Botsogo (Botswana Oncology Global Outreach) Tumor Boards: A Model For Global Oncology Education And Collaboration

Challenges of providing cancer care in Botswana include longer times to diagnosis and limited treatment resources. BOTSOGO (Botswana Oncology Global Outreach) was established in 2011 as a collaboration between Massachusetts General Hospital (MGH) in Boston, MA, USA and Botswana Harvard AIDS Institute in Gaborone, Botswana. Our mission is to improve cancer care in Botswana at the levels of education, research and direct clinical improvements, by means of an ongoing productive, bilateral partnership. A forum was needed for specialists on both sides to review cases, learn about real-time cancer care issues faced in Botswana, and discuss best practices for diagnosis and treatment. The Tumor Board model, in which a multidisciplinary team meets regularly to review cases, is widely accepted as improving cancer outcomes. Since February 2012, BOTSOGO has held a monthly Tumor Board in which MGH and two oncology centers in Botswana (Gaborone and Francistown) connect via web conferencing. A recent cancer case is presented by the treating team in Botswana, and disease experts from MGH discuss pathology, diagnosis and recommended treatment strategies. We promote open and respectful discussion, allowing clinicians from both sides to speak candidly and to highlight any opportunities for improvement. As cancer care is a team effort, the audience comprises attending physicians, trainees, nurses, social workers, and other caregivers. As of February 2020, we have held 79 Tumor Boards, with average attendance of 75 in Gaborone, 50 in Francistown and 15 at MGH. The most frequent cancers presented include cervical, breast and prostate cancers, sarcomas, and lymphomas, with special sessions on Ethical Issues in Oncology; Religious Factors Affecting Patient Decisions; and the Role of Nurse Advocacy in Patient Care. The August 2016 session, “A 41 year old female with sexual dysfunction following treatment for cervical cancer,” led to the implementation in 2017 of a program where women receiving radiation for vaginal cancers are provided dilators and education to treat vaginal stenosis, a frequent side effect. Since 2016, we offer Continuing Medical Education (CME) credits through Harvard Medical School for attendees, with 904 CME credits awarded as of August 2019. Evaluations received to date in the current 2019-2020 academic year (07/2019 – 1/2020; n = 305) report: 83.3% thought the presentation and discussion level was ‘just right;’ 86.6% found the session was ‘very likely’ or ‘somewhat likely’ to change their work; 97.1% of attendees would ‘definitely’ or ‘probably’ recommend attending the BOTSOGO tumor board. Tumor Board discussions are complex and free-ranging. We promote a collaborative environment, making time for questions, comments and insights from the participants in Gaborone and Francistown. The Tumor Board continues to anchor the BOTSOGO partnership.