A protocol paper on the implementation of health care model to improve the survival of breast cancer patients in India

Abstract

Background: Breast cancer is the leading cause of cancer-related morbidity and mortality among Indian females, accounting for 13.5% of new cancer cases and 10.6% of all cancer deaths. The median 5-year survival rate was 73.8%, ranging from 93.3% for patients with stage I to only 24.5% for those with stage IV disease. A comprehensive package of effective interventions implemented with quality is expected to improve survival. Objectives: To develop and implement a package of interventions so that at least 80% of patients with breast cancer are provided with evidence-based quality care. Design: The proposed implementation research will follow a mixed-method approach executed at 13 sites in India. Methods: The study will be conducted in three phases. During the formative phase, facilitators and barriers in diagnostic evaluation and treatment delivery in patients with non-metastatic breast cancer will be identified using a mixed-method approach. Simultaneously, prospective baseline data collection with emphasis on selected key performance indicators (KPIs) will be done for 6 months. Results from the formative phase will be used to develop a healthcare model that will ensure evidence-based quality care for at least 80% of stage II breast cancer patients. In the implementation phase, a trial run of this health care package will be conducted, and periodic assessment of its smooth running will be ensured. Depending on the requirements of each site, two to three iterations will be done, and a final healthcare package will be fixed. This finalized model will be executed for 1 year. At the end of 1 year, selected KPIs will be reassessed. At the evaluation phase, the outcome of the model will be assessed by comparing KPIs. Even after completing this project, patients will be followed up regularly for tracking long-term outcomes. Discussion: Achieved targeted interventions will help to set up a clinical care pathway with early diagnosis, timeliness of providing treatment, reduced default and abandonment, and improved survival among breast cancer patients in India.