Endometrial Cancer Risk Prediction Tool Aims to Prioritize High-Risk Patients for Hysteroscopy in Brazil's Public Health System

Khái niệm cốt lõi

A new tool called the Endometrial Malignancy Prediction System (EMPS) has been developed to identify patients at high risk of endometrial cancer and prioritize them for hysteroscopy in Brazil's public health system.

Tóm tắt

The article discusses the development of the Endometrial Malignancy Prediction System (EMPS), a nomogram that can be used to identify patients at high risk of endometrial cancer and prioritize them for hysteroscopy in Brazil's public health system.

The EMPS was developed by researchers at the Municipal Hospital of Vila Santa Catarina in São Paulo, a public unit managed by Hospital Israelita Albert Einstein. The tool was created during the COVID-19 pandemic, when the researchers noticed that patients with postmenopausal bleeding, who have a higher risk of endometrial cancer, were waiting in the same line as patients with less severe complaints for hysteroscopy.

The EMPS was developed based on a retrospective case-control study involving 1,945 patients who had undergone diagnostic hysteroscopy. The researchers identified several risk factors for endometrial cancer, including the presence or absence of hypertension, diabetes, postmenopausal bleeding, endometrial polyps, uterine volume, number of pregnancies, body mass index, age, and endometrial thickness. These factors were used to create the EMPS nomogram, which can be used by physicians to classify a patient's risk of endometrial cancer or precursor lesions.

The goal of the EMPS is not to remove low-risk patients from the hysteroscopy waiting list, but rather to prioritize high-risk patients to receive the examination sooner. This is particularly important in Brazil's public health system, where some patients can wait up to 2 years for a hysteroscopy.

The researchers plan to continue their research by conducting a prospective study to evaluate the tool within their own service and to explore ways to implement the EMPS in primary care clinics, where patients are initially referred for hysteroscopy.

Thống kê

The study involved 1,945 patients with suspected endometrial cancer who had undergone diagnostic hysteroscopy at Hospital Israelita Albert Einstein between March 2019 and March 2022.
Among these patients, 107 were diagnosed with precursor lesions or endometrial cancer on the basis of biopsy.
The other 1,838 participants, who had had cancer ruled out by biopsy, formed the control group.

Trích dẫn

"We noticed that…when outpatient clinics resumed, we were seeing many patients for intrauterine device (IUD) removal. We thought it was unfair for a patient with postmenopausal bleeding, who has a chance of having cancer, to have to wait in the same line as a patient needing IUD removal."
"Many patients are on the hysteroscopy waiting list for 2 years. Considering patients in more advanced stages [of endometrial cancer], it makes a difference."

Thông tin chi tiết chính được chắt lọc từ

Tool May Help Prioritize High-Risk Patients for Hysteroscopy

by Teresa Santo... lúc www.medscape.com 05-01-2024

https://www.medscape.com/viewarticle/tool-may-help-prioritize-high-risk-patients-hysteroscopy-2024a10008em

Yêu cầu sâu hơn

How can the EMPS tool be effectively integrated into primary care clinics to ensure timely referral of high-risk patients for hysteroscopy?

The integration of the EMPS tool into primary care clinics can be achieved through several key steps. Firstly, healthcare providers in primary care settings need to be trained on how to use the EMPS nomogram effectively. This training should include understanding the risk factors for endometrial cancer, interpreting the EMPS scores, and knowing when to refer high-risk patients for hysteroscopy. Additionally, incorporating the EMPS tool into electronic health record systems can streamline the risk assessment process and ensure that all relevant patient data is considered. Regular updates and feedback mechanisms should be established to monitor the tool's performance and make necessary adjustments. Collaboration between primary care clinics and specialized healthcare facilities, like the Municipal Hospital of Vila Santa Catarina, is essential to facilitate the timely referral of high-risk patients for hysteroscopy. By creating a standardized protocol for risk assessment and referral, primary care clinics can effectively prioritize high-risk patients and improve the early detection of endometrial cancer.

What are the potential limitations or challenges in implementing the EMPS tool in a large-scale, nationwide healthcare system like Brazil's public health system?

Implementing the EMPS tool in a large-scale, nationwide healthcare system like Brazil's public health system may face several limitations and challenges. One major challenge is the need for extensive training and education of healthcare providers across primary care clinics to ensure consistent and accurate use of the EMPS nomogram. Limited resources, both in terms of funding and personnel, could hinder the widespread adoption of the tool. Additionally, resistance to change and the establishment of new protocols within the healthcare system may slow down the implementation process. Ensuring the interoperability of the EMPS tool with existing electronic health record systems and data management platforms is crucial but may require significant investment in infrastructure and technology. Moreover, addressing issues related to data privacy and patient confidentiality when using the EMPS tool in a nationwide system is essential to maintain trust and compliance with regulatory standards. Overcoming these challenges will require strong leadership, stakeholder engagement, and a phased approach to implementation that considers the unique needs and constraints of Brazil's public health system.

What other diagnostic or risk assessment tools could be developed to improve the early detection and management of endometrial cancer in resource-constrained healthcare settings?

In resource-constrained healthcare settings, the development of simple and cost-effective diagnostic or risk assessment tools can significantly improve the early detection and management of endometrial cancer. One potential tool could be a symptom-based questionnaire that helps identify women with postmenopausal bleeding or other concerning symptoms associated with endometrial cancer. This questionnaire could be administered by primary care providers during routine consultations to prompt further evaluation and referral for diagnostic procedures like hysteroscopy. Another approach could involve the use of portable ultrasound devices for transvaginal ultrasound screening, which is less invasive and more accessible in low-resource settings compared to hysteroscopy. Implementing risk prediction models based on easily accessible clinical parameters, such as age, BMI, and medical history, could also aid in stratifying patients based on their likelihood of having endometrial cancer. Leveraging telemedicine and mobile health technologies to remotely assess and monitor high-risk patients for endometrial cancer could further enhance early detection efforts in resource-constrained settings. By innovating and adapting existing tools to suit the specific needs of these settings, healthcare providers can improve outcomes for women at risk of endometrial cancer.