PUBLIC HEALTH RESEARCH

Cancer tele-diagnosis capacity building

Anecdotal evidence suggests that there is growingcancer incidence in Nepal. Nepal ranks 9th and 10thon oral and ovarian cancer respectively (World LifeExpectancy, 2012). Certainly the burden of cancer tonational healthcare is exasperated by lack of adequatehospitals, but more importantly the front and center ofcancer treatment-diagnosis, is not only limited in Nepal,majority of pathologists are not well versed in morespecific differential diagnosis of cancer using techniqueslike immuno-histo chemistry. Most of the pathologistsin the country are making primary diagnosis based onmorphological characterization only.

The challenge of cancer diagnosis was well recognized and realized but nothing substantial was happeninguntil a locally based diagnostic laboratory calledIntrepid Cancer Diagnostics (ICD) started exploringways to address this gap. Enhancing cancer diagnosticcapability in Nepal had two adherent problem- i) lackof laboratory infrastructure and ii) trained humanresources (pathologists and laboratory technicians).

There is only handful of pathologists who are trainedon immune-histotechnique which is most widelyused method to do accurate diagnosis of various typesof cancer. Keeping these two challenges in mind ICDpartnered with Stichting Dutch Cancer DiagnosticDevelopment Fund and Department of Pathology atMaasstad Hospital of the Netherlands to build state ofthe art cancer diagnostic laboratory in Nepal.

ICD had two key objectives: i) offer highest qualitycancer diagnosis in Nepal and ii) provide quickestturnaround time on diagnosis report delivery. ICD’spathologist and laboratory technician received trainingat the Maasstad Hospital in the Netherlands, andsubsequently expert from the same hospital visitedICD to make sure all quality assurance checklist wereticked off. But one of the main technological advancesthat ICD invested was on its tele-diagnostic capability.ICD is one of the few labs in South Asian region tohave digital histopathology capability. By having thisplatform, ICD can directly share histo-pathologicalimages to do consultative diagnosis between Nepaliand Dutch experts. This greatly enhances Nepal’scapability to offer swift high quality cancer diagnosticservices.

The cancer tele-diagnostic capacity also allowsvarious pathologists from different corners of Nepalto get direct training from experts from ICD and theDutch hospital; the only prerequisite is availability ofinternet connection. Pathology and diagnostic relatedcase discussion and consultation is now possibleconnecting pathologists from Bhaktapur to BharatpurAdditionally, ICD has developed online software that allows pathologists to directly view diagnostic progress on their cases, significantly cutting time of receivingreports.

Since its operation from the middle of 2013, ICDhas provided cancer diagnostic services to varioushospitals on mainly difficult to diagnose cases.Average diagnosis time has been cut down to lessthan 5 days, which often means there is extra time forearly treatment interventions. ICD is also planningon starting molecular (DNA) based cancer detection,disease progression and treatment effectivenessmonitoring service soon.