Changes needed for cancer modules

[RobertManningSmith]

The cancer modules need to have their HSIs redesigned:

1) They need to include inpatient days for surgical treatment 2) They need to include the option for non-surgical treatment methods (chemotherapy) 3) For other adult cancers, we need to design a way to assign some of the cancers for surgical treatment and some for chemotherapy, as some cancers covered by the other adult cancers module will not use surgery as a treatment plan (i.e. cancers of blood) 4) Overall the cancer modules are producing too many deaths compared to the GBD estimates

[RobertManningSmith]

Also at some point it would be good to combine the modules into one overarching 'Cancer' module

[tbhallett]

Just noting here the comments by @andrew-phillips-1 re the discussion about cancer and the use of chemotherapy

I was told there was little radiotherapy used but perhaps that has changed with the new cancer centre. Perhaps we should assume surgery + chemotherapy in all cases and we can add in radiotherapy when we are sure it is happening and understand where it is most being used. I am not aware about which chemo drugs to use when so I think we just have to choose all of them and assume all are used in combination until we find out more. I have been watching some videos about cancer in Malawi which is helpful https://www.youtube.com/watch?v=45nnKM4CjVU&list=PL0pAcgMbsBfyFWbtg_VVeAaQoYlJbynSx&index=5&ab_channel=CancerEducationforMalawi

[RobertManningSmith]

Potential changes to palliative care events in Cancer modules

Based on the YouTube video time posted above, it seems like pain management is provided in Malawi. I have some code in RTI which gives out pain killers based on the level of pain the person is in and that was pain management in general so not RTI-specific.

• In Malawi (QECH) 56% of cervical cancer patients were given morphine as part of palliative care (morphine is used for severe pain so presumably the rest can be split into pain management for mild and moderate pain) https://www.ajol.info/index.php/mmj/article/view/124875

• The automatic follow up appointment of palliative care for each cancer patient may not be 100% accurate, only 47% of cancer patients at QECH had a follow up appointment scheduled and only 65% of the 47% attended the appointment. Some had unplanned follow up appointments and overall 30% of discharged cancer patients returned for a follow up appointment https://link.springer.com/article/10.1186/1472-684X-10-12. This obviously won't result in changes to mortality in the models, but it would reduce the burden placed on the health system by reducing time spent treating these patients and could speed up larger model runs by reducing the amount of HSIs the cancer modules create

[andrew-phillips-1]

That's useful information, Robbie. Use of the same pain management approach as RTI module makes sense. Interesting that relatively few turn up for follow up appointments - I assume it relates to their poor health status and in some cases even that they have died. The proposed changes look reasonable in principle.

[tbhallett]

Yes indeed. Thanks @RobertManningSmith this is great detective work.

[tbhallett]

We also need to make sure that the referrals are happening in the way we think (and the way we will learn from the data collection): i.e. some tests can happen at level 2, but some only at level 3.

[BinglingICL]

Hi Tim @tbhallett and Andrew @andrew-phillips-1, as evidenced in our latest scale run result, our cancer modules need to represent the use of lab/radiography HSIs.