There are many barriers to the care of head and neck cancers in low and middle income countries (LMICs), notably difficult-to-visualize anatomic locations, lack of adequately trained professionals, and the need for specialized, costly equipment. Head and neck cancers, which involve the oral-nasal cavities, pharynx and larynx, present a significant global health burden and have a significant impact on quality of life and daily living activities such as speaking and eating. In Vietnam, many provincial and district hospitals lack the proper training and equipment to adequately exam patients presenting with head and neck symptoms and complaints. To this end, our partnership of academic and industrial investigators has developed a low cost, mobile flexible nasolaryngoscope (FNS) for use to exam and triage patients for treatment locally or for referral to specialists in tertiary treatment centers. Using Vietnam as a model for other resource-poor healthcare systems, the goals of the proposed project are to deliver new diagnostic and treatment capacity for head and neck cancers to health providers at local hospitals and clinics. Furthermore, the use of FNS will improve triaging to and utilization of specialized medical centers. This will be achieved through decreasing the number of patients unnecessarily seeking general care at tertiary facilities, locally treating those with early cancers, and referring only those patients needing specialized care. We will accomplish these goals through the following specific aims:1) Optimize the FNS by comparison to standard of care scopes at the main tertiary care centers; 2) Educate and train local healthcare providers in FNS technique and examinations; and 3) Assess implementation of FNS within the practice research network. We will plan to achieve these aims through establishing a practice based research network of 30 hospitals sites in and around Hanoi Vietnam. Data will be collected from an estimated 125,000 subjects over 5 years via electronic web based survey. The expected outcomes will improve head and neck care by health providers at local facilities within Vietnam and provide timely diagnosis, local treatment or referral for head and neck cancer patients. These outcomes will also be the basis for expansion of training and use of the low cost FNS in other low resource settings worldwide.

Public Health Relevance

This project aims to improve local detection of head and neck cancer through implementation of a novel low- cost flexible nasolaryngoscope (FNS) in low-resource settings. Using Vietnam as a model low-resource country, this study will enable physicians in local settings with a new capability to detect cancers using the FNS within a newly formed practice based research network. The expected outcomes will result in improved cancer care in Vietnam and be a model for integrating the low-cost FNS into head and neck cancer care in other low- resource settings.

National Institute of Health (NIH)
National Institute of Dental & Craniofacial Research (NIDCR)
Research Project (R01)
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Special Emphasis Panel (ZRG1)
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Chen, Zhong
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Duke University
Schools of Medicine
United States
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