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Asuquo EO, Absolom K, Ebenso B, Allsop MJ. Symptoms, concerns, and experiences of women living with and beyond breast cancer in Africa: A mixed-methods systematic review. Psychooncology 2024; 33:e6342. [PMID: 38747633 DOI: 10.1002/pon.6342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 03/10/2024] [Accepted: 03/30/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVE A mixed-methods systematic review to determine reported symptoms, concerns, and experiences of women living with and beyond breast cancer in Africa. METHODS Literature searches were conducted in Medline, Embase, PsycINFO, Global Health, Web of Science, CINAHL, and the Cochrane Library. Quantitative and qualitative studies that comprised study populations of women with breast cancer from countries in Africa, detailing symptoms, concerns, and experiences of living with and beyond breast cancer were included. Inductive framework analysis was applied to organise existing literature with the Adversity, Restoration, and Compatibility framework and quality was assessed using the Mixed Methods Appraisal Tool. RESULTS In total, 48 studies were included, comprising quantitative (n = 24), qualitative (n = 23) and mixed method (n = 1) studies. Women reported multiple complex and burdensome symptoms at all stages of the breast cancer disease trajectory. Multiple pervasive factors influencing participants' experiences included a lack of cancer knowledge, being removed from decision-making, religion, and the presence and use of traditional medicines. Literature relating to benefit finding, understanding identity for the future, and broader perspectives of well-being was absent. CONCLUSIONS This review contributes insights and mapping of symptoms, concerns, and experiences of women with breast cancer in Africa. There is a great necessity to increase an understanding of the needs and experiences of women with breast cancer in Africa following cancer treatment, stages of remission, and longer-term monitoring and follow-up. This is required to ensure access to prompt and timely clinical and individualized supportive care for women with breast cancer in Africa.
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Affiliation(s)
- Eme O Asuquo
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Kate Absolom
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Bassey Ebenso
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Mathew J Allsop
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Martei YM, Mokokwe L, Ngwako N, Kebuang K, Setlhako DI, Gabaatlhole G, Baaitse B, Segadimo T, Shulman LN, Barg F, Gaolebale BE. Development, acceptability and usability of culturally appropriate survivor narrative videos for breast cancer treatment in Botswana: a pilot study. BMJ Open 2024; 14:e073867. [PMID: 38296302 PMCID: PMC10828869 DOI: 10.1136/bmjopen-2023-073867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 12/14/2023] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVES Narrative communication has demonstrated effectiveness in promoting positive health behaviours, delivering support and coping with complex decision-making. Formal research evaluating this intervention for cancer treatment in Africa is lacking. We aimed to develop, and assess acceptability and usability of survivor video narrative interventions for breast cancer treatment in Botswana. DESIGN A pilot study design. SETTING Single-centre, tertiary hospital, sub-Saharan Africa. PARTICIPANTS Eight women, ≥18 years old, with stages I-III breast cancer were enrolled for the video intervention. 106 women, ≥18 years old, with stages I-IV breast cancer viewed the narrative videos and 98 completed the acceptability and usability surveys. INTERVENTION Survivor narrative videos were developed using the theory of planned behaviour and using a purposive sample of Batswana, Setswana-speaking, breast cancer survivors, who had completed systemic treatment and surgery with high rates of adherence to the prescribed treatment plan. PRIMARY OUTCOMES We assessed acceptability and usability among prospectively enrolled patients presenting for routine breast cancer care at Princess Marina Hospital in Botswana, using a 13-item survey. RESULTS Participants expressed high acceptability and usability of the videos, including 99% (97/98) who strongly agreed/agreed that the video presentations were easy to understand, 92% (90/98) who would recommend to other survivors and 94% (92/98) who wished there were more videos. Additionally, 89% (87/98) agreed or strongly agreed that the one-on-one instruction on how to use the tablet was helpful and 87% (85/98) that the video player was easy to use. CONCLUSION Culturally appropriate survivor video narratives have high acceptability and usability among patients with breast cancer in Botswana. There is an opportunity to leverage this intervention in routine breast cancer care for treatment support. Future studies will test the implementation and effectiveness of narrative videos on a wider scale, including for patients being treated for other cancers.
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Affiliation(s)
- Yehoda M Martei
- Department of Medicine (Hematology - Oncology Division), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lebogang Mokokwe
- Botswana University of Pennsylvania Partnership, Gaborone, Botswana
- University of Botswana, Gaborone, Botswana
| | | | | | | | | | | | | | - Lawrence N Shulman
- Department of Medicine (Hematology - Oncology Division), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Frances Barg
- Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Wondimagegnehu A, Assefa M, Teferra S, Kantelhardt EJ, Zebrack B, Addissie A. A Qualitative Study on Psychosocial Challenges of Patients With Cancer in Ethiopia Using the Social-Ecological Model. QUALITATIVE HEALTH RESEARCH 2024:10497323231219409. [PMID: 38229470 DOI: 10.1177/10497323231219409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Cancer diagnosis and treatment can be physically arduous, disrupting patients' social and work lives. Understanding the extent of these problems is key to addressing patients' needs, but specific psychosocial challenges have not yet been well studied in resource-limited settings. A qualitative study was conducted in the capital and two regions of Ethiopia with the aim of exploring psychosocial challenges among cancer patients. A total of 14 in-depth interviews (IDIs) and 16 focus group discussions (FGDs) were done with cancer patients, health professionals, community representatives, and religious leaders. Four separate interview guides were used to facilitate the interviews and discussions. All transcribed documents, field notes, and reflexive memos were entered into NVivo 12 software, and deductive thematic analysis using the social-ecological model was applied to summarize the main findings. At an individual level, emotional distress, suicidal risk, denial, and refusal of treatment were identified immediately after diagnosis while hopelessness, feeling depressed, and fear of death were commonly reported psychosocial challenges during the course of treatment. Involvement of family members in major treatment decisions was recognized at an interpersonal level. Our result also revealed that cancer patients had strong social support from family members and close friends. In the community, traditional medicine and religious rituals were considered an alternative treatment for cancer. The findings indicate that counselling and psychoeducation are crucial for cancer patients, family members, and close friends. Awareness creation programmes should be delivered through collaboration with religious leaders and traditional healers.
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Affiliation(s)
- Abigiya Wondimagegnehu
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle, Germany
| | - Mathewos Assefa
- Department of Oncology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Teferra
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eva J Kantelhardt
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle, Germany
- Department of Gynecology, Martin-Luther-University, Halle, Germany
| | - Bradley Zebrack
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Adamu Addissie
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle, Germany
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Umo I, Kulai M, Umo P, James K, Ikasa R. The direct medical cost of breast cancer management in a provincial hospital of Papua New Guinea: A cost of illness study of consecutive patients from 2017 to 2022. J Cancer Policy 2023; 38:100447. [PMID: 37813161 DOI: 10.1016/j.jcpo.2023.100447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Breast cancer is a major global health, gender and socioeconomic challenge. In PNG it is the leading cause of female mortality. Understanding direct medical costs related to breast cancer management can direct resource allocation and investment in breast cancer screening, treatment, infastructure and training. METHODS A cost of illness study was conducted amongst patients with breast cancer at Alotau Provincial Hospital from the 12th of January 2017-9 th of August 2022. A bottom up approach of micro costing was applied to estimate the patient and hospital perspectives of direct medical costs. RESULTS The total cost of breast cancer management was K1,624,656.14 (US$471,150.28). 58.5 % (n = 38) of patients with breast cancer did not undergo any form of surgery. Hospital costs accounted for 99.7 % (K1,620,156.14, US$469,845.28) of the total direct medical costs. The average cost per patient was K24,994.71 (US$ 7248.47). The dollar conversion was 1 KINA = 0.29 USD. CONCLUSION Investment in screening, diagnosis and treatment is crucial in addressing the burden of breast cancer in PNG. POLICY SUMMARY Provincial hospitals (in PNG) must invest in and implement the 2015 National Cancer Control Policy strategies that aim to develop hospital based cancer registries, human resources, equip health systems, improve cancer screening, improve diagnostics, research, funding and treatment for breast cancer control.
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Affiliation(s)
- Ian Umo
- Surgical Department, Alotau Provincial Hospital, Milne Bay Provincial Health Authority, Papua New Guinea.
| | - Michealynne Kulai
- School of Medicine and Health Science, Divine Word University, Papua New Guinea
| | - Pius Umo
- Pacific International Hospital, Papua New Guinea
| | - Kennedy James
- Surgical Department, Alotau Provincial Hospital, Milne Bay Provincial Health Authority, Papua New Guinea
| | - Rodger Ikasa
- Surgical Department, Alotau Provincial Hospital, Milne Bay Provincial Health Authority, Papua New Guinea
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Daniel O, Ashrafi A, Muthoni MA, Njoki N, Eric H, Marilynn O, Faith AB, Beth WG, Nyakio M, Odero-Marah V, Ragin C, Llanos AAM. Delayed breast cancer presentation, diagnosis, and treatment in Kenya. Breast Cancer Res Treat 2023; 202:515-527. [PMID: 37668821 DOI: 10.1007/s10549-023-07067-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/08/2023] [Indexed: 09/06/2023]
Abstract
PURPOSE In this mixed-methods study, we evaluated the factors that contribute to delayed breast cancer (BC) diagnosis and treatment at a Kenyan hospital. METHODS Individuals with a diagnosis of BC, either as a referral or index patient, were recruited to participate in this study through convenience sampling. Data were collected on sociodemographics, health history, and cancer history, diagnosis, and treatment of patients at Kenyatta National Hospital (KNH). For the quantitative analyses, the relationship between sociodemographic and health history factors with stage at diagnosis, number of visits before diagnosis, time to diagnosis, and time to initial intervention, stratified by time to onset of symptoms, were examined using regression analyses. For the qualitative analysis, in-depth interviews of every fifth patient were completed to assess reasons for delayed diagnosis and treatment. RESULTS The final analytic sample comprised of 378 female BC patients with an average age of 50. These females were generally of lower SES: 49.2% attained no or only primary-level education, 57.4% were unemployed, and the majority (74.6%) had a monthly household income of < 5000 Kenyan shillings (equivalent to ~ $41 USD). The median time from BC symptom onset to presentation at KNH was 13 (IQR = 3-36) weeks, from presentation to diagnosis was 17.5 (IQR = 7-36.5) weeks, and from diagnosis to receipt of the initial intervention was 6 (IQR = 3-13) weeks. Female BC patients who were never/unmarried, less educated, less affluent, users of hormonal contraception, and had ≥ 3 children were more likely to experience diagnosis and treatment delays. Qualitative data showed that financial constraints, lack of patient BC awareness, and healthcare practitioner misdiagnosis and/or strikes delayed patient diagnosis and treatment. CONCLUSIONS BC patients experience long healthcare system delays before diagnosis and treatment. Educating communities and providers about BC and expediting referrals may minimize such delays and subsequently BC mortality rates in Kenya.
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Affiliation(s)
- Ojuka Daniel
- Department of Surgery, University of Nairobi, P.O. Box, Nairobi, 19969-00202, Kenya.
- African Caribbean Cancer Consortium, Philadelphia, USA.
| | - Adiba Ashrafi
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA
| | - Musibi Alice Muthoni
- Cancer Treatment Centre, Kenyatta National Hospital, Nairobi, Kenya
- African Caribbean Cancer Consortium, Philadelphia, USA
| | - Njiraini Njoki
- Cancer Treatment Centre, Kenyatta National Hospital, Nairobi, Kenya
| | - Hungu Eric
- Cancer Treatment Centre, Kenyatta National Hospital, Nairobi, Kenya
- Department of Surgery, Kenyatta National Hospital, Nairobi, Kenya
| | - Omondi Marilynn
- Cancer Treatment Centre, Kenyatta National Hospital, Nairobi, Kenya
- Department of Surgery, Kenyatta National Hospital, Nairobi, Kenya
| | - Aseta Bonareri Faith
- Department of Surgery, University of Nairobi, P.O. Box, Nairobi, 19969-00202, Kenya
| | - Wambui Githambo Beth
- Department of Surgery, University of Nairobi, P.O. Box, Nairobi, 19969-00202, Kenya
| | - Mburu Nyakio
- Department of Surgery, University of Nairobi, P.O. Box, Nairobi, 19969-00202, Kenya
| | - Valerie Odero-Marah
- Biology Department, Center for Urban Health Disparities Research and Innovation, Morgan State University, Baltimore, MD, USA
- African Caribbean Cancer Consortium, Philadelphia, USA
| | - Camille Ragin
- Fox Chase Cancer Center, Cancer Prevention and Control Program, Philadelphia, PA, USA
- African Caribbean Cancer Consortium, Philadelphia, USA
| | - Adana A M Llanos
- Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
- African Caribbean Cancer Consortium, Philadelphia, USA
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Iezadi S, Ebrahimi N, Ghamari SH, Esfahani Z, Rezaei N, Ghasemi E, Moghaddam SS, Azadnajafabad S, Abdi Z, Varniab ZS, Golestani A, Langroudi AP, Dilmaghani-Marand A, Farzi Y, Pourasghari H. Global and regional quality of care index (QCI) by gender and age in oesophageal cancer: A systematic analysis of the Global Burden of Disease Study 1990-2019. PLoS One 2023; 18:e0292348. [PMID: 37788249 PMCID: PMC10547202 DOI: 10.1371/journal.pone.0292348] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/19/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND The aim of this study was to examine the quality of care by age and gender in oesophageal cancer using Global Burden of Disease (GBD) database. METHODS Patients aged 20 and over with oesophageal cancer were included in this longitudinal study using GBD 1990-2019 data. We used the Socio-Demographic Index (SDI) to classify the regions. We used Principal Component Analysis (PCA) method to calculate the Quality of Care Index (QCI). The QCI was rescaled into a 0-100 single index, demonstrating that the higher the score, the better the QC. RESULTS The age-standardized QCI for oesophageal cancer dramatically increased from 23.5 in 1990 to 41.1 in 2019 for both sexes, globally. The high SDI regions showed higher QCI than the rest of the regions (45.1 in 1990 and 65.7 in 2019) whereas the low SDI regions had the lowest QCI, which showed a 4.5% decrease through the years (from 13.3 in 1990 to 12.7 in 2019). Globally, in 2019, the QCI showed the highest scores for patients aged 80-84, reported 48.2, and the lowest score for patients aged 25-29 reported 31.5, for both sexes. Globally, in 2019, age-standardized Gender Disparity Ratio (GDR) was 1.2, showing higher QCI in females than males. CONCLUSION There were fundamental differences in the QCI both globally and regionally between different age groups as well as between males and females. To achieve the goal of providing high-quality services equally to people in need in all over the world, health systems need to invest in effective diagnostic services, treatments, facilities, and equipment and to plan for screening and surveillance of high-risk individuals.
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Affiliation(s)
- Shabnam Iezadi
- Research Center for Emergency and Disaster Resilience, Red Crescent Society of the Islamic Republic of Iran, Tehran, Iran
- Hospital Management Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Narges Ebrahimi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyed-Hadi Ghamari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Esfahani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Ghasemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Kiel Institute for the World Economy, Kiel, Germany
| | - Sina Azadnajafabad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zhaleh Abdi
- National Institute of Health Research (NIHR), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Zahra Shokri Varniab
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Golestani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ashkan Pourabhari Langroudi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezou Dilmaghani-Marand
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Yosef Farzi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Pourasghari
- Hospital Management Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Chamba C, Mawalla W. The future of lymphoma diagnosis, prognosis, and treatment monitoring in countries with limited access to pathology services. Semin Hematol 2023; 60:215-219. [PMID: 37596119 DOI: 10.1053/j.seminhematol.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/17/2023] [Accepted: 07/24/2023] [Indexed: 08/20/2023]
Abstract
The world is moving towards precision medicine for cancer. This movement goes hand in hand with the development of newer advanced technologies for early, precise diagnosis of cancer and personalized treatment plans with fewer adverse effects for the patient. Liquid biopsy is one such advancement. At the same time, it has the advantage of minimal invasion and avoids serial invasive biopsies. In countries with limited access to pathology services, such as sub-Saharan Africa, liquid biopsy may provide an opportunity for early detection and prognostication of lymphoma. We discuss the current diagnostic modalities for lymphoma, highlighting the existing challenges with tissue biopsy, and how feasible it is for countries with limited pathology resources to leverage advancements made in the clinical application of liquid biopsy to improve lymphoma care.
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Affiliation(s)
- Clara Chamba
- Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - William Mawalla
- Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Mapoko BSE, Ndi KC, Tabola L, Mouaye V, Douanla P, Nsangou N, Nkeng G, Vanvolkenburgh C, Dzekem B, Huo D, Ndom P, Olopade O. Feasibility of cancer genetic counselling and screening in Cameroon: perceived benefits and barriers. Ecancermedicalscience 2023; 17:1588. [PMID: 37799957 PMCID: PMC10550300 DOI: 10.3332/ecancer.2023.1588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Indexed: 10/07/2023] Open
Abstract
Because there was no genetic testing service in Cameroon, we assessed the acceptance, perceived benefits and barriers and willingness to pay for genetic cancer screening in Cameroon amongst patients with cancers. We carried out a hospital-based, cross-sectional study on adult cancer patients at the Yaoundé General Hospital and the non-Governmental Organisation Solidarity Chemotherapy between February 1, 2021, and December 31, 2021. This was a convenience sampling that included all consenting patients. Qualitative and quantitative data were analysed by Epi info version 7 and SPSS version 20. Our study included 160 (87.5% females) cancer patients, whose ages ranged from 20 to 82 years, with a mean of 49.9 ± 13.0 years. Only 11.9% had undergone some form of genetic counselling or information sessions, and most found this to be helpful in terms of increased knowledge and prevention strategies (13, 68.4%). Almost all participants (156, 97.5%) stated they will like their relatives to undergo genetic counselling. Of these, 151 (94.4%) expressed their desire for their relatives to discuss their cancer risk with a specialist. Perceived benefits of genetic testing included cancer prevention (108, 67.5%) and motivation of self-examination (81, 50.6%). Prominent possible barriers included the cost (129, 80.6%), unavailability of equipment (49, 30.6%) and anticipated anxiety (40, 25.0%). However, a majority of the participants (156, 97.5%) were willing to test for genetic mutations. One hundred and thirty-five (84.4%) participants were willing to pay for genetic testing, with the majority of them (71.8%) ready to pay between $16.7 and $100. Almost all of the participants expressed their willingness to receive cancer genetic counselling and testing but the cost became the main barrier. This pilot study will serve as a guide to the processes of establishing a cancer risk assessment clinic in Cameroon.
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Affiliation(s)
- Berthe Sabine Esson Mapoko
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé 99322, Cameroon
- National Cancer Control Committee, Yaoundé 99322, Cameroon
| | - Kenn Chi Ndi
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé 99322, Cameroon
| | - Lionel Tabola
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé 99322, Cameroon
| | - Vanessa Mouaye
- National Cancer Control Committee, Yaoundé 99322, Cameroon
| | - Pelagie Douanla
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé 99322, Cameroon
| | - Nasser Nsangou
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé 99322, Cameroon
| | - Glenda Nkeng
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé 99322, Cameroon
| | - Carmen Vanvolkenburgh
- Center for Global Health, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Bonaventure Dzekem
- Center for Global Health, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Dezheng Huo
- Center for Global Health, University of Chicago Medical Center, Chicago, IL 60637, USA
| | - Paul Ndom
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé 99322, Cameroon
- National Cancer Control Committee, Yaoundé 99322, Cameroon
| | - Olufunmilayo Olopade
- Center for Global Health, University of Chicago Medical Center, Chicago, IL 60637, USA
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Mitwalli S, Hammoudeh W, Giacaman R, Harding R. Access to advanced cancer care services in the West Bank-occupied Palestinian territory. Front Oncol 2023; 13:1120783. [PMID: 37007067 PMCID: PMC10062449 DOI: 10.3389/fonc.2023.1120783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
IntroductionUniversal Health Coverage (UHC) identifies the provision of palliative care for people with advanced disease as an essential health service. Palliative care is also stipulated as a human right under existing covenants. Oncology services provided by the Palestinian Authority under Israeli military occupation are limited to surgery and chemotherapy treatment. Our study aimed to describe the experiences of patients with advanced-stage cancer in the West Bank in accessing oncology services and meeting their health care needs.MethodologyWe conducted a qualitative study among adult patients diagnosed with advanced lung, colon, or breast cancer in three Palestinian governmental hospitals, and with oncologists. Thematic analysis was conducted on the verbatim interview transcripts.ResultsThe sample consisted of 22 Palestinian patients (10 men and 12 women) and 3 practicing oncologists. The findings reveal that cancer care is fragmented, with limited access to the services needed. Patients face referral delays in accessing treatment which worsen their health condition in some cases. Some patients reported difficulties in getting Israeli permits to access radiotherapy treatment in East-Jerusalem, and others experienced interruptions of their chemotherapy treatment sessions due to the unavailability of chemotherapy medications caused by Israeli-side delays. Other reported problems were related to the Palestinian health system and service delivery and quality, including fragmentation of services, infrastructure issues, and unavailability of medications. Advanced diagnostic services and palliative care are almost absent at Palestinian governmental hospitals, and patients need to seek these services in the private sector.ConclusionThe data demonstrate specific access restrictions to cancer care in the West Bank due to Israeli military occupation of Palestinian land. This affects all stages of the care pathway, from restricted diagnosis services, to limited treatment and then poor availability of palliative care. Cancer patients will continue to suffer if the root causes of these structural constraints are not addressed.
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Affiliation(s)
- Suzan Mitwalli
- Institute of Community and Public Health, Birzeit University, West Bank, Palestine
- *Correspondence: Suzan Mitwalli,
| | - Weeam Hammoudeh
- Institute of Community and Public Health, Birzeit University, West Bank, Palestine
| | - Rita Giacaman
- Institute of Community and Public Health, Birzeit University, West Bank, Palestine
| | - Richard Harding
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, London, United Kingdom
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10
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Niyibizi BA, Muhizi E, Rangira D, Ndoli DA, Nzeyimana IN, Muvunyi J, Irakoze M, Kazindu M, Rugamba A, Uwimana K, Cao Y, Rugengamanzi E, de Dieu Kwizera J, Manirakiza AVC, Rubagumya F. Multidisciplinary approach to cancer care in Rwanda: the role of tumour board meetings. Ecancermedicalscience 2023; 17:1515. [PMID: 37113712 PMCID: PMC10129399 DOI: 10.3332/ecancer.2022.1515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Indexed: 04/29/2023] Open
Abstract
Introduction Cancer treatment is complex and necessitates a multidisciplinary approach. Tumour Board Meetings (TBMs) provide a multidisciplinary platform for health care providers to communicate about treatment plans for patients. TBMs improve patient care, treatment outcomes and, ultimately, patient satisfaction by facilitating information exchange and regular communication among all parties involved in a patient's treatment. This study describes the current status of case conference meetings in Rwanda including their structure, process and outcomes. Methods The study included four hospitals providing cancer care in Rwanda. Data gathered included patients' diagnosis, number of attendance and pre-TBM treatment plan, as well as changes made during TBMs, including diagnostic and management plan changes. Results From 128 meetings that took place at the time of the study, Rwanda Military Hospital hosted 45 (35%) meetings, King Faisal Hospital had 32 (25%), Butare University Teaching Hospital (CHUB) had 32 (25%) and Kigali University Teaching Hospital (CHUK) had 19 (15%). In all hospitals, General Surgery 69 (29%) was the leading speciality in presenting cases. The top three most presented disease site were head and neck 58 (24%), gastrointestinal 28 (16%) and cervix 28 (12%). Most (85% (202/239)) presented cases sought inputs from TBMs on management plan. On average, two oncologists, two general surgeons, one pathologist and one radiologist attended each meeting. Conclusion TBMs in Rwanda are increasingly getting recognised by clinicians. To influence the quality of cancer care provided to Rwandans, it is crucial to build on this enthusiasm and enhance TBMs conduct and efficiency.
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Affiliation(s)
| | - Eulade Muhizi
- Rwanda Cancer Relief, Kigali, Rwanda
- Department of Gynecology, Munini District Hospital, Nyabihu, Rwanda
| | - Daniella Rangira
- Rwanda Cancer Relief, Kigali, Rwanda
- Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto M5T 3M7, Canada
| | - Diane A Ndoli
- Rwanda Cancer Relief, Kigali, Rwanda
- Department of Oncology, Rwanda Military Hospital, Kigali, Rwanda
| | | | - Jackson Muvunyi
- Department of Oncology, Rwanda Military Hospital, Kigali, Rwanda
| | - Magnifique Irakoze
- Department of Gynecology, Kigali University Teaching Hospital, Kigali, Rwanda
| | - Madeleine Kazindu
- Rwanda Cancer Relief, Kigali, Rwanda
- School of Medicine, College of Medical and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Alex Rugamba
- Rwanda Cancer Relief, Kigali, Rwanda
- Department of Internal Medicine, Ruhango Provincial Hospital, Ruhango, Rwanda
| | - Khadidja Uwimana
- Rwanda Cancer Relief, Kigali, Rwanda
- School of Medicine, College of Medical and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Yuanzhen Cao
- Department of Internal Medicine, Dartmouth–Hitchcock Medical Center, Lebanon, NH 03766, USA
| | - Eulade Rugengamanzi
- Rwanda Cancer Relief, Kigali, Rwanda
- Department of Oncology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Jean de Dieu Kwizera
- Rwanda Cancer Relief, Kigali, Rwanda
- Department of Internal Medicine, Gisenyi Hospital, Rubavu, Gisenyi, Rwanda
| | - Achille VC Manirakiza
- Rwanda Cancer Relief, Kigali, Rwanda
- Unit of Oncology, Department of Internal Medicine, King Faisal Hospital, Kigali, Rwanda
| | - Fidel Rubagumya
- Rwanda Cancer Relief, Kigali, Rwanda
- Department of Oncology, Rwanda Military Hospital, Kigali, Rwanda
- School of Medicine, College of Medical and Health Sciences, University of Rwanda, Kigali, Rwanda
- Unit of Oncology, Department of Internal Medicine, King Faisal Hospital, Kigali, Rwanda
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11
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Ferhanoglu B, Kim TM, Karduss A, Brittain D, Tumyan G, Al-Mansour M, Zerga M, Song Y, Rivas-Vera S, Kwong YL, Lim ST, Yeh SP, Abdillah A, Huang Z, Dalal M, Wan H, Hertzberg M. Treatment pathways and clinical outcomes in Hodgkin lymphoma outside Europe and North America: results from the international, multicenter, retrospective, B-HOLISTIC study. Leuk Lymphoma 2022; 63:3317-3330. [PMID: 36200380 DOI: 10.1080/10428194.2022.2126281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Information on Hodgkin lymphoma (HL) is mostly limited to Europe and North America. This real-world, retrospective study assessed treatment pathways and clinical outcomes in adults with stage IIB-IV classical HL receiving frontline treatment (n = 1598) or relapsed/refractory HL (RRHL, n = 426) in regions outside Europe and North America between January 2010 and December 2013. The primary endpoint was progression-free survival (PFS) in the RRHL group. Among patients with RRHL, 89.0% received salvage chemotherapy; most common regimen was etoposide, methylprednisolone, cytarabine, cisplatin (ESHAP; 26.3%). Median PFS in the RRHL group was 13.2 months (95% confidence interval [CI]: 9.9-20.2) and was longer in patients with vs. without stem cell transplantation (SCT; 20.6 vs. 7.5 months; p = 0.0071). This large-scale study identified a lower PFS for RRHL in the rest of the world compared with Europe and North America, highlighting the need for novel targeted therapies and SCT earlier in the treatment continuum.Clinical trial registration: NCT03327571.
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Affiliation(s)
- Burhan Ferhanoglu
- Division of Hematology, Department of Internal Medicine, Koç University School of Medicine, Istanbul, Turkey
| | - Tae Min Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University Cancer Research Institute, Seoul, South Korea
| | - Amado Karduss
- Bone Marrow Transplant Program, Instituto de Cancerologia, Clínica las Américas, Medellín, Colombia
| | - David Brittain
- Albert Alberts Stem Cell Transplant Center, Pretoria East Hospital, Pretoria, South Africa
| | - Gayane Tumyan
- Department of Chemotherapy of Hemoblastosis, Blokhin Russian Cancer Research Center, Moscow, Russia
| | - Mubarak Al-Mansour
- Adult Medical Oncology, Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs-Western Region, Jeddah, The Kingdom of Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, The Kingdom of Saudi Arabia
| | - Marta Zerga
- Department of Hematology, Angel Roffo Institute, Buenos Aires, Argentina
| | - Yuqin Song
- Department of Lymphoma, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital, Beijing, China
| | - Silvia Rivas-Vera
- Department of Hematology, Instituto Nacional de Cancerologia Mexico, Mexico City, Mexico
| | - Yok Lam Kwong
- Bone Marrow Transplant Unit, Queen Mary Hospital, Hong Kong, China.,Hematology Division, Medical Oncology and Bone Marrow Transplantation, Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Soon Thye Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Su-Peng Yeh
- Division of Hematology and Oncology, Department of Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Arif Abdillah
- Takeda Pharmaceuticals International AG-Singapore Branch, Singapore, Singapore
| | - Zhongwen Huang
- Takeda R&D Data Sciences Institute, Takeda Development Center Americas, Inc. (TDCA), Lexington, MA, USA
| | - Mehul Dalal
- Takeda R&D Data Sciences Institute, Takeda Development Center Americas, Inc. (TDCA), Lexington, MA, USA
| | - Hui Wan
- Takeda Pharmaceuticals International AG-Singapore Branch, Singapore, Singapore
| | - Mark Hertzberg
- Department of Clinical Haematology, Prince of Wales Hospital, Sydney, Australia.,University of New South Wales, Sydney, Australia
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12
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Trends in Hospitalization and Mortality from Cervical Cancer in Brazil Are Linked to Socioeconomic and Care Indicators. WOMEN 2022. [DOI: 10.3390/women2030026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We aimed, through an ecological survey of cervical cancer outcomes in Brazil, to analyze the influence of socioeconomic and care indicators of social vulnerability. The study sample (2010–2015) is composed of women diagnosed with cervical cancer, in different regions of the country. Data were collected from the Department of Health, in addition to searching the social vulnerability database of the Institute of Applied Economic Research. The incidence of age-standardized hospital admission declined over the years of the study in almost all regions but only one region showed a significant decline in indices of social vulnerability. In two other regions, one important indicator (human capital) significantly decreased. There was a positive correlation between vulnerability indices and age-standardized hospital admissions in most of the country. Decreasing vulnerability by easy access to cancer screening and early treatment improves cervical cancer outcomes.
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13
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Xu Y, Abdelazeem B, Abbas KS, Lin Y, Wu H, Zhou F, Peltzer K, Chekhonin VP, Li S, Li H, Ma W, Zhang C. Non-cancer Causes of Death Following Initial Synchronous Bone Metastasis in Cancer Patients. Front Med (Lausanne) 2022; 9:899544. [PMID: 35721072 PMCID: PMC9201113 DOI: 10.3389/fmed.2022.899544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To investigate the non-cancer causes of death (COD) in cancer patients with synchronous bone metastasis (BM) that is based on the Surveillance, Epidemiology, and End Results (SEER) database. Methods The retrospective cohort study included malignant cancer patients with synchronous BM diagnosed from 2010 to 2018 in the SEER database. The frequencies and proportion of non-cancer COD were calculated and analyzed in different genders, ages, and races subgroups. Results A total of 97,997 patients were deceased and included into the current study and 6,782 patients were died of non-cancer causes with a male predominance (N = 4,515, 66.6%). Around half of deaths (N = 3,254, 48.0%) occurred within 6 months after diagnosis while 721 patients were deceased after 3 years. Lung and bronchus cancer, prostate cancer, breast cancer, kidney and renal pelvis cancer, and liver cancer were proved to be the top five cancer types resulting in non-cancer caused death. Cardiovascular and cerebrovascular diseases were the leading non-cancer cause of death (N = 2,618), followed by COPD and associated conditions (N = 553) and septicemia, infectious and parasitic diseases (N = 544). Sub-analyses stratified by gender, age and race were performed and the similar results with slightly difference were observed. Conclusions Cardiovascular and cerebrovascular diseases were the main non-cancer cause of death in cancer patients with synchronous BM. Other non-cancer causes included COPD, septicemia, infectious and parasitic diseases, and so on. These findings should be considered by physicians. Physicians can counsel cancer patients with BM regarding survivorship with death causes screening and focus on prevention of non-cancer deaths.
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Affiliation(s)
- Yao Xu
- Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- The Sino-Russian Joint Research Center for Bone Metastasis in Malignant Tumor, Tianjin, China
| | - Basel Abdelazeem
- McLaren Health Care, Flint, MI, United States
- Department of Internal Medicine, Michigan State University, East Lansing, MI, United States
| | | | - Yile Lin
- The Sino-Russian Joint Research Center for Bone Metastasis in Malignant Tumor, Tianjin, China
- Tianjin Medical University General Hospital, Tianjin, China
| | - Haixiao Wu
- Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- The Sino-Russian Joint Research Center for Bone Metastasis in Malignant Tumor, Tianjin, China
| | - Fei Zhou
- Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- The Sino-Russian Joint Research Center for Bone Metastasis in Malignant Tumor, Tianjin, China
| | - Karl Peltzer
- Department of Psychology, University of the Free State, Bloemfontein, South Africa
| | - Vladimir P. Chekhonin
- The Sino-Russian Joint Research Center for Bone Metastasis in Malignant Tumor, Tianjin, China
- N. P. Serbsky National Medical Research Centre of Psychiatry and Narcology, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Shu Li
- The Sino-Russian Joint Research Center for Bone Metastasis in Malignant Tumor, Tianjin, China
- Department of Public Service Management, School of Management, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Huiyang Li
- The Sino-Russian Joint Research Center for Bone Metastasis in Malignant Tumor, Tianjin, China
- Tianjin Medical University General Hospital, Tianjin, China
| | - Wenjuan Ma
- Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- The Sino-Russian Joint Research Center for Bone Metastasis in Malignant Tumor, Tianjin, China
- *Correspondence: Wenjuan Ma
| | - Chao Zhang
- Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- The Sino-Russian Joint Research Center for Bone Metastasis in Malignant Tumor, Tianjin, China
- Chao Zhang
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14
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Arakelyan J, Movsisyan A, Sargsyan L, Chopikyan A, Andreasyan D, Torosyan A, Papyan R, Vardevanyan H, Bardakhchyan S, Tadevosyan A, Tamamyan G, Tananyan A, Danielyan S, Kazandjian D. Incidence patterns and review of Hodgkin lymphoma in the Republic of Armenia. Ecancermedicalscience 2022; 15:1319. [PMID: 35047070 PMCID: PMC8723743 DOI: 10.3332/ecancer.2021.1319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Indexed: 12/24/2022] Open
Abstract
Hodgkin lymphoma (HL) accounts for roughly 10% of all lymphomas and 0.6% of all malignant tumours analysed worldwide yearly. Data regarding HL in developing world are exceptionally constrained. The main objective of this research is to investigate the incidence patterns of HL within the Republic of Armenia and to portray disease distribution according to age and sex. There is a very strict evidence on the frequency of HL in Armenia. The results of our research find out that the frequency of HL in Armenia has not changed altogether over the past 15 years and is comparable to that detailed from the USA and Europe.
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Affiliation(s)
- Jemma Arakelyan
- Department of Oncology, Yerevan State Medical University, 2 Koryun St, 0025 Yerevan, Armenia.,Department of Adult Oncology and Hematology, Hematology Center after Prof. R.H.Yeolyan, 7 Nersisyan St, 0014 Yerevan, Armenia.,Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R.H. Yeolyan, 7 Nersisyan St., 0014 Yerevan, Armenia.,Drug Discovery Lab, Department of Chemistry, City University of Hong Kong, 83 Tat Chee Avenue, Hong Kong 999077, China
| | - Alisa Movsisyan
- Department of Adult Oncology and Hematology, Hematology Center after Prof. R.H.Yeolyan, 7 Nersisyan St, 0014 Yerevan, Armenia
| | - Lilit Sargsyan
- Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R.H. Yeolyan, 7 Nersisyan St., 0014 Yerevan, Armenia.,Department of Pediatric Oncology and Hematology, Yerevan State Medical University, 2 Koryun St, 0025 Yerevan, Armenia.,Armenian Pediatric Hematology and Oncology Group, 7 Nersisyan St., 0014 Yerevan, Armenia
| | - Armine Chopikyan
- Department of Public Health, Yerevan State Medical University, 2 Koryun St, 0025 Yerevan, Armenia
| | - Diana Andreasyan
- National Health Information Analytic Center, National Institute of Health, Ministry of Health of the Republic of Armenia, 49/4, Komitas ave, Yerevan, 375051, Armenia
| | - Arevik Torosyan
- National Health Information Analytic Center, National Institute of Health, Ministry of Health of the Republic of Armenia, 49/4, Komitas ave, Yerevan, 375051, Armenia
| | - Ruzanna Papyan
- Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R.H. Yeolyan, 7 Nersisyan St., 0014 Yerevan, Armenia.,Department of Pediatric Oncology and Hematology, Yerevan State Medical University, 2 Koryun St, 0025 Yerevan, Armenia.,Armenian Pediatric Hematology and Oncology Group, 7 Nersisyan St., 0014 Yerevan, Armenia
| | - Hovhannes Vardevanyan
- Armenian Pediatric Hematology and Oncology Group, 7 Nersisyan St., 0014 Yerevan, Armenia.,Department of Radiology, Armenian-American Wellness Center, 5 Heratsu Street, Yerevan 0025, Armenia
| | - Samvel Bardakhchyan
- Department of Oncology, Yerevan State Medical University, 2 Koryun St, 0025 Yerevan, Armenia.,Department of Adult Oncology and Hematology, Hematology Center after Prof. R.H.Yeolyan, 7 Nersisyan St, 0014 Yerevan, Armenia
| | - Artashes Tadevosyan
- Department of Public Health, Yerevan State Medical University, 2 Koryun St, 0025 Yerevan, Armenia
| | - Gevorg Tamamyan
- Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R.H. Yeolyan, 7 Nersisyan St., 0014 Yerevan, Armenia.,Department of Pediatric Oncology and Hematology, Yerevan State Medical University, 2 Koryun St, 0025 Yerevan, Armenia.,Armenian Pediatric Hematology and Oncology Group, 7 Nersisyan St., 0014 Yerevan, Armenia
| | - Armen Tananyan
- Department of Oncology, Yerevan State Medical University, 2 Koryun St, 0025 Yerevan, Armenia
| | - Samvel Danielyan
- Department of Adult Oncology and Hematology, Hematology Center after Prof. R.H.Yeolyan, 7 Nersisyan St, 0014 Yerevan, Armenia.,Armenian Pediatric Hematology and Oncology Group, 7 Nersisyan St., 0014 Yerevan, Armenia
| | - Dickran Kazandjian
- Department of Oncology, Yerevan State Medical University, 2 Koryun St, 0025 Yerevan, Armenia.,Multiple Myeloma Program, National Cancer Institute, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
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15
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Palliative Care’s Role in Austere Medicine. Wilderness Environ Med 2022; 33:102-108. [DOI: 10.1016/j.wem.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/28/2021] [Accepted: 12/09/2021] [Indexed: 11/20/2022]
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16
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Grover S, Ning MS, Bale M, Lichter KE, Shah S, Bvochora-Nsingo M, Chiyapo S, Balang D, McGinnis GJ, Ralefala T, Moloi T, Luckett R, Ramogola-Masire D, Robertson ES, Zetola NM. Chemoradiation versus radiation alone in stage IIIB cervical cancer patients with or without human immunodeficiency virus. Int J Gynecol Cancer 2021; 31:1220-1227. [PMID: 34312220 DOI: 10.1136/ijgc-2021-002601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/08/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Cervical cancer remains the most common cancer among women in sub-Saharan Africa and is also a leading cause of cancer related deaths among these women. The benefit of chemoradiation in comparison with radiation alone for patients with stage IIIB disease has not been evaluated prospectively in women living with human immunodeficiency virus (HIV). We assessed the survival of chemoradiation versus radiation alone among stage IIIB cervical cancer patients based on HIV status. METHODS Between February 2013 and June 2018, patients with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IIIB cervical cancer with or without HIV and treated with chemoradiation or radiation alone, were prospectively enrolled in an observational cohort study. Overall survival was evaluated using the Kaplan-Meier method. Cox proportional hazards modeling was used to analyze associations with survival. RESULTS Among 187 patients, 63% (n=118) of women had co-infection with HIV, and 48% (n=69) received chemoradiation. Regardless of HIV status, patients who received chemoradiation had improved 2 year overall survival compared with those receiving radiation alone (59% vs 41%, p<0.01), even among women living with HIV (60% vs 38%, p=0.02). On multivariable Cox regression analysis, including all patients regardless of HIV status, 2 year overall survival was associated with receipt of chemoradiation (hazard ratio (HR) 0.63, p=0.04) and total radiation dose ≥80 Gy (HR 0.57, p=0.02). Among patients who received an adequate radiation dose of ≥80 Gy, adjusted overall survival rates were similar between chemoradiation versus radiation alone groups (HR 1.07; p=0.90). However, patients who received an inadequate radiation dose of <80 Gy, adjusted survival was significantly higher in chemoradiation versus radiation alone group (HR 0.45, p=0.01). CONCLUSIONS Addition of chemotherapy to standard radiation improved overall survival, regardless of HIV status, and is even more essential in women who cannot receive full doses of radiation.
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Affiliation(s)
- Surbhi Grover
- Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA .,Oncology, University of Botswana, Gaborone, Botswana
| | - Matthew S Ning
- Radiation Oncology, University of Texas MD Anderson Cancer Center Division of Radiation Oncology, Houston, Texas, USA
| | - Michelle Bale
- Radiation Oncology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Katie E Lichter
- Radiation Oncology, University of California San Francisco, San Francisco, California, USA
| | - Sidrah Shah
- The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Sebathu Chiyapo
- Life Gaborone Private Hospital, Gaborone, Gaborone, Botswana
| | - Dawn Balang
- Life Gaborone Private Hospital, Gaborone, Gaborone, Botswana
| | - Gwendolyn J McGinnis
- Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Thabo Moloi
- Princess Marina Hospital, Gaborone, Gaborone, Botswana
| | - Rebecca Luckett
- Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Doreen Ramogola-Masire
- Obstetrics & Gynaecology - Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Erle S Robertson
- Microbiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nicola M Zetola
- Botswana-University of Pennsylvania Partnership, Philadelphia, Pennsylvania, USA
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17
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Cancer Drugs in Asian Populations: Availability, Accessibility, and Affordability. ACTA ACUST UNITED AC 2021; 26:323-329. [PMID: 32732675 DOI: 10.1097/ppo.0000000000000460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Accessibility to effective cancer treatments is a goal of Universal Health Coverage; yet, achieving this in the context of escalating costs in a diversity of Asian nations with different socioeconomic development is extremely challenging. Value-based assessments within the context of each health care system, financing infrastructure that will facilitate appropriate prioritization of high-cost medications, transparency in international pricing and reducing out-of-pocket costs through national insurance programs are measures that Asian countries should take toward Universal Health Coverage for cancer care. Encouraging sharing data on pricing through the World Health Organization, sharing expertise in health technology assessments and regulatory approvals, and exploring bulk negotiations would also strengthen the process of price control. For each individual country, rational selection of national cancer formulary, aiming at price reduction and sound procurement strategies for each drug, is important toward ensuring affordable access to quality cancer medications.
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18
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McCutchan G, Weiss B, Quinn-Scoggins H, Dao A, Downs T, Deng Y, Ho H, Trung L, Emery J, Brain K. Psychosocial influences on help-seeking behaviour for cancer in low-income and lower middle-income countries: a mixed-methods systematic review. BMJ Glob Health 2021; 6:bmjgh-2020-004213. [PMID: 33531348 PMCID: PMC7868297 DOI: 10.1136/bmjgh-2020-004213] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/09/2020] [Accepted: 01/06/2021] [Indexed: 12/14/2022] Open
Abstract
Introduction Starting cancer treatment early can improve outcomes. Psychosocial factors influencing patients’ medical help-seeking decisions may be particularly important in low and lower middle-income countries (LMIC) where cancer outcomes are poor. Comprehensive review evidence is needed to understand the psychosocial influences on medical help-seeking for cancer symptoms, attendance for diagnosis and starting cancer treatment. Methods Mixed-methods systematic review registered on PROSPERO (CRD42018099057). Peer-reviewed databases were searched until April 2020 for studies assessing patient-related barriers and facilitators to medical help-seeking for cancer symptoms, diagnosis and treatment in adults (18+ years) living in LMICs. Quality of included studies was assessed using the Critical Appraisal Skills Programme tool. Data were synthesised using meta-analytic techniques, meta-ethnography or narrative synthesis as appropriate. Results Of 3963 studies identified, 64 were included. In quantitative studies, use of traditional, complementary and alternative medicine (TCAM) was associated with 3.60 higher odds of prolonged medical help-seeking (95% CI 2.06 to 5.14). Qualitative studies suggested that use of TCAM was a key barrier to medical help-seeking in LMICs, and was influenced by causal beliefs, cultural norms and a preference to avoid biomedical treatment. Women face particular barriers, such as needing family permission for help-seeking, and higher stigma for cancer treatment. Additional psychosocial barriers included: shame and stigma associated with cancer such as fear of social rejection (eg, divorce/disownment); limited knowledge of cancer and associated symptoms; and financial and access barriers associated with travel and appointments. Conclusion Due to variable quality of studies, future evaluations would benefit from using validated measures and robust study designs. The use of TCAM and gender influences appear to be important barriers to help-seeking in LMIC. Cancer awareness campaigns developed with LMIC communities need to address cultural influences on medical help-seeking behaviour.
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Affiliation(s)
- Grace McCutchan
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK .,Wales Cancer Research Centre, Cardiff University, Cardiff, UK
| | - Bahr Weiss
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Harriet Quinn-Scoggins
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.,PRIME Centre Wales, Cardiff University, Cardiff, UK
| | - Anh Dao
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Tom Downs
- Department of Acute Medicine, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, Gwynedd, UK
| | - Yunfeng Deng
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Ha Ho
- Center for Research, Information and Services in Psychology, Vietnam National University, Hanoi, Vietnam
| | - Lam Trung
- Danang Psychiatric Hospital, Da Nang, Vietnam
| | - Jon Emery
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Kate Brain
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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19
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Khan A, Siddiqui S, Husain SA, Mazurek S, Iqbal MA. Phytocompounds Targeting Metabolic Reprogramming in Cancer: An Assessment of Role, Mechanisms, Pathways, and Therapeutic Relevance. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2021; 69:6897-6928. [PMID: 34133161 DOI: 10.1021/acs.jafc.1c01173] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The metabolism of cancer is remarkably different from that of normal cells and confers a variety of benefits, including the promotion of other cancer hallmarks. As the rewired metabolism is a near-universal property of cancer cells, efforts are underway to exploit metabolic vulnerabilities for therapeutic benefits. In the continued search for safer and effective ways of cancer treatment, structurally diverse plant-based compounds have gained substantial attention. Here, we present an extensive assessment of the role of phytocompounds in modulating cancer metabolism and attempt to make a case for the use of plant-based compounds in targeting metabolic vulnerabilities of cancer. We discuss the pharmacological interactions of phytocompounds with major metabolic pathways and evaluate the role of phytocompounds in the regulation of growth signaling and transcriptional programs involved in the metabolic transformation of cancer. Lastly, we examine the potential of these compounds in the clinical management of cancer along with limitations and challenges.
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Affiliation(s)
- Asifa Khan
- Department of Biotechnology, Faculty of Natural Sciences, Jamia Millia Islamia (A Central University), New Delhi 110025, India
- Department of Biosciences, Faculty of Natural Sciences, Jamia Millia Islamia (A Central University), New Delhi 110025, India
| | - Shumaila Siddiqui
- Department of Biotechnology, Faculty of Natural Sciences, Jamia Millia Islamia (A Central University), New Delhi 110025, India
| | - Syed Akhtar Husain
- Department of Biosciences, Faculty of Natural Sciences, Jamia Millia Islamia (A Central University), New Delhi 110025, India
| | - Sybille Mazurek
- Institute of Veterinary-Physiology and Biochemistry, University of Giessen, Giessen 35392, Germany
| | - Mohammad Askandar Iqbal
- Department of Biotechnology, Faculty of Natural Sciences, Jamia Millia Islamia (A Central University), New Delhi 110025, India
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Leighl NB, Nirmalakumar S, Ezeife DA, Gyawali B. An Arm and a Leg: The Rising Cost of Cancer Drugs and Impact on Access. Am Soc Clin Oncol Educ Book 2021; 41:1-12. [PMID: 33956494 DOI: 10.1200/edbk_100028] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Increasing cancer drug prices present global challenges to treatment access and cancer outcomes. Substantial variability exists in drug pricing across countries. In countries without universal health care, patients are responsible for treatment costs. Low- or middle-income countries are heavily impacted, with limited patient access to novel cancer treatments. Financial toxicity is seen across cancer types, countries, and health care systems. Those at highest risk include younger patients, new immigrants, visible minority groups, and those without private health coverage. Currently, cancer drug pricing does not correlate with value or clinical benefit. Value-based pricing of oncology drugs may incentivize development of higher-value medicines and eliminate excess spending on drugs that yield little benefit. Generics and biosimilars in oncology can also improve affordability and patient access, offering dramatic reductions in drug spending while maintaining patient benefit. Oncologists can promote value-based care by following evidence-based clinical guidelines that avoid low-value treatments. Researchers can also engage in value-based research that critically explores optimal cancer drug dosing, schedules, and treatment duration and defines patient populations most likely to benefit (e.g., through biomarker selection). Cancer Groundshot proposes that we improve outcomes for today's patients with cancer, including broader global access for high-value treatments, promotion of affordable cancer control strategies, and reduction of cancer morbidity and mortality through low-cost prevention and screening initiatives. Moving forward, major oncology societies recommend promoting uniform global access to essential cancer medicines and avoiding financial harm for patients as key principles in addressing the affordability of cancer drugs.
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Affiliation(s)
- Natasha B Leighl
- Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Sharon Nirmalakumar
- Department of Medical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Doreen A Ezeife
- Department of Medical Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada
| | - Bishal Gyawali
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
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Linwa EMM, Ngom EM, Orock GEE, Ekoube CE, Linwa EEN, Budzi NM, Meh MG, Louis RN. Clinical profile and management of primary thyroid cancer in patients with nodular goitre at the Douala General Hospital, Cameroon. Pan Afr Med J 2021; 38:405. [PMID: 34381549 PMCID: PMC8325457 DOI: 10.11604/pamj.2021.38.405.25614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 04/08/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction thyroid cancer (TC) is considered to have become the fastest growing cancer in terms of incidence worldwide. Despite literature reporting a prevalence of 5-10% in clinically identified thyroid nodules, Cameroon still has limited data on the profile of TCs in patients with Nodular Goitres (NGs). The Objective were to describe the epidemiological, diagnostic and therapeutic profiles of TCs in patients with nodular goitres at the Douala General Hospital (DGH). Methods this was a retrospective cross-sectional analysis of patient records with diagnoses of NGs, over 11 years (2006 to 2016) at the DGH. Results overall, 187 patients (mean age= 46.8±13.9 years, men=27 (14.4%)) were included; 43 (23%) cancers were identified. The most common histological type was papillary cancer (50%). Nodule size of >4cm and hypoechogenicity were independently associated with malignancy. Most patients presented with TNM stage II (47.4%) and well-differentiated cancers were considered to be predominantly at low-risk according to MACIS (55%) and AMES (74%) scores. Surgery was offered to 95.3% of patients. Conclusion TCs are frequent in patients with NGs with papillary cancer dominating. A high index of suspicion should be held if a nodule is >4cm and/or is hypoechogenic. Prognostic studies are needed to describe the outcome of TCs in our setting.
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Affiliation(s)
| | - Esthelle Minka Ngom
- Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
| | | | | | | | | | - Martin Geh Meh
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
| | - Richard Njock Louis
- Faculty of Medicine and Biomedical Sciences University of Yaoundé I, Yaoundé, Cameroon
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Foerster M, McKenzie F, Zietsman A, Galukande M, Anele A, Adisa C, Parham G, Pinder L, Schüz J, McCormack V, dos‐Santos‐Silva I. Dissecting the journey to breast cancer diagnosis in sub-Saharan Africa: Findings from the multicountry ABC-DO cohort study. Int J Cancer 2021; 148:340-351. [PMID: 32663320 PMCID: PMC7754476 DOI: 10.1002/ijc.33209] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/29/2020] [Accepted: 06/23/2020] [Indexed: 12/11/2022]
Abstract
Most breast cancer patients in sub-Saharan Africa are diagnosed at advanced stages after prolonged symptomatic periods. In the multicountry African Breast Cancer-Disparities in Outcomes cohort, we dissected the diagnostic journey to inform downstaging interventions. At hospital presentation for breast cancer, women recalled their diagnostic journey, including dates of first noticing symptoms and health-care provider (HCP) visits. Negative binomial regression models were used to identify correlates of the length of the diagnostic journey. Among 1429 women, the median (inter-quartile range) length (months) of the diagnostic journey ranged from 11.3 (5.7-21.2) in Ugandan, 8.2 (3.4-16.4) in Zambian, 6.5 (2.4-15.7) in Namibian-black to 5.6 (2.3-13.1) in Nigerian and 2.4 (0.6-5.5) in Namibian-non-black women. Time from first HCP contact to diagnosis represented, on average, 58% to 79% of the diagnostic journey in each setting except Nigeria where most women presented directly to the diagnostic hospital with advanced disease. The median number of HCPs visited was 1 to 4 per woman, but time intervals between visits were long. Women who attributed their initial symptoms to cancer had a 4.1 months (absolute) reduced diagnostic journey than those who did not, while less-educated (none/primary) women had a 3.6 months longer journey than more educated women. In most settings the long journey to breast cancer diagnosis was not primarily due to late first presentation but to prolonged delays after first presentation to diagnosis. Promotion of breast cancer awareness and implementation of accelerated referral pathways for women with suspicious symptoms are vital to downstaging the disease in the region.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Joachim Schüz
- International Agency for Research on CancerLyonFrance
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Tesfaw A, Getachew S, Addissie A, Jemal A, Wienke A, Taylor L, Kantelhardt EJ. Late-Stage Diagnosis and Associated Factors Among Breast Cancer Patients in South and Southwest Ethiopia: A Multicenter Study. Clin Breast Cancer 2020; 21:e112-e119. [PMID: 33536135 DOI: 10.1016/j.clbc.2020.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/19/2020] [Accepted: 08/30/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Breast cancer is a leading cause of cancer death in women in low- and middle-income countries, largely because of late-stage diagnosis. Yet studies are very limited in the Ethiopian context. Therefore, we determined the occurrence of late-stage disease and associated factors in selected public hospitals in south and southwest Ethiopia. PATIENTS AND METHODS A 5-year retrospective cross-sectional study was conducted on breast cancer patient medical records from January 2013 to December 2017 in 6 hospitals. Multivariable logistic regression was performed to identify factors associated with late-stage disease (stage III and IV). Adjusted odds ratios (AOR) with 95% confidence intervals were used. P < .05 was considered statistically significant. RESULTS Overall, 426 breast cancer patients were identified, and 72.5% were diagnosed with late-stage disease. The mean ± standard deviation patient age was 42.8 ± 13.4 years. Factors associated with late diagnosis were patient delay in seeking care (AOR = 2.50; 95% confidence interval [CI], 1.51-4.16); health system delays (AOR = 1.62; 95% CI, 1.02-2.59); female sex (AOR = 3.46; 95% CI, 1.50-7.98); rural residence (AOR = 2.37; 95% CI, 1.45-3.86); chief complaint of breast lump (AOR = 3.01; 95% CI, 1.49-6.07); and history of comorbidities (AOR = 1.72; 95% CI, 1.02-2.91). CONCLUSION The majority of patients were diagnosed with late-stage diagnosis of breast cancer. Patient delays in seeking care, health system delays, being female, rural residence, and patient comorbidities were associated factors. These findings provide evidence that efforts to increase public and health provider awareness to promote early breast cancer diagnosis, particularly in rural areas, are needed in south and southwest Ethiopia.
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Affiliation(s)
- Aragaw Tesfaw
- Department of Public Health, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sefonias Getachew
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia; Institute of Medical Epidemiology, Biometrics, and Informatics, Martin-Luther-University Halle-Wittenberg, Germany
| | - Adamu Addissie
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ahmedin Jemal
- American Cancer Society, Surveillance & Health Services Research, Atlanta, GA
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biometrics, and Informatics, Martin-Luther-University Halle-Wittenberg, Germany
| | - Lesley Taylor
- City of Hope National Medical Center, Division of Breast Surgery, Department of Surgery, Duarte, Los Angeles County, CA
| | - Eva Johanna Kantelhardt
- Institute of Medical Epidemiology, Biometrics, and Informatics, Martin-Luther-University Halle-Wittenberg, Germany; Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Germany.
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Byamugisha J, Munabi IG, Mubuuke AG, Mwaka AD, Kagawa M, Okullo I, Niyonzima N, Lusiba P, Ainembabazi P, Kankunda C, Muhumuza DD, Orem J, Atwine D, Ibingira C. A health care professionals training needs assessment for oncology in Uganda. HUMAN RESOURCES FOR HEALTH 2020; 18:62. [PMID: 32873293 PMCID: PMC7465387 DOI: 10.1186/s12960-020-00506-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 08/20/2020] [Indexed: 05/25/2023]
Abstract
BACKGROUND Cancer incidence and mortality in sub-Saharan Africa are increasing and do account for significant premature death. The expertise of health care providers is critical to downstaging cancer at diagnosis and improving survival in low- and middle-income countries. We set out to determine the training needs of health care providers for a comprehensive oncology services package in selected hospitals in Uganda, in order to inform capacity development intervention to improve cancer outcomes in the East African region. METHODS This was a cross-sectional survey using the WHO Hennessey-Hicks questionnaire to identify the training needs of health workers involved in cancer care, across 22 hospitals in Uganda. Data were captured in real time using the Open Data Kit platform from which the data was exported to Stata version 15 for analysis using the Wilcoxon signed-rank test and Somers-Delta. RESULTS There were 199 respondent health professionals who were predominately female (146/199, 73.37%), with an average age of 38.97 years. There were 158/199 (79.40%) nurses, 24/199 (12.06%) medical doctors and 17/199 (8.54%) allied health professionals. Overall, the research and audit domain had the highest ranking for all the health workers (Somers-D = 0.60). The respondent's level of education had a significant effect on the observed ranking (P value = 0.03). Most of the continuing medical education (CME) topics suggested by the participants were in the clinical task-related category. CONCLUSION The "research and audit" domain was identified as the priority area for training interventions to improve oncology services in Uganda. There are opportunities for addressing the identified training needs with an expanded cancer CME programme content, peer support networks and tailored training for the individual health care provider.
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Affiliation(s)
- Josaphat Byamugisha
- Department of Obstetrics and Gynaecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ian G. Munabi
- Department of Human Anatomy, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Aloysius G. Mubuuke
- Department of Radiology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Amos D. Mwaka
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Mike Kagawa
- Department of Obstetrics and Gynaecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Isaac Okullo
- Department of Dentistry, School of Health Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Pastan Lusiba
- Office of the Principal, Makerere University College of Health Sciences, Kampala, Uganda
| | - Peruth Ainembabazi
- Office of the Principal, Makerere University College of Health Sciences, Kampala, Uganda
| | - Caroline Kankunda
- Office of the Principal, Makerere University College of Health Sciences, Kampala, Uganda
| | - Dennis D. Muhumuza
- Office of the Principal, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - Charles Ibingira
- Department of Human Anatomy, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
- Office of the Principal, Makerere University College of Health Sciences, Kampala, Uganda
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Manirakiza AVC, Rubagumya F, Ngendahayo L. Burundi Cancer Care Needs: A Call to Action. Oncologist 2020; 25:1055-1059. [PMID: 32735037 DOI: 10.1634/theoncologist.2020-0410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/25/2020] [Indexed: 12/24/2022] Open
Abstract
Burundi is a landlocked country in the East Central Africa region. Beyond a long civil war strife, cancer care remains overlooked, in terms of both infrastructure and human resources needs, and it shows from estimated global incidence and mortality figures. Through a focused literature search, this study highlights the main cancer care needs in this country, with the aim to gather global oncology support to Burundi. IMPLICATIONS FOR PRACTICE: There is little knowledge about the state of oncology in Burundi. This article, based on a literature search, depicts an image of the current state of cancer care in Burundi and aims to compel global health enthusiasts to join in curbing the death toll of cancers in Burundi.
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Affiliation(s)
| | - Fidel Rubagumya
- Rwanda Cancer Center, Rwanda Military Hospital, Kigali, Rwanda
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Freeman EE, Busakhala N, Regan S, Asirwa FC, Wenger M, Seth D, Moon KC, Semeere A, Maurer T, Wools-Kaloustian K, Bassett I, Martin J. Real-world use of chemotherapy for Kaposi's sarcoma in a large community-based HIV primary care system in Kenya. BMC Cancer 2020; 20:71. [PMID: 31996161 PMCID: PMC6990575 DOI: 10.1186/s12885-019-6506-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 12/30/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Kaposi's sarcoma (KS) is one of the most common HIV-associated malignancies in sub-Saharan Africa. Worldwide, the availability of antiretroviral therapy (ART) has improved KS survival. In resource-rich settings, survival has also benefited from chemotherapy, which is widely available. Little is known, however, about the epidemiology of chemotherapy use for HIV-associated KS in resource-limited regions such as sub-Saharan Africa. METHODS We identified all patients newly diagnosed with HIV-related KS from 2009 to 2012 in the 26-clinic AMPATH network, a large community-based care network in Kenya. We ascertained disease severity at diagnosis, frequency of initiation of chemotherapy, and distribution of chemotherapeutic regimens used. Indications for chemotherapy included AIDS Clinical Trial Group T1 stage and/or "severe" disease defined by WHO KS treatment guidelines. RESULTS Of 674 patients diagnosed with KS, charts were available for 588; 61% were men, median age was 35 years, and median CD4 at KS diagnosis was 185 cells/μl. At time of diagnosis, 58% had at least one chemotherapy indication, and 22% had more than one indication. For patients with a chemotherapy indication, cumulative incidence of chemotherapy initiation (with death as a competing event) was 37% by 1 month and 56% by 1 year. Median time from diagnosis to chemotherapy initiation was 25 days (IQR 1-50 days). In multivariable regression, patients with > 3 chemotherapy indications at time of diagnosis had a 2.30 (95% CI 1.46-3.60) increased risk of rapid chemotherapy initiation (within 30 days of diagnosis) compared to those with only one chemotherapy indication (p < 0.001). Initial regimens were bleomycin-vincristine (78%), adriamycin-bleomycin-vincristine (11%), etoposide (7%), and gemcitabine (4%). CONCLUSIONS A substantial fraction of patients with KS in East Africa are diagnosed at advanced disease stage. For patients with chemotherapy indications, nearly half did not receive chemotherapy by one year. Liposomal anthracyclines, often used in resource-rich settings, were not first line. These findings emphasize challenges in East Africa cancer care, and highlight the need for further advocacy for improved access to higher quality chemotherapy in this setting.
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Affiliation(s)
- Esther E Freeman
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Bartlett Hall 6R, 55 Fruit Street, Boston MA, MA, 02114, USA.
| | | | - Susan Regan
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Bartlett Hall 6R, 55 Fruit Street, Boston MA, MA, 02114, USA
| | - Fredrick Chite Asirwa
- AMPATH, Moi University, Eldoret, Kenya
- Indiana University, Indianapolis, Indiana, USA
| | | | - Divya Seth
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Bartlett Hall 6R, 55 Fruit Street, Boston MA, MA, 02114, USA
| | - Khatiya Chelidze Moon
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Bartlett Hall 6R, 55 Fruit Street, Boston MA, MA, 02114, USA
| | - Aggrey Semeere
- University of California, San Francisco, USA
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Toby Maurer
- University of California, San Francisco, USA
| | | | - Ingrid Bassett
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Bartlett Hall 6R, 55 Fruit Street, Boston MA, MA, 02114, USA
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Ibikunle A, Taiwo A, Braimah R, Adamson O, Fashina A, Bala M. The challenge of late presentation by dental patients in our climes: Reasons behind the enigma. JOURNAL OF INDIAN ASSOCIATION OF PUBLIC HEALTH DENTISTRY 2020. [DOI: 10.4103/jiaphd.jiaphd_91_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Williams VL, Narasimhamurthy M, Rodriguez O, Mosojane K, Bale T, Kesalopa K, Kayembe MA, Grover S. Dermatology-Driven Quality Improvement Interventions to Decrease Diagnostic Delays for Kaposi Sarcoma in Botswana. J Glob Oncol 2019; 5:1-7. [PMID: 31702944 PMCID: PMC6882519 DOI: 10.1200/jgo.19.00181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2019] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Kaposi sarcoma (KS) is an HIV-associated skin cancer that is highly prevalent in Botswana and associated with significant morbidity and mortality. Histopathology-confirmed diagnosis is required for chemotherapeutic interventions in Botswana, which creates barriers to care because of limited biopsy and pathology services. We sought to understand the role a dermatology specialist can play in improving KS care through quality improvement (QI) initiatives to reduce histologic turnaround times (TATs) for KS. METHODS Employment of a dermatology specialist within a public health care system that previously lacked a local dermatologist generated quality improvements in KS care. Retrospective review identified patients diagnosed with KS by skin biopsy in the predermatology QI interval (January 1, 2015, to December 31, 2015) versus the postdermatology QI interval (January 1, 2016, to November 31, 2017). Histology TATs and clinical characteristics were recorded. A t test compared the median histology TATs in the pre- and post-QI intervals. RESULTS A total of 192 cases of KS were diagnosed by skin biopsy. Nearly all (98.4%) were HIV-positive; and 52.8% of patients were male with a median age of 39 years. Median TAT in the postdermatology QI interval was 11 days (interquartile range, 12-23 days) compared with 32 days in the predermatology QI interval (interquartile range, 24-56 days; P < .00). CONCLUSION Dermatology-led QI initiatives to improve multispecialty care coordination can significantly decrease histology TATs for KS. The reduction of diagnostic delays is a key first step to decreasing the morbidity and mortality associated with this cancer in resource-limited settings.
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Affiliation(s)
- Victoria L. Williams
- University of Botswana, Gaborone, Botswana
- Princess Marina Hospital, Gaborone, Botswana
- Botswana-UPenn Partnership, Gaborone, Botswana
- University of Pennsylvania, Philadelphia, PA
| | | | | | | | | | | | - Mukendi A. Kayembe
- University of Botswana, Gaborone, Botswana
- National Health Laboratory, Gaborone, Botswana
| | - Surbhi Grover
- University of Botswana, Gaborone, Botswana
- Princess Marina Hospital, Gaborone, Botswana
- Botswana-UPenn Partnership, Gaborone, Botswana
- University of Pennsylvania, Philadelphia, PA
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Ergen M, Arikan F. Psychometric validation of the Turkish version of the Supportive Care Needs Survey for Partners and Caregivers (SCNS-P&C-T) of cancer patients. Eur J Cancer Care (Engl) 2019; 29:e13177. [PMID: 31571324 DOI: 10.1111/ecc.13177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 09/03/2019] [Accepted: 09/09/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the validity and reliability study of the Supportive Care Needs Survey for partners and caregivers of cancer patients in Turkish society (SCNS-P&C-T). METHODS This cross-sectional survey followed by a test-retest reliability and psychometric validation study was conducted with 270 participants. The research data were collected using a patient and caregiver demographic survey, the SCNS-P&C-T, the Caregiver Strain Index, and the Hospital Anxiety and Depression Scale. RESULTS Ten expert opinions were found to be consistent for content validity of the scale (I-CVI = 0.993, S-CVI = 0.956). The confirmatory factor analysis could not confirm the factor structure of the original scale. Therefore, an exploratory factor analysis was performed and the scale factor structure was determined. These factor structures are (a) psychological and emotional needs, (b) health care and information, (c) work and social needs, (d) communication and family needs. CONCLUSION The SCNS-P&C-T is a valid and reliable tool which can be used to identify unmet needs among caregivers in Turkish populations.
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Affiliation(s)
- Mevlüde Ergen
- Department of Medical Oncology, Memorial Hospital, Antalya, Turkey
| | - Fatma Arikan
- Faculty of Nursing, Akdeniz University, Antalya, Turkey
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Alawa J, Alhalabi F, Khoshnood K. Breast Cancer Management Among Refugees and Forcibly Displaced Populations: a Call to Action. CURRENT BREAST CANCER REPORTS 2019. [DOI: 10.1007/s12609-019-00314-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Setyowibowo H, Iskandarsyah A, Sadarjoen SS, Badudu DF, Suardi DR, Passchier J, Hunfeld JAM, Sijbrandij M. A Self-Help Guided Psychoeducational Intervention for Indonesian Women with Breast Cancer Symptoms: Development and Pilot Feasibility Study. Asian Pac J Cancer Prev 2019; 20:711-722. [PMID: 30909669 PMCID: PMC6825796 DOI: 10.31557/apjcp.2019.20.3.711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Delay in the diagnosis of breast cancer (BC) may lead to an advanced stage of the disease and a poor prognosis. A psychoeducational intervention can be crucial in helping women with BC symptoms complete the examination procedures and reduce diagnosis delay of BC. Objective: To develop a psychoeducational intervention to reduce the delay of BC diagnosis among Indonesian women with BC symptoms. Methods: The development of the intervention included an inventory of crucial elements in developing psychoeducation through literature review as well as consultation with BC patients and healthcare providers. Additionally, we developed PERANTARA as the first pilot version of the self-help guided psychoeducational intervention. PERANTARA is an abbreviation for “Pengantar Perawatan Kesehatan Payadura”, which means an introduction to breast health treatment. The pilot feasibility study combined an expert review and a pilot testing in hospital settings. A semi-structured interview and the client satisfaction inventory were utilized to measure feasibility and acceptability of the intervention for Indonesian women with BC symptoms. Results: PERANTARA contained an oncologist’s explanation about BC and the BC survivors’ testimony to reduce the time to diagnosis. The pilot study results showed that most patients were satisfied with and trusted on PERANTARA. Conclusion: PERANTARA was feasible and acceptable for Indonesian patients with BC symptoms. The development framework suggested in this study can be applied to develop psychoeducational packages for other patients group, in particular, those interventional packages aimed at reducing diagnosis and treatment delays and non-adherence.
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Affiliation(s)
- Hari Setyowibowo
- Department of Educational Psychology, Faculty of Psychology, Universitas Padjadjaran, Jatinangor, Indonesia. ,Department of Clinical, Neuro-and Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU University, Amsterdam, Netherlands
| | - Aulia Iskandarsyah
- Department of Clinical Psychology, Faculty of Psychology, Universitas Padjadjaran, Jatinangor, Indonesia
| | - Sawitri S Sadarjoen
- Department of Clinical Psychology, Faculty of Psychology, Universitas Padjadjaran, Jatinangor, Indonesia
| | | | - Drajat R Suardi
- Department of Surgical Oncology, Hasan Sadikin Hospital, Bandung, Indonesia
| | - Jan Passchier
- Department of Clinical, Neuro-and Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU University, Amsterdam, Netherlands
| | - Joke A M Hunfeld
- Department of Psychiatry, section Medical Psychology, and Psychotherapy, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro-and Developmental Psychology, Faculty of Behavioural and Movement Sciences, VU University, Amsterdam, Netherlands
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Challenges Facing Radiation Oncologists in The Management of Older Cancer Patients: Consensus of The International Geriatric Radiotherapy Group. Cancers (Basel) 2019; 11:cancers11030371. [PMID: 30884827 PMCID: PMC6468336 DOI: 10.3390/cancers11030371] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/02/2019] [Accepted: 03/08/2019] [Indexed: 02/07/2023] Open
Abstract
The management of older cancer patients remains difficult because of data paucity. Radiation oncologists need to identify potential issues which could affect treatment of those patients. A workshop was organized in Barcelona among international radiation oncologists with special interest in the management of older cancer patients on April 22, 2018. The following consensus was reached: 1. Older cancer patients often faced unconscious discriminating bias from cancer specialists and institutions because of their chronological age. 2. Advances in radiotherapy techniques have allowed patients with multiple co-morbidities precluding surgery or systemic therapy to achieve potential cure in early disease stages. 3. The lack of biomarkers for frailty remains an impediment to future research. 4. Access to healthcare insurance and daily transportation remains an issue in many countries; 5. Hypofractionation, brachytherapy, or stereotactic techniques may be ideally suited for older cancer patients to minimize transportation issues and to improve tolerance to radiotherapy. 6. Patients with locally advanced disease who are mentally and physically fit should receive combined therapy for potential cure. 7. The role of systemic therapy alone or combined with radiotherapy for frail patients needs to be defined in future clinical trials because of targeted agents or immunotherapy may be less toxic compared to conventional chemotherapy.
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Tchounzou R, Simo Wambo AG, Njamen TN, Ilick IO, Neng HT, Dadao F, Sone AM. Patients Lost to Follow-Up for Cervical Cancer in the Limbe Regional Hospital. J Glob Oncol 2019; 5:1-5. [PMID: 30707663 PMCID: PMC6426531 DOI: 10.1200/jgo.18.00067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Cervical cancer constitutes a public health problem in Cameroon where it represents 13.8% of cancers in women. We wanted to evaluate compliance with cervical cancer care with a focus on patients who are lost to follow-up from the time that symptoms suggestive of cervical cancer are clinically recognized to treatment. PATIENTS AND METHODS Sociodemographic data, attitude toward diagnosis and treatment, and reason for discontinuing care were recorded and analyzed for a period of 5 years from January 2010 to December 2015. RESULTS One hundred twenty-six patients had symptoms suggestive of cervical cancer, but only 110 (87.30%) could pay for biopsy, 29 (26.36%) of those did not collect their results, 17 (18.7%) denied their results, and 20 (19%) did not benefit from treatment. Only 44 of 110 patients were able to finish their cancer care treatment program. Reasons for discontinuing the cancer care included lack of financial means to pay for it, distance from the care center, and belief in alternative treatments. CONCLUSION This study highlights the magnitude of the difficulties of accessing and receiving cancer care in semiurban areas in Cameroon. Poverty, belief in alternative treatment options, and unequal distribution of care services determined which patients would be lost to follow-up. Redistribution of resources and cancer care providers is mandatory to improve this situation.
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Affiliation(s)
- Robert Tchounzou
- Regional Hospital Limbe, Limbe, Cameroon.,University of Buea, Buea, Cameroon
| | | | | | | | | | - François Dadao
- Gynaeco-Obstetric and Paediatric Hospital, Douala, Cameroon
| | - Albert Mouelle Sone
- Douala General Hospital, Douala, Cameroon.,University of Douala, Douala, Cameroon
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Martin AN, Kaneza KM, Kulkarni A, Mugenzi P, Ghebre R, Ntirushwa D, Ilbawi AM, Pace LE, Costas-Chavarri A. Cancer Control at the District Hospital Level in Sub-Saharan Africa: An Educational and Resource Needs Assessment of General Practitioners. J Glob Oncol 2019; 5:1-8. [PMID: 30668270 PMCID: PMC6426480 DOI: 10.1200/jgo.18.00126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
PURPOSE The WHO framework for early cancer diagnosis highlights the need to improve health care capacity among primary care providers. In Rwanda, general practitioners (GPs) at district hospitals (DHs) play key roles in diagnosing, initiating management, and referring suspected patients with cancer. We sought to ascertain educational and resource needs of GPs to provide a blueprint that can inform future early cancer diagnosis capacity–building efforts. METHODS We administered a cross-sectional survey study to GPs practicing in 42 Rwandan DHs to assess gaps in cancer-focused knowledge, skills, and resources, as well as delays in the referral process. Responses were aggregated and descriptive analysis was performed to identify trends. RESULTS Survey response rate was 76% (73 of 96 GPs). Most responders were 25 to 29 years of age (n = 64 [88%]) and 100% had been practicing between 3 and 12 months. Significant gaps in cancer knowledge and physical exam skills were identified—88% of respondents were comfortable performing breast exams, but less than 10 (15%) GPs reported confidence in performing pelvic exams. The main educational resource requested by responders (n = 59 [81%]) was algorithms to guide clinical decision-making. Gaps in resource availability were identified, with only 39% of responders reporting breast ultrasound availability and 5.8% reporting core needle biopsy availability in DHs. Radiology and pathology resources were limited, with 52 (71%) reporting no availability of pathology services at the DH level. CONCLUSION The current study reveals significant basic oncologic educational and resource gaps in Rwanda, such as physical examination skills and diagnostic tools. Capacity building for GPs in low- and middle-income countries should be a core component of national cancer control plans to improve accurate and timely diagnosis of cancer. Continuing professional development activities should address and focus on context-specific educational gaps, resource availability, and referral practice guidelines.
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Affiliation(s)
| | | | | | | | - Rahel Ghebre
- University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda.,University of Minnesota Medical School, Minneapolis, MN.,Yale School of Medicine, New Haven, CT
| | - David Ntirushwa
- University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | | | | | - Ainhoa Costas-Chavarri
- Rwanda Military Hospital, Kigali, Rwanda.,Yale School of Medicine, New Haven, CT.,Boston Children's Hospital, Boston, MA
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Saleem MS, Aljurf M, Srivastava A, Shamsi T, Lu PH, Hamidieh AA, El Haddad A, Hashmi SK. Challenges in managing graft-versus-host disease in developing countries: a perspective. Bone Marrow Transplant 2018; 54:641-647. [PMID: 30237541 DOI: 10.1038/s41409-018-0333-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 08/27/2018] [Accepted: 08/29/2018] [Indexed: 01/07/2023]
Abstract
Hematopoietic cell transplant (HCT) activity is increasing worldwide due to safer techniques, widening indications, and more availability of donors. New HCT centers have recently been established in many developing countries including Asian and African countries. Due to limited resources, logistic, political, and social issues in developing countries, the treatment of orphan diseases like graft-versus-host disease (GVHD) can be challenging. We intended to delineate the current issues that institutions and clinicians face in managing GVHD. We conducted a comprehensive systematic electronic review of peer-reviewed published articles on GVHD management in developing countries. We used PubMed, Cochrane, and Embase databases as our primary source of data. Studies that were included described the treatments for both acute and chronic GVHD. Consensus on the use of high-dose methyl-prednisone and prednisolone as the initial therapy was widely accepted and used in practice. Socio-economic factors were found to be the major factor involved in GVHD management in lower income patients. Delayed diagnosis and treatment, lack of availability of healthcare professionals, lack of knowledge among cancer patients, and poverty are major concerns in the developing world. For optimal management, HCT programs should develop systems in place for long-term follow-up of HCT survivors and have a low threshold to initiate treatments for GVHD early. Awareness and health policy programs must be initiated at the grass-root level for long-term management of these survivors in developing countries.
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Affiliation(s)
| | - Mahmoud Aljurf
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Alok Srivastava
- Department of Hematology, Christian Medical College, Vellore, India
| | - Tahir Shamsi
- Department of Hematology, National Institutes of Blood Diseases, Karachi, Pakistan
| | - Pei Hua Lu
- Department of Hematology, Dao Pei Lu Hospital, Beijing, China
| | - Amir Ali Hamidieh
- Department of Pediatric Hematology/Oncology, Tehran University of Medical Sciences, Tehran, Iran
| | - Alaa El Haddad
- National Cancer Institute, Cairo University, Cairo, Egypt
| | - Shahrukh K Hashmi
- Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. .,Department of Internal Medicine, Mayo Clinic, Rochester, NY, USA.
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Gyedu A, Gaskill CE, Agbedinu K, Salazar DR, Kingham TP. Surgical oncology at a major referral center in Ghana: Burden, staging, and outcomes. J Surg Oncol 2018; 118:581-587. [PMID: 30095201 PMCID: PMC6160332 DOI: 10.1002/jso.25168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 06/27/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Outcome data after surgery for cancer in Sub-Saharan Africa are insufficient. We aimed to describe the presentation and outcomes of patients with solid cancers managed at a tertiary hospital in Ghana. METHODS Records of cancer patients admitted to Komfo Anokye Teaching Hospital general surgery wards from 2013 to 2016 were reviewed for data on presentation, staging, management, and mortality. Patients discharged alive were followed-up by biannual telephone calls to establish their postdischarge status. Survival analysis was performed for patients with pathologic or radiologic confirmation of cancer and adequate staging. RESULTS A total of 343 patients were included. Of these, 76% were female. The most common diagnoses were breast 136 (40%), foregut 70 (20%), and colorectal 63 (18%) cancers. Cancer diagnosis was confirmed by pathology or radiology in 281 (82%) patients, but only 112 (40%) had adequate staging. Seventy-four (66%) patients were stage IV. Two-year overall survival for all 343 patients was 22% to 69%, depending on cancer site. Among those with adequate staging who were alive after postoperative 90 days, 3-year survival was similar for curative compared with palliative operations (P = 0.64). CONCLUSIONS Improved capacity for both therapeutic and palliative cancer care is needed to achieve better outcomes by more appropriate allocation of surgery with respect to the goal of treatment.
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Affiliation(s)
- Adam Gyedu
- Department of Surgery, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; University Hospital, KNUST, Kumasi, Ghana,
| | | | | | | | - T. Peter Kingham
- Division of Hepatopancreatobiliary Surgery, Dept. of Surgery, Memorial Sloan-Kettering Hospital, New York, USA,
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Ginsburg O, Rositch AF, Conteh L, Mutebi M, Paskett ED, Subramanian S. Breast Cancer Disparities Among Women in Low- and Middle-Income Countries. CURRENT BREAST CANCER REPORTS 2018. [DOI: 10.1007/s12609-018-0286-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Brown CA, Kohler RE, John O, Motswetla G, Mmalane M, Tapela N, Grover S, Dryden-Peterson S, Lockman S, Dryden-Peterson SL. Multilevel Factors Affecting Time to Cancer Diagnosis and Care Quality in Botswana. Oncologist 2018; 23:1453-1460. [PMID: 30082488 DOI: 10.1634/theoncologist.2017-0643] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 04/20/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cancer incidence is increasing in Africa, and the majority of patients are diagnosed with advanced disease, limiting treatment options and survival. We sought to understand care patterns and factors contributing to delayed diagnosis and treatment initiation among patients with cancer in Botswana. PATIENTS AND METHODS We recruited 20 patients who were enrolled in a prospective cancer cohort in Botswana to a qualitative substudy that explored cancer care pathways and factors affecting cancer care access and quality. We conducted an in-depth interview with each participant between October 2014 and January 2015, using a a structured interview guide with questions about initial cancer symptoms, previous consultations, diagnosis, and care pathways. Medical records were used to confirm dates or treatment details when needed. RESULTS Individual and interpersonal factors such as cancer awareness and social support facilitated care-seeking behaviors. However, patients experienced multiple delays in diagnosis and treatment because of provider and health system barriers. Health system factors, such as misdiagnosis, understaffed facilities, poor referral communication and scheduling, and inadequate laboratory reporting systems, affected access to and quality of cancer care. CONCLUSION These findings highlight the need for interventions at the patient, provider, and health system levels to improve cancer care quality and outcomes in Botswana. Results also suggest that widespread cancer education has potential to promote early diagnosis through family and community networks. Identified barriers and facilitators suggest that interventions to improve community education and access to diagnostic technologies could help improve cancer outcomes in this setting. IMPLICATIONS FOR PRACTICE The majority (54%) of patients with cancer in Botswana present with advanced-stage cancer despite universal access to free health care, limiting the options for treatment and decreasing the likelihood of positive treatment outcomes. To reduce time from symptom onset to cancer treatment initiation, causes of delay in cancer care trajectories must be identified. The narratives of the patients interviewed for this study give insight into psychosocial factors, outlooks on disease, lower-level provider delays, and health system barriers that contribute to substantial delays for patients with cancer in Botswana. Identification of problems and barriers is essential for development of effective interventions to mitigate these factors, in order to improve cancer outcomes in this population.
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Affiliation(s)
- Carolyn A Brown
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Emory Rollins School of Public Health, Atlanta, Georgia, USA
| | - Racquel E Kohler
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Oaitse John
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | - Mompati Mmalane
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Neo Tapela
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Ministry of Health Botswana, Gaborone, Botswana
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Surbhi Grover
- Department of Radiation Oncology, Botswana-UPENN Partnership, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Oncology, Princess Marina Hospital, Gaborone, Botswana
| | | | - Shahin Lockman
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Scott L Dryden-Peterson
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Martei YM, Vanderpuye V, Jones BA. Fear of Mastectomy Associated with Delayed Breast Cancer Presentation Among Ghanaian Women. Oncologist 2018; 23:1446-1452. [PMID: 29959283 DOI: 10.1634/theoncologist.2017-0409] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 04/17/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Breast cancer is the leading cause of cancer mortality among women globally. Most women in Ghana present with advanced stage disease. The aim of this study is to characterize sociocultural factors associated with delayed presentation. MATERIALS AND METHODS Qualitative study (grounded theory, constant comparative method) using individual in-depth interviews with breast cancer patients seen at the Korle Bu Teaching Hospital in Accra, Ghana. Interviews were conducted in English and three local languages. We achieved theoretical saturation with 31 participants. RESULTS The mean length of delay reported by patients was approximately 1 year. Five recurrent themes were related to delayed presentation: (a) Women with a confirmed breast cancer diagnosis delay treatment because of the fear of mastectomy due to self and societal stigma; (b) role of the church as a social support system given the societal stigma associated with breast cancer; (c) study participants expressed some awareness of breast cancer, but with varying depths of breast cancer knowledge encompassing both myths and misconceptions about breast cancer; (d) most patients present late because they do not associate a "painless" breast lump with possible breast malignancy; and (e) delayed presentation linked to significant financial burden associated with breast cancer treatment. CONCLUSION Despite current efforts to increase breast cancer awareness, the fear of mastectomy remains one of the main reasons for delayed presentation. Successful breast cancer education programs will need to be framed within the broader sociocultural dimensions of femininity that address some of the stigma associated with mastectomy reported in the Ghanaian context. IMPLICATIONS FOR PRACTICE Most women in Ghana present with advanced-stage disease. The aim of this study was to characterize sociocultural factors associated with delayed presentation. Although several quantitative studies have been conducted on delays in presentation in sub-Saharan Africa (SSA), this study is one of the few to identify fear of mastectomy as a reason for delayed presentation. Anecdotal data from current clinical experiences in SSA suggest that this is still an issue that has not been adequately reported and addressed in most SSA countries. The research results presented here will hopefully guide health providers and national organizations in designing breast cancer education programs in Ghana and other parts of SSA.
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Affiliation(s)
- Yehoda M Martei
- Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Verna Vanderpuye
- National Center for Radiotherapy and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Beth A Jones
- Yale School of Public Health, Yale Comprehensive Cancer Center, New Haven, Connecticut, USA
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Anwar SL, Tampubolon G, Van Hemelrijck M, Hutajulu SH, Watkins J, Wulaningsih W. Determinants of cancer screening awareness and participation among Indonesian women. BMC Cancer 2018; 18:208. [PMID: 29506486 PMCID: PMC5838961 DOI: 10.1186/s12885-018-4125-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 02/12/2018] [Indexed: 02/07/2023] Open
Abstract
Background Cancer screening awareness and participation may be lower in low- and middle-income countries that lack established national screening programmes compared with those that do. We evaluated potential determinants of awareness about and participation in breast and cervical cancer screening, and breast self-examination (BSE) in women using survey data from Indonesia. Methods From the fifth Indonesian Family Life Survey (2014–2015), a total of 5397 women aged 40 and older without any history of cancer who responded to questionnaires concerning Pap smears, mammography, and BSE were included. Multilevel modelling was used to assess potential determinants in relation to awareness about Pap smears and mammography, and participation in Pap smears and BSE practice. Multivariable analyses were performed to identify independent predictors of cancer screening. Results Of the 5397 respondents, 1058 (20%) women were aware of Pap smears, of which 297 had never had the procedure. Only 251 (5%) participants were aware of mammography. A total of 605 (12%) of women reported they performed BSE. Higher education and household expenditure were consistently associated with higher odds of awareness about Pap smears and mammography (e.g. odds ratio [OR] of being aware of Pap smear and mammography: 7.82 (95% CI: 6.30–9.70) and 7.70 (6.19–9.58), respectively, for high school graduates compared to women with less educational attainment in the multivariable models), and participation in Pap smears and BSE. We also identified enabling factors linked with greater cancer screening awareness and participation, including health insurance, shorter distance to health services, and social participation. Conclusion There are socioeconomic disparities in cancer screening awareness and participation among Indonesian women. Our findings may help inform targeted health promotion and screening for cancer in the presence of limited resources. Electronic supplementary material The online version of this article (10.1186/s12885-018-4125-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sumadi L Anwar
- Division of Surgical Oncology Department of Surgery, Faculty of Medicine Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia.,PILAR Research and Education, 20 Station Road, Cambridge, CB1 2JD, UK
| | - Gindo Tampubolon
- Cathie Marsh Institute for Social Research, University of Manchester, M13 9PL, Manchester, UK
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research, King's College London, London, SE1 9RT, UK
| | - Susanna H Hutajulu
- Division of Medical Haematology and Oncology Department of Internal Medicine, Faculty of Medicine Universitas Gadjah Mada, Yogyakarta, 55281, Indonesia
| | - Johnathan Watkins
- PILAR Research and Education, 20 Station Road, Cambridge, CB1 2JD, UK
| | - Wahyu Wulaningsih
- PILAR Research and Education, 20 Station Road, Cambridge, CB1 2JD, UK. .,MRC Unit for Lifelong Health and Ageing, University College London, Place London WC1B 5JU, Bedford, 33, UK.
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Resource-stratified implementation of a community-based breast cancer management programme in Peru. Lancet Oncol 2017; 18:e607-e617. [PMID: 28971827 DOI: 10.1016/s1470-2045(17)30592-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 01/26/2017] [Accepted: 02/09/2017] [Indexed: 11/24/2022]
Abstract
Breast cancer incidence and mortality rates continue to rise in Peru, with related deaths projected to increase from 1208 in 2012, to 2054 in 2030. Despite improvements in national cancer control plans, various barriers to positive breast cancer outcomes remain. Multiorganisational stakeholder collaboration is needed for the development of functional, sustainable early diagnosis, treatment and supportive care programmes with the potential to achieve measurable outcomes. In 2011, PATH, the Peruvian Ministry of Health, the National Cancer Institute in Lima, and the Regional Cancer Institute in Trujillo collaborated to establish the Community-based Program for Breast Health, the aim of which was to improve breast health-care delivery in Peru. A four-step, resource-stratified implementation strategy was used to establish an effective community-based triage programme and a practical early diagnosis scheme within existing multilevel health-care infrastructure. The phased implementation model was initially developed by the Breast Cancer Initiative 2·5: a group of health and non-governmental organisations who collaborate to improve breast cancer outcomes. To date, the Community-based Program for Breast Health has successfully implemented steps 1, 2, and 3 of the Breast Cancer Initiative 2·5 model in Peru, with reports of increased awareness of breast cancer among women, improved capacity for early diagnosis among health workers, and the creation of stronger and more functional linkages between the primary levels (ie, local or community) and higher levels (ie, district, region, and national) of health care. The Community-based Program for Breast Health is a successful example of stakeholder and collaborator involvement-both internal and external to Peru-in the design and implementation of resource-appropriate interventions to increase breast health-care capacity in a middle-income Latin American country.
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Espina C, McKenzie F, Dos-Santos-Silva I. Delayed presentation and diagnosis of breast cancer in African women: a systematic review. Ann Epidemiol 2017; 27:659-671.e7. [PMID: 29128086 PMCID: PMC5697496 DOI: 10.1016/j.annepidem.2017.09.007] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 08/24/2017] [Accepted: 09/01/2017] [Indexed: 01/07/2023]
Abstract
PURPOSE Africa has low breast cancer incidence rates but high mortality rates from this disease due to poor survival. Delays in presentation and diagnosis are major determinants of breast cancer survival, but these have not been comprehensively investigated in Africa. METHODS MEDLINE, Embase, and Global Health were searched to identify studies reporting on delays in presentation and/or diagnosis of breast cancer published between January 1, 2000 and May 31, 2016. Data were synthesized in narrative, tabular, and graphical forms. Meta-analyses were not possible due to between-study differences in the way delays were reported. RESULTS Twenty-one studies were included in the review. Study-specific average times between symptom recognition and presentation to a health care provider ranged from less than 1 to 4 months in North Africa and from less than 3 to greater than 6 months in sub-Saharan Africa. Study-specific average times from presentation to diagnosis were less than 1 month in North Africa but ranged from less than 3 to greater than 6 months in sub-Saharan Africa. Reported reasons for these delays included patient-mediated (e.g., socioeconomic factors) and health system-mediated factors (e.g., referral pathways). CONCLUSIONS This systematic review revealed marked delays in presentation and diagnosis of breast cancer in Africa. Identification of their drivers is crucial to the development of appropriate control strategies in the continent.
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Affiliation(s)
- Carolina Espina
- International Agency for Research on Cancer (IARC), Lyon, France.
| | - Fiona McKenzie
- International Agency for Research on Cancer (IARC), Lyon, France
| | - Isabel Dos-Santos-Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Lukong KE, Ogunbolude Y, Kamdem JP. Breast cancer in Africa: prevalence, treatment options, herbal medicines, and socioeconomic determinants. Breast Cancer Res Treat 2017; 166:351-365. [PMID: 28776284 DOI: 10.1007/s10549-017-4408-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 07/17/2017] [Indexed: 12/11/2022]
Abstract
Breast cancer is the leading cause of cancer-related deaths in women worldwide. GLOBOCAN estimated about 1.7 million new cases of breast cancer diagnoses worldwide and about 522,000 deaths in 2012. The burden of breast cancer mortality lies in the developing low-income and middle-income countries, where about 70% of such deaths occur. The incidence of breast cancer is also rising in low-income and middle-income countries in Africa as trend towards urbanization, and adoption of Western lifestyles increases. In general, the triple-negative breast cancer (TNBC) subtype tends to be frequent in women of African ancestry. What are the factors contributing to this prevalence? Are there genetic predispositions to TNBC in African women? This review addresses these questions and provides an update on the incidence, survival, and mortality of breast cancer in Africans, with a focus on sub-Saharan Africans. We have also addressed factors that could account for ethical disparities in incidence and mortality. Further, we have highlighted challenges associated with access to essential drug and to healthcare treatment in some African countries and outlined alternative/herbal treatment methods that are increasingly implemented in Africa and other developing nations.
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Affiliation(s)
- Kiven Erique Lukong
- Department of Biochemistry, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada.
| | - Yetunde Ogunbolude
- Department of Biochemistry, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada
| | - Jean Paul Kamdem
- Department of Biological Sciences, Regional University of Cariri, Campus Pimenta, Crato, Ceará, CEP: 63105-000, Brazil
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Gichuhi S, Kabiru J, M'bongo Zindamoyen A, Rono H, Ollando E, Wachira J, Munene R, Onyuma T, Sagoo MS, Macleod D, Weiss HA, Burton MJ. Delay along the care-seeking journey of patients with ocular surface squamous neoplasia in Kenya. BMC Health Serv Res 2017; 17:485. [PMID: 28705204 PMCID: PMC5512725 DOI: 10.1186/s12913-017-2428-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 07/03/2017] [Indexed: 12/29/2022] Open
Abstract
Background In Africa, accessing eye health services is a major challenge. Ocular surface squamous neoplasia (OSSN) is a substantial ocular health problem in Africa related to solar UV light exposure and HIV infection among other risk factors. The disease causes visual loss and even death in advanced cases. This study was conducted to assess referral pathway and treatment delay for patients with OSSN in Kenya. Methods Adults with conjunctival lesions presenting to four eye centres were asked about their occupations, when they noticed the growth, health facilities visited in seeking care, cost of consultation, surgery, medicines and histopathology and dates at each step. The time-to-presentation was divided into quartiles and correlates analysed using ordinal logistic regression. Results We evaluated 158 first-time presenters with OSSN. Most were women (102 [65%]), living with HIV (78/110 tested [71%]), with low to medium income (127 [80%]). Most of the HIV patients (49/78 [63%]) were in antiretroviral care programs. About half (88/158, [56%]) presented directly to the study centres while the rest were referred. Indirect presenters sought care earlier than direct presenters (median 2.0 months vs 5.5 months) and travelled a shorter distance to the first health facility (median 20 km vs 30 km) but had surgery later (median 12.5 months vs 5.5 months). Visits beyond the first health facility for indirect presenters markedly increased delay (median 7.3, 29.0, 37.9, and 32.0 months for 1–4 facilities, respectively). Delay was associated with number of health facilities visited (adjusted ordered OR = 9.12; 95%CI 2.83–29.4, p < 0.001) and being female (adjusted ordered OR = 2.42; 95%CI 1.32–4.44, p = 0.004). At the time of presentation at the study centres for surgery the median tumour diameter in both directly and indirectly presenting patients was 6 mm (p = 0.52) and the histological spectrum of OSSN was similar between the groups (p = 0.87). Conclusions Referral delays definitive treatment for OSSN. Women were more likely to experience delay. Despite regular contact with the health system for those with known HIV infection, delays occurred. Early detection and referral of OSSN in the HIV service might reduce delays, but reassuringly delay did not give rise to a larger proportion with more advanced grade of OSSN. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2428-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stephen Gichuhi
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. .,Department of Ophthalmology, University of Nairobi, P.O Box 19676-00202, Nairobi, Kenya.
| | - Joy Kabiru
- PCEA Kikuyu Eye Unit, PO Box 45, Kikuyu, Kenya
| | | | - Hillary Rono
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Kitale District Hospital, PO Box 98-30200, Kitale, Kenya
| | | | - Joseph Wachira
- Kenyatta National Hospital, PO Box 20723-00202, Nairobi, Kenya
| | - Rhoda Munene
- Kenyatta National Hospital, PO Box 20723-00202, Nairobi, Kenya
| | - Timothy Onyuma
- Department of Pathology, MP Shah Hospital, PO Box 14497-00800, Nairobi, Kenya
| | - Mandeep S Sagoo
- UCL Institute of Ophthalmology, 11-43 Bath Street, London, EC1V 9EL, UK.,Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK.,St. Bartholomew's Hospital, W Smithfield, London, London, EC1A 7BE, UK
| | - David Macleod
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Helen A Weiss
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Moorfields Eye Hospital, 162 City Road, London, EC1V 2PD, UK
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Reeder-Hayes KE, Anderson BO. Breast Cancer Disparities at Home and Abroad: A Review of the Challenges and Opportunities for System-Level Change. Clin Cancer Res 2017; 23:2655-2664. [PMID: 28572260 PMCID: PMC5499686 DOI: 10.1158/1078-0432.ccr-16-2630] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 03/03/2017] [Accepted: 04/06/2017] [Indexed: 01/06/2023]
Abstract
Sizeable disparities exist in breast cancer outcomes, both between Black and White patients in the United States, and between patients in the United States and other high-income countries compared with low- and middle-income countries (LMIC). In both settings, health system factors are key drivers of disparities. In the United States, Black women are more likely to die of breast cancer than Whites and have poorer outcomes, even among patients with similar stage and tumor subtype. Over-representation of higher risk "triple-negative" breast cancers contributes to breast cancer mortality in Black women; however, the greatest survival disparities occur within the good-prognosis hormone receptor-positive (HR+) subtypes. Disparities in access to treatment within the complex U.S. health system may be responsible for a substantial portion of these differences in survival. In LMICs, breast cancer mortality rates are substantially higher than in the United States, whereas incidence continues to rise. This mortality burden is largely attributable to health system factors, including late-stage presentation at diagnosis and lack of availability of systemic therapy. This article will review the existing evidence for how health system factors in the United States contribute to breast cancer disparities, discuss methods for studying the relationship of health system factors to racial disparities, and provide examples of health system interventions that show promise for mitigating breast cancer disparities. We will then review evidence of global breast cancer disparities in LMICs, the treatment factors that contribute to these disparities, and actions being taken to combat breast cancer disparities around the world. Clin Cancer Res; 23(11); 2655-64. ©2017 AACRSee all articles in this CCR Focus section, "Breast Cancer Research: From Base Pairs to Populations."
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Affiliation(s)
- Katherine E Reeder-Hayes
- Division of Hematology and Oncology, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
- The University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina
| | - Benjamin O Anderson
- Departments of Surgery and Global Health Medicine, School of Medicine, University of Washington, Seattle, Washington
- Program in Epidemiology, Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
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Edwards LB, Greeff LE. A descriptive qualitative study of childhood cancer challenges in South Africa: Thematic analysis of 68 photovoice contributions. SOUTH AFRICAN JOURNAL OF ONCOLOGY 2017. [DOI: 10.4102/sajo.v1i0.14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
<strong>Background:</strong> Many childhood cancers are treatable with cure rates between 70% and 80% in well-resourced countries, while approximately 80% of African children with cancer die without access to adequate care. South Africa has an established oncology health care service with overburdened infrastructure, low cancer awareness in the primary health care service and widespread service delivery challenges.<br /><strong>Aim:</strong> The aim of this study was to explore, document and analyse the subjective experience of childhood cancer-related challenges in South Africa, and to make the results available to stakeholders.<br /><strong>Setting:</strong> A total of 58 patient-participants (childhood cancer patients, parents and guardians of children with cancer) and 10 paediatric oncology workers (oncology social workers, oncology nurses and interim home carers) were selected from tertiary oncology centres and from the Childhood Cancer Foundation of South Africa (CHOC) interim care homes across South Africa.<br /><strong>Method:</strong> Participants were selected via convenience sampling and qualitative data were derived from face-to-face photovoice interviews conducted by psychologists and social workers and supported by translators when necessary.<br /><strong>Results:</strong> Nine themes of cancer challenges were identified via thematic content analysis of the photo-narratives, that is, physical and treatment challenges, emotional, poor services, transport, finances, information, powerlessness, stigma and schooling challenges.<br /><strong>Conclusion:</strong> Lack of awareness and knowledge about cancer at the African traditional healer, primary and regional health care service levels were frequent challenges. Important feedback included lack of patient-centred care, separation of children with cancer from guardians, diagnostic delays, permanent disabilities for children because of cancer, emotional trauma, special needs of teenagers and a lack of community and palliative care support.
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Wu ES, Jeronimo J, Feldman S. Barriers and Challenges to Treatment Alternatives for Early-Stage Cervical Cancer in Lower-Resource Settings. J Glob Oncol 2017; 3:572-582. [PMID: 29094097 PMCID: PMC5646895 DOI: 10.1200/jgo.2016.007369] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Cervical cancer is one of the most common cancers among women worldwide, and approximately 85% of new diagnoses occur in less-developed regions of the world. Global efforts in cervical cancer to date have focused on primary and secondary prevention strategies of human papillomavirus vaccination and cervical cancer screening. Cervical cancer screening is effective to reduce the incidence of cervical cancer and can result in diagnosis at earlier stages, but it will take time to realize its full impact. With expansion of screening programs, there is now a greater imperative to increase access to treatment for women who have cervical cancer, particularly in earlier stages of disease, when it is still curable. Resources for multimodality treatment can be limited-or even absent-in many less-developed regions of the world and may be associated with geographic, social, and financial barriers for the patient. However, there is evidence that, in many cases, less-invasive and less-resource-intensive treatment options are still effective. To this end, the National Comprehensive Cancer Network and American Society of Clinical Oncology have published guideline adaptations for specific resource constraints, and research about more conservative approaches to the treatment of cervical cancer continues. This review focuses on potential barriers and challenges to provision of safe and effective treatment of early-stage cervical cancer in lower-resource settings, and it suggests future directions for expansion of access to cervical cancer treatment around the world.
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Affiliation(s)
- Emily S Wu
- , University of Washington; , PATH, Seattle, WA; and , Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jose Jeronimo
- , University of Washington; , PATH, Seattle, WA; and , Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Sarah Feldman
- , University of Washington; , PATH, Seattle, WA; and , Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Vanderpuye V, Grover S, Hammad N, PoojaPrabhakar, Simonds H, Olopade F, Stefan DC. An update on the management of breast cancer in Africa. Infect Agent Cancer 2017; 12:13. [PMID: 28228841 PMCID: PMC5307840 DOI: 10.1186/s13027-017-0124-y] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 02/03/2017] [Indexed: 01/04/2023] Open
Abstract
Background There is limited information about the challenges of cancer management and attempts at improving outcomes in Africa. Even though South and North Africa are better resourceds to tackle the burden of breast cancer, similar poor prognostic factors are common to all countries. The five-year overall Survival rate for breast cancer patients does not exceed 60% for any low and middle-income country (LMIC) in Africa. In spite of the gains achieved over the past decade, certain characteristics remain the same such as limited availability of breast conservation therapies, inadequate access to drugs, few oncology specialists and adherence to harmful socio-cultural practices. This review on managing breast cancer in Africa is authored by African oncologists who practice or collaborate in Africa and with hands-on experience with the realities. Methods A search was performed via electronic databases from 1999 to 2016. (PubMed/Medline, African Journals Online) for all literature in English or translated into English, covering the terms “breast cancer in Africa and developing countries”. One hundred ninety were deemed appropriate. Results Breast tumors are diagnosed at earlier ages and later stages than in highincome countries. There is a higher prevalence of triple-negative cancers. The limitations of poor nursing care and surgery, inadequate access to radiotherapy, poor availability of basic and modern systemic therapies translate into lower survival rate. Positive strides in breast cancer management in Africa include increased adaptation of treatment guidelines, improved pathology services including immuno-histochemistry, expansion and upgrading of radiotherapy equipment across the continent in addition to more research opportunities. Conclusion This review is an update of the management of breast cancer in Africa, taking a look at the epidemiology, pathology, management resources, outcomes, research and limitations in Africa from the perspective of oncologists with local experience.
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Affiliation(s)
- V Vanderpuye
- National center for Radiotherapy and Nuclear Medicine, Korle-Bu Teaching Hospital, Accra, Ghana
| | - S Grover
- Hospital of University of Pennsylvania, Department of Radiation Oncology, (Botswana-UPENN program), 3400 Civic Center Blvd., Philadelphia, PA 19104 USA
| | - N Hammad
- Cancer Centre of Southeastern Ontario, Burr 2, Kingston General Hospital, 25 King Street W, Kingston, ON K7L 5P9 Canada
| | - PoojaPrabhakar
- University of Texas Southwestern Medical Center, Dallas, TX USA
| | - H Simonds
- Division of Radiation Oncology, Tygerberg Hospital/University of Stellenbosch, Tygerberg, South Africa
| | - F Olopade
- The University of Chicago, 5841 S Maryland Avenue, MC 2115, Chicago, IL 60637 USA
| | - D C Stefan
- Walter Sisulu University Nelson Mandela Dr, Nelson Mandela Drive, Mthatha, 5100 Eastern Cape South Africa
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Anderson BO. Cancer Research in Low- and Middle-Income Countries: Consortiums, Implementation Science and Healthcare Delivery. Ann Surg Oncol 2016; 24:624-626. [DOI: 10.1245/s10434-016-5627-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Indexed: 12/29/2022]
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