Training Non-Oncologist Healthcare Providers to Manage Oral Endocrine Therapy for Breast Cancer

PURPOSE Oral endocrine therapy (OETs) is a crucial component of breast cancer management. However, they have traditionally only been available at tertiary cancer centers. Recent studies at Butaro Cancer Center of Excellence (BCCOE), in Northern Rwanda revealed sub-optimal adherence to OETs. Patients reported challenges including travel-related costs to BCCOE. To alleviate these challenges, we implemented a program that decentralizes the distribution of OETs to hospitals located in other provinces. METHODS In July 2023, before decentralization, we conducted a 5-day training of healthcare providers to empower them with skills and knowledge on clinical breast cancer management including OET management. Trainees included 5 internists, 3 general practitioners, 3 pharmacists and 9 nurses selected from 4 participating hospitals. Training included 2 days for theory and 3 days of experiential site visits. Trainees took pre- and post-assessments (20 questions) of their knowledge to evaluate the effectiveness of the training and assess the knowledge gained. Each test was graded and given a score from 0-100;mean results were compared between the pre and post-assessments. We also surveyed trainees to obtain feedback on the details of the training and their opinions on the next steps. RESULTS The mean scores (standard deviation) were 62 (22) and 89 (15) for the pre-and post-assessments, respectively, with a p-value < 0.0001 (T-test). Most trainees agreed/strongly agreed that the training was well organized (100%), relevant (100%), informative (100%), and effective (95%). Majority of trainees noted high levels of commitment and confidence in applying learned skills, with mean ratings of 9.07/10 and 8.73/10, respectively. Trainees recommended expansion of OET training to more hospitals and more healthcare providers, as well as incorporating more practical exercises and mentorship. CONCLUSION There was an increase in scores between the pre and post-assessments. We demonstrated that an abbreviated 5-day short course including theory and experiential components could impart knowledge and skills of OET management to non-oncology clinicians. The decentralization project was rolled out with longitudinal support and mentorship. Future studies will evaluate the impact of the decentralization program and provide a basis for future broader expansion of cancer care in Rwanda.