Implementation Research for Breast Cancer Survivorship Care in Mexico

About This Grant

Sean McClellan, MD, MAS, is a family physician and cancer survivorship care provider at the University of Illinois Chicago (UIC). He will acquire mentored training to become an independent clinician-investigator leading implementation research in the U.S. and globally to improve care for cancer survivors. This award will accelerate research on integrating primary care into survivorship care, which has been identified by the National Cancer Institute (NCI) as a critical priority for survivors in the U.S. The project will build on and extend NCI-funded research in the U.S. by leveraging distinct national conditions in Mexico, where limited existing survivorship infrastructure creates an opportunity to evaluate the potential impact of a primary care approach more fully by designing new models that involve primary care physicians from the start rather than adapting them to established, oncology-led systems. Through this work, we will develop practical strategies to implement and scale up primary care-led survivorship care that can be adapted to the U.S. Conditions in Mexico will also support the development of efficient care models that can inform high-value care in the U.S.; implementation strategies translatable to low-resource U.S. settings; and culturally tailored resources adaptable to Hispanic or Latino communities in the U.S. Through this project, Dr. McClellan will acquire experience in reciprocal innovation, the mutually beneficial, bilateral exchange of innovation between countries to address shared health challenges and improve the health of Americans. SIGNIFICANCE: Reflecting the shared needs of breast cancer survivors globally, U.S. and international expert organizations such as the National Comprehensive Cancer Network and the Breast Health Global Initiative (BHGI) have developed closely aligned guidelines recommending evidence-based interventions (EBIs) for survivorship care. To expand the reach of survivorship EBIs, integrating primary care into survivorship care is critical, as primary care physicians are uniquely positioned to address survivors’ diverse needs and improve access. APPROACH: This award will develop an implementation strategy package for BHGI survivorship guidelines in Mexico City. We will use the Implementation Mapping process to select and tailor implementation strategies. We will partner with a public healthcare system to: 1) examine stakeholder perspectives on the implementation of BHGI survivorship guidelines (survivors, caregivers, PCPs, specialists, institutional leaders); 2) develop CAMINOS, an implementation strategy package for BHGI survivorship guidelines that integrates PCPs into survivorship care; and 3) conduct a feasibility study of CAMINOS at two clinics (total n = 30) to inform a future large-scale implementation/effectiveness hybrid trial. TRAINING: Dr. McClellan will build expertise in 1) the impact of social risk factors on cancer control interventions; 2) implementation science methods used to develop implementation strategy packages; and 3) clinical trial design and evaluation. His mentors are Dr. Marian Fitzgibbon of UIC and Dr. Carmen García-Peña of the Mexican National Institute of Geriatrics.