practice.

To our knowledge , The MBCG is the first regional project that screen
and asses the real practice in management of Breast cancer in the
MENA region.
MBCG project

Management of Breast cancer was covered in
three on line surveys which cover diagnosis,
screening , management of early breast
cancer as well as advanced Breast cancer .
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The surveys were sent to all the oncologist in our
data base as well as in the EASO data base.
MBCG Primary Results.
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The surveys were sent to about 600
Oncologists who are practicing
oncology in the MENA region
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We got replies from 90 oncologists
( 15 % reply) till now from the
MENA region.
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There was participation from the
majorities of countries in the MENA
region but with different
proportion
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More than 50% of the replies came
from oncologists with more than 10
years of practice.
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The majority of replies were from
University and Governmental
institutes
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The majority were places where
treatment is covered by
government
Remember that you can ask questions and send
comments at any time
Specialized Breast cancer center
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In around 35% , there was no
specialized breast cancer unit
available.
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In around 40% there was no
Radiodiagnosis specialist
specialized in breast cancer
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In spite of the absence of
specialized breast cancer unit,
there was also defect in the
presence of a multidisciplinary
tumor board
Facilities

There was no centralized
specialized pathology lab in 25%
of replies.

Radiotherapy facility was not
available to 25% of our
participant.
Radiodiagnosis

Most of the essential
Radiodiagnosis facilities required
for screening and diagnosis as well
as staging of breast cancer were
available

The main concern was with the
duration of reporting ( average of
1 week)
Pathology reporting
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An important issue that has been
raised is the long time required for
pathology reporting.
Remember that you can ask questions and send
comments at any time
Breast screening and familial breast
cancer
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There is a clear defect in the
presence of national or
institutional breast screening
program, as well as the
unavailability of genetic counsel
unit .
Surgery
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Regarding surgery, and surgical
facilities, there was clear concern
regarding the presence of
specialized breast onco-surgeon.
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There is also clear defect in the
performance of putting marker
before preoperative
chemotherapy
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In more than 40% , there is no
facility to perform SLNB
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Also, in more than 40% , there was
defect in performing skin sparing
mastectomy
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The absence of facilities as well as
the long waiting list for
radiotherapy were representing
the reason in around 35% to
perform Mastectomy in early
breast cancer
Chemotherapeutic agents
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The availability of
chemotherapeutic agents was
acceptable regarding the
classical agents as well as
trastuzumab.
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But, for new agents and new anti
her2 agents, there was a clear
availability defect.
Trastuzumab
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Trastuzumab is available in the
majority (>80%) for adjuvant
treatment for one year.
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But in around 25%, anti her2
treatment is either not available or
not offered in the metastatic
setting.
Remember that you can ask questions and send
comments at any time
Hormonal treatment
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First line hormonal treatment is
available in the majority
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However, there is some defect in
the options of second line (
fulvestrant , everolimus )
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The Oncotype-Dx was not
available to more than 70% of the
oncologist participated with us.
Feedback from the oncologist in
the region
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Around 50% are applying the
NCCN guidelines.
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More than 40% of the institutes
participating in our survey were
not involved in clinical trials
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The long time taken to have
reports of pathology as well as the
radiology investigation was the
main concern that delay
treatment.
Improving care
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Having more facilities that allow
following the guidelines as well as
participating more in the clinical
trials were the main suggestions to
improve the quality of care to the
patients
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90% of the participant see that we
need regional guidelines for our
region.
Remember that you can ask questions and send
comments at any time
Conclusion and take home
message
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There is a need to have a specialized Breast cancer units with
dedicated onco-surgeon, Radiodiagnosis facilities as well as centralized
pathology labs. Able to perform IHC.
National and \or institutional breast screening programs are highly
required for screening and early detection ( specially with the fact that
around 30% of our patients are below age of 45)
Surgical facilities and ability to perform the new techniques of diagnosis
and treatment is also required to avoid suboptimal or overtreatment of
the patients
New chemotherapeutic agents and targeted therapies are required to
be available ( at least to be able to follow the guidelines ) specially in
second line setting
There is a clear need to increase the research work and the
participation in the international and regional clinical trials, with more
concentration on collaborative work between different institutes
Conclusion cont…

There is a need to have a regional guidelines and
recommendations to be able to :
1.
Put the essential requirement for treatment of breast cancer
2.
Put a plan to involve governmental , non governmental, charities
and research institutes to participate in creating a regional
supporting program to breast cancer patients
3.
Detect the best alternative if the recommended treatment will not
be available ( new clinical trial designs)
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We will continue to collect more reply to have a more representing
data for our real situation
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We hope that by the end of 2014, we will be able to come with a
detailed recommendation regarding the management of breast
cancer in the MENA region
Thank You