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Tolani MA, Agbo CA, Paciorek A, Umar SS, Ojewola RW, Mohammed F, Kaninjing E, Ahmed M, DeBoer R. Detection and management of localized prostate cancer in Nigeria: barriers and facilitators according to patients, caregivers and healthcare providers. BMC Health Serv Res 2024; 24:918. [PMID: 39135037 PMCID: PMC11318139 DOI: 10.1186/s12913-024-11340-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 07/22/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Prostate cancer mortality rates are high in Nigeria. While prostate cancer is highly curable with early detection and effective multidisciplinary management, the quality of care is suboptimal in this setting. Sustainable delivery of high-quality care for patients with localized prostate cancer is needed to save more lives. To inform future interventions to improve care, this study aimed to identify barriers and facilitators that influence prostate cancer detection and management in Nigeria. METHODS Six focus group discussions (FGDs), stratified by stakeholders were conducted with a purposive sample of prostate cancer patients (n = 19), caregivers (n = 15), and healthcare providers (n = 18), in two academic tertiary hospitals in northern and southern Nigeria. A discussion guide organized based on the socio-ecological model was used. FGDs were recorded, transcribed, and analysed using the framework technique. RESULTS Barriers and facilitators were identified at the individual, interpersonal, and organizational levels. Barriers to detection included limited knowledge and misperceptions among patients, caregivers, and community-based non-specialist healthcare providers, and limitations of centralized opportunistic screening; while facilitators included the potential for religious institutions to encourage positive health-seeking behaviour. Barriers to management included non-uniformity in clinical guideline usage, treatment abandonment amidst concerns about treatment and survival, absence of patient interaction platforms and follow-up support systems, difficulty in navigating service areas, low health insurance coverage and limited financial resource of patients. Facilitators of management included the availability of resource stratified guidelines for prostate cancer management and the availability of patient peers, caregivers, nurses, and medical social workers to provide correct medical information and support patient-centred services. Participants also provided suggestions that could help improve prostate cancer detection and management in Nigeria. CONCLUSION This study identified multiple determinants affecting the detection and management of localized prostate cancer. These findings will inform the refinement of implementation strategies to improve the quality of prostate cancer care in Nigeria.
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Affiliation(s)
- Musliu Adetola Tolani
- Ahmadu Bello University / Ahmadu Bello University Teaching Hospital, P.M.B. 06, Shika- Zaria, Kaduna State, Nigeria.
- Division of Urology, Department of Surgery, Ahmadu Bello University Teaching Hospital, P.M.B. 06, Shika-Zaria, Kaduna State, Nigeria.
| | - Christian A Agbo
- Dalhatu Araf Specialist Hospital, Shendam Road, Lafia, Nasarawa State, Nigeria
| | - Alan Paciorek
- University of California, San Francisco, Box 0874, San Francisco, CA, 94110, USA
| | - Shehu S Umar
- Ahmadu Bello University / Ahmadu Bello University Teaching Hospital, P.M.B. 06, Shika- Zaria, Kaduna State, Nigeria
| | - Rufus W Ojewola
- University of Lagos, Lagos University Teaching Hospital, Idi-Araba, Lagos State, Nigeria
| | - Faruk Mohammed
- Ahmadu Bello University / Ahmadu Bello University Teaching Hospital, P.M.B. 06, Shika- Zaria, Kaduna State, Nigeria
| | - Ernie Kaninjing
- Georgia College and State University, Campus Box 112, Milledgeville, GA, 31061, USA
| | - Muhammed Ahmed
- Ahmadu Bello University / Ahmadu Bello University Teaching Hospital, P.M.B. 06, Shika- Zaria, Kaduna State, Nigeria
| | - Rebecca DeBoer
- University of California, San Francisco, Box 0874, San Francisco, CA, 94110, USA
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Nwozichi CU, Ramos MD, Ogunmuyiwa AO, Gigi MB. Dominant Worldviews, Institutional, and Contextual Factors Affecting Cancer Care: Evidence From an Institutional Ethnonursing Study in Nigeria. J Transcult Nurs 2024; 35:216-225. [PMID: 38351591 DOI: 10.1177/10436596241230998] [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] [Indexed: 05/05/2024] Open
Abstract
INTRODUCTION Cancer remains a significant health burden in Nigeria and requires the efforts of all stakeholders to address it. Little is known about how the worldviews of Nigerian patients with cancer and other institutional factors affect cancer management in Nigeria. This paper draws evidence from an ethnonursing study conducted in a Nigerian cancer care setting. METHOD This study adopted a qualitative design using an ethnonursing approach. The study was conducted in one of the primary cancer treatment centers owned by the federal government of Nigeria. Data collection was conducted using participant observation, interviews, and field notes. Data collected were analyzed using NVivo 12 and presented as categories and sub-categories. RESULTS Analysis yielded two themes and seven sub-themes. The major themes included (1) dominant worldview and (2) institutional/contextual factors. Participants attributed life, living, and death as being controlled by a supreme being. Cancer care was constrained by unfavorable institutional factors such as lack of equipment, staffing, and intensified workload. DISCUSSION Cancer institutions should provide more cancer care infrastructure that will facilitate the work of nurses and other health care workers. There should be an enabling environment that would attract and retain nurses in the cancer wards. The hospital environment should be made conducive for the cancer care providers, patients with cancer, and their relatives.
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Joseph A, Akinsete A, Adeneye S, Balogun O, Awofeso O, Oladipo A, Ajose A, Elhamamsi I, Merrell K, Ngwa W, Puthoff D, Shour AR, Onitilo A. Feasibility and Safety of Implementing Volumetric Arc Therapy (VMAT) for Pediatric Craniospinal Irradiation in a Low-Middle-Income Region: The Nigerian Experience. Adv Radiat Oncol 2024; 9:101325. [PMID: 38405304 PMCID: PMC10885594 DOI: 10.1016/j.adro.2023.101325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 07/19/2023] [Indexed: 02/27/2024] Open
Abstract
Purpose Volumetric modulated arc therapy (VMAT) is a relatively new treatment technique in sub-Saharan Africa. Although craniospinal irradiation (CSI) in the pediatric population has been practiced in Nigeria for many years, the use of VMAT to deliver this treatment is previously undocumented. We reviewed the first set of patients to undergo CSI at a cancer center in Nigeria, detailing the treatment technique, the progress experienced, dose statistics achieved, treatment toxicities, and cancer outcomes to date. Methods and Materials This was a prospective case series of 5 children with histologically diagnosed cancers requiring CSI whose parents consented to the study. They were recruited at evaluation and followed through the process of their therapy. Toxicity was monitored at weekly review appointments using the Common Terminology Criteria for Adverse Events version 5.0. Follow-up of the children will continue in the long-term effects clinic. Results Five patients with a median age of 6 were recruited. Diagnoses were intracranial germ cell tumor (n = 2), medulloblastoma (n = 1), pineoblastoma (n = 1), and ependymoma (n = 1). For all patients, a dose of 36.0 Gy in 1.8 Gy daily fractions was prescribed to the entire neuraxis. A subsequent boost of 18 Gy (n = 4) to 19.8 Gy (n = 1) in 10 daily fractions to the primary tumor bed (n = 2) and posterior fossa (n = 2) was delivered. Four patients had chemotherapy before, during, or after radiation therapy. No patient experienced grade 3 or greater toxicity. Conclusions Our results indicate great progress has been made in the delivery of CSI in Nigeria, demonstrating tolerable acute side effects using VMAT. This series suggests the feasibility of implementing VMAT technology in low- or middle-income countries. Additional follow-up will be needed to determine whether survival rates and chronic toxicity rates are similar to those reported in the literature.
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Affiliation(s)
- Adedayo Joseph
- NSIA-LUTH Cancer Center, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Adeseye Akinsete
- Department of Pediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Samuel Adeneye
- NSIA-LUTH Cancer Center, Lagos University Teaching Hospital, Lagos, Nigeria
- Department of Radiation Biology, Radiotherapy and Radiodiagnosis, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Onyinye Balogun
- Department of Radiation Oncology, Weill Cornell Medicine, New York, New York
| | - Opeyemi Awofeso
- Psychosocial Oncology & Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Aishat Oladipo
- NSIA-LUTH Cancer Center, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Azeezat Ajose
- NSIA-LUTH Cancer Center, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Ibrahim Elhamamsi
- NSIA-LUTH Cancer Center, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Kenneth Merrell
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Wilfred Ngwa
- Sidney Kimmel Comprehensive Cancer Center, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - David Puthoff
- Office of Research and Sponsored Programs, Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, Wisconsin
| | - Abdul R. Shour
- Cancer Care and Research Center, Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, Wisconsin
| | - Adedayo Onitilo
- Cancer Care and Research Center, Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, Wisconsin
- Department of Oncology, Cancer Care and Research Center, Marshfield Clinic Health System, Marshfield, Wisconsin
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Joseph A, Akinsete AM, Lasebikan NN, Adeneye S, Awofeso OM, Oladipo AT, Ajose AO, Ojo O, Merrell K, Ngwa W, Puthoff DS, Onitilo AA. The Landscape of Pediatric Radiation Oncology in Nigeria. JCO Glob Oncol 2024; 10:e2300219. [PMID: 38207247 DOI: 10.1200/go.23.00219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/11/2023] [Accepted: 10/23/2023] [Indexed: 01/13/2024] Open
Abstract
Radiation therapy (RT) is an essential part of the multidisciplinary treatment of pediatric cancer. Over the past five decades, significant advances have been made in the delivery of RT, with better dose delivery to disease targets while minimizing exposure to nearby organs at risk. These advances have led to improved treatment outcomes, increased survival, and reduced treatment-related toxicities. Advanced treatment techniques, however, require significant investment in infrastructural and personnel resources. This review documents what is currently available regarding expertise and infrastructure for pediatric radiation oncology practice in Nigeria. It was performed to serve as a foundation for the creation and design of tailored solutions (initiatives and policies) to increase pediatric radiation availability, accessibility, and equity in Nigeria and ultimately improve pediatric cancer treatment outcomes in the region.
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Affiliation(s)
- Adedayo Joseph
- NSIA-LUTH Cancer Centre, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Adeseye M Akinsete
- Hematology & Oncology Unit, Department of Pediatrics, College of Medicine University of Lagos, Lagos, Nigeria
| | | | - Samuel Adeneye
- NSIA-LUTH Cancer Centre, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Opeyemi M Awofeso
- Psychosocial Oncology & Palliative Care, Dana Farber Cancer Institute, Boston, MA
| | - Aishat T Oladipo
- NSIA-LUTH Cancer Centre, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Azeezat O Ajose
- NSIA-LUTH Cancer Centre, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Oluwatimileyin Ojo
- Long Island Jewish Medical Center and North Shore University Hospital, New Hyde Park, NY
| | - Kenneth Merrell
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | | | - David S Puthoff
- Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI
| | - Adedayo A Onitilo
- Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI
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Akinwande AM, Ugwuanyi DC, Chiegwu HU, Idigo F, Ogolodom MP, Anakwenze CP, Abi R, Odukoya O. Radiotherapy services in low resource settings: The situation in Nigeria. SAGE Open Med 2023; 11:20503121231153758. [PMID: 36778199 PMCID: PMC9909043 DOI: 10.1177/20503121231153758] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 01/12/2023] [Indexed: 02/10/2023] Open
Abstract
Objective About 50%-60% of all cancer cases will require radiotherapy during their treatment. Nonetheless, radiotherapy facilities are limited in low- and middle-income countries and despite high cancer burden in these regions of the world, only 5% have access to radiation therapy. This study identified the location of radiotherapy centers, the types of radiotherapy machines available and the personnel available in each radiotherapy center in Nigeria. Methods A cross-sectional questionnaire-based study conducted across the six geopolitical zones of Nigeria from May 2020 to April 2021. A questionnaire having sections on facility profile, status of facility, and human resources, was used to elucidate information for the study. Descriptive statistics (frequency and proportion) were used to describe facilities' characteristics, status, and human resources available. Results Out of nine radiotherapy centers evaluated, the majority 33.3% (n = 3) were found in the southwest geopolitical zone of Nigeria. Out of 10 equipment and accessories evaluated for availability, Ahmadu Bello University Teaching Hospital and University of Benin Teaching Hospital had the highest number of available equipment and accessories 90% (n = 9) each respectively. Out of the nine centers evaluated, only four centers had at least one functional equipment. The highest number 64.3% (n = 9) out of the 14 required number of staff in each center was found at University College Hospital. Out of 31 medical physicists identified, the majority 22.6% (n = 7) was found at University of Nigeria Teaching Hospital. Conclusion A high percentage of radiotherapy centers in Nigeria lacks the equipment and manpower to function optimally and is located within the southwest geopolitical zone of Nigeria. Therefore, proper investment in the radiotherapy service through private-public partnership, staff training, and equipment upgrade and maintenance could substantially improve the state of cancer care.
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Affiliation(s)
- Abidoye Matthew Akinwande
- Department of Radiography and Radiological Sciences, Faculty of Health Sciences and Technology, College of Health Sciences, Nnamdi Azikiwe University, Awka, Nigeria,Department of Radiation Oncology, College of Medicine, University of Ibadan, Ibadan, Nigeria,Department of Radiography and Radiation Science, Lead City University, Ibadan, Nigeria,Abidoye Matthew Akinwande, Department of Radiation Oncology, University College Hospital, Queen Elizabeth Road, P.M.B. 5116, Ibadan, Oyo state 200211, Nigeria.
| | - Daniel Chimuanya Ugwuanyi
- Department of Radiography and Radiological Sciences, Faculty of Health Sciences and Technology, College of Health Sciences, Nnamdi Azikiwe University, Awka, Nigeria
| | - Hyacienth Uche Chiegwu
- Department of Radiography and Radiological Sciences, Faculty of Health Sciences and Technology, College of Health Sciences, Nnamdi Azikiwe University, Awka, Nigeria
| | - Felicitas Idigo
- Department of Radiography and Radiological Sciences, Faculty of Health Sciences and Technology, College of Health Sciences, Nnamdi Azikiwe University, Awka, Nigeria,Department of Medical Radiography and Radiological Sciences, University of Nigeria Nsukka, Nsukka, Nigeria
| | - Michael Promise Ogolodom
- Department of Radiography and Radiological Sciences, Faculty of Health Sciences and Technology, College of Health Sciences, Nnamdi Azikiwe University, Awka, Nigeria
| | | | - Roland Abi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Oluwaponmile Odukoya
- Department of Radiation Oncology, College of Medicine, University of Ibadan, Ibadan, Nigeria
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The associations of statin intake and the trabecular bone score and bone mineral density status in elderly Iranian individuals: a cross-sectional analysis of the Bushehr Elderly Health (BEH) program. Arch Osteoporos 2021; 16:144. [PMID: 34570258 DOI: 10.1007/s11657-021-00991-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 08/16/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED In recent years, a growing interest on the impact of statin intake on bone health has emerged, although the reported results are controversial. The results of this study revealed that BMD at lumbar spine has a significant association with statin intake. However, such association appears to be weaker regarding TBS values compared to BMD. This study was performed with the aim of evaluating associations of statin intake with BMD and TBS using data from 2426 individuals aged ≥ 60 years from the second phase of the Bushehr Elderly Health (BEH) program. We found a positive association between statin and BMD at lumbar spine, whereas association between statin and TBS was detected only in the men in the final model. INTRODUCTION In recent years, a growing interest has been established to evaluate the impact of statin intake on bone health, although the reported results are controversial. This study aimed to evaluate the association of statin intake with bone health status according to BMD and TBS. METHODS This cross-sectional analysis used data from the elderly Iranian individuals who participated in the Bushehr Elderly Health (BEH) program. Dual x-ray absorptiometry (DXA) device was used to evaluate the BMD at lumbar spine (L1-L4), femoral neck, and total hip, as well as TBS at lumbar spine. RESULTS Among 2426 (1260 women and 1166 men) study participants, 778 were statin users. A positive significant association, irrespective of sex, was observed between statin intake and BMD at L1-L4, even after controlling for potential variables in total population (β = 0.016, p = 0.013). The mean TBS values at L1-L4 were negatively associated with statin intake in total population (β = - 0.009, p = 0.001), while in the full adjusted model, significant positive association between TBS and statin intake was detected only in men (β = 0.013, p = 0.02). CONCLUSION The results of this study revealed that BMD at lumbar spine has a significant association with statin intake. However, such an association appears to be weaker regarding TBS values compared to BMD.
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Anakwenze Akinfenwa CP, Ibraheem A, Nwankwo K, Lasebikan N, Ali-Gombe M, Aliyu UM, Ikhile E, Adegboyega O, Abdullahi A, Klopp AH, Schmeler K, Lin LL, Jhingran A, Page BR, Leng J, Grover S, Ntekim A. Emerging Use of Public-Private Partnerships in Public Radiotherapy Facilities in Nigeria. JCO Glob Oncol 2021; 7:1260-1269. [PMID: 34351813 PMCID: PMC8389883 DOI: 10.1200/go.21.00066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Radiotherapy (RT) treatment at public hospitals in Nigeria is often interrupted by prolonged periods of machine breakdown because of insufficient funds for maintenance and repair. These delays have prompted the uptake of public-private partnerships (PPPs) to acquire and maintain RT equipment. This study aimed to understand Nigeria's current RT capacity and the impact of PPPs on RT availability and cost. METHODS Eleven radiation oncologists, each representing one of the 11 RT centers in Nigeria (eight public and three private), were invited to complete a survey on the type, status, acquisition, and maintenance plan of existing RT equipment, cost incurred by patients for external-beam radiation (EBRT) and brachytherapy treatment, and number of patients treated per year on each machine. Type and status of equipment at nonresponding facilities were obtained through literature review and confirmed with the facility. RESULTS A total of eight (81%) respondents completed the survey, all representing public centers, three of which reported PPP use. They reported 11 megavoltage units in total (seven linear accelerators [LINACs] and four Cobalt-60s) and 10 brachytherapy afterloaders. Of those, 57% (4/7) of the LINACs, 100% (4/4) of the Cobalt-60s, and 63% (7/11) of the afterloaders were in clinical use. All commissioned equipment supported by PPPs (three LINACs and one afterloader) were in operation. The public EBRT equipment were nonfunctional 35% of the year (resulting in 60% fewer patients treated per year). The PPP EBRT and afterloaders did not experience any periods of breakdown, but PPP costs were 338% higher than public equipment. CONCLUSION This study characterizes the use of PPP as a more reliable method of RT delivery in Nigeria, albeit at higher costs.
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Affiliation(s)
| | - Abiola Ibraheem
- Section of Hematology Oncology, University of Chicago, Chicago, IL
| | - Kenneth Nwankwo
- Department of Radiation Medicine, College of Medicine, University of Nigeria, Nsukka, Nigeria
| | - Nwamaka Lasebikan
- Department of Radiation Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Musa Ali-Gombe
- Radiology Department, Gombe State University, Gombe, Gombe State, Nigeria
| | - Usman Malami Aliyu
- Department of Radiotherapy and Oncology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Sokoto State, Nigeria
| | - Emmanuel Ikhile
- Department of Radiation Oncology, University of Benin Teaching Hospital, Benin, Edo State, Nigeria
| | | | - Adamu Abdullahi
- Department of Radiotherapy and Oncology, Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria
| | - Ann H Klopp
- Division of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Kathleen Schmeler
- Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lilie L Lin
- Division of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Anuja Jhingran
- Division of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX
| | - Brandi R Page
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jim Leng
- The University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Surbhi Grover
- Department of Radiation Oncology, Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania; Botswana-UPENN Partnership, Gaborone, Botswana
| | - Atara Ntekim
- Department of Radiation Oncology, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
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Olasehinde O, Alatise O, Omisore A, Wuraola F, Odujoko O, Romanoff A, Akinkuolie A, Arowolo O, Adisa A, Knapp G, Famurewa O, Omisile I, Onabanjo E, Constable J, Omoniyi-Esan G, Adesunkanmi AR, Lawal O, Kingham TP. Contemporary management of breast cancer in Nigeria: Insights from an institutional database. Int J Cancer 2021; 148:2906-2914. [PMID: 33506499 DOI: 10.1002/ijc.33484] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 12/01/2020] [Accepted: 01/04/2021] [Indexed: 01/07/2023]
Abstract
High-quality data are needed to guide interventions aimed at improving breast cancer outcomes in sub-Saharan Africa. We present data from an institutional breast cancer database to create a framework for cancer policy and development in Nigeria. An institutional database was queried for consecutive patients diagnosed with breast cancer between January 2010 and December 2018. Sociodemographic, diagnostic, histopathologic, treatment and outcome variables were analyzed. Of 607 patients, there were 597 females with a mean age of 49.8 ± 12.2 years. Most patients presented with a palpable mass (97%) and advanced disease (80.2% ≥ Stage III). Immunohistochemistry was performed on 21.6% (131/607) of specimens. Forty percent were estrogen receptor positive, 32.8% were positive for HER-2 and 43.5% were triple negative. Surgery was performed on 49.9% (303/607) of patients, while 72% received chemotherapy and 7.9% had radiotherapy. At a median follow-up period of 20.5 months, the overall survival was 43.6% (95% CI -37.7 to 49.5). Among patients with resectable disease, 18.8% (57/303) experienced a recurrence. Survival was significantly better for early-stage disease (I and II) compared to late-stage disease (III or IV) (78.6% vs 33.3%, P < .001). Receipt of adjuvant radiotherapy after systemic chemotherapy was associated with improved survival in patients with locally advanced disease (68.5%, CI -46.3 to 86 vs 51%, CI 38.6 to 61.9, P < .001). This large cohort highlights the dual burden of advanced disease and inadequate access to comprehensive breast cancer care in Nigeria. There is a significant potential for improving outcomes by promoting early diagnosis and facilitating access to multimodality treatment.
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Affiliation(s)
- Olalekan Olasehinde
- Department of Surgery, Obafemi Awolowo University/Obafemi Awolowo University Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Olusegun Alatise
- Department of Surgery, Obafemi Awolowo University/Obafemi Awolowo University Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Adeleye Omisore
- Department of Radiology, Obafemi Awolowo University/ Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Funmilola Wuraola
- Department of Surgery, Obafemi Awolowo University/Obafemi Awolowo University Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Oluwole Odujoko
- Department of Morbid Anatomy and Forensic pathology, Obafemi Awolowo University / Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Anya Romanoff
- Breast Surgery, Dubin Breast Center, Icahn School of Medicine at The Mount Sinai Hospital, New York, New York, USA.,Department of Health System Design and Global Health, Icahn School of Medicine at The Mount Sinai Hospital, New York, New York, USA
| | - Akinbolaji Akinkuolie
- Department of Surgery, Obafemi Awolowo University/Obafemi Awolowo University Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Olukayode Arowolo
- Department of Surgery, Obafemi Awolowo University/Obafemi Awolowo University Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Adewale Adisa
- Department of Surgery, Obafemi Awolowo University/Obafemi Awolowo University Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Gregory Knapp
- Department of Oncology, Division of Surgical Oncology, University of Calgary, Alberta, Canada
| | - Olusola Famurewa
- Department of Radiology, Obafemi Awolowo University/ Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Idowu Omisile
- Department of Psychology, Faculty of Social Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | - Jeremy Constable
- Department of Surgery, Memorial Sloan-Kettering Cancer center, New York
| | - Ganiyat Omoniyi-Esan
- Department of Morbid Anatomy and Forensic pathology, Obafemi Awolowo University / Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Abdul-Rasheed Adesunkanmi
- Department of Surgery, Obafemi Awolowo University/Obafemi Awolowo University Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Oladejo Lawal
- Department of Surgery, Obafemi Awolowo University/Obafemi Awolowo University Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria
| | - Thomas P Kingham
- Department of Surgery, Memorial Sloan-Kettering Cancer center, New York
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Tumba N, Adewuyi SA, Eguzo K, Adenipekun A, Oyesegun R. Radiotherapy waiting time in Northern Nigeria: experience from a resource-limited setting. Ecancermedicalscience 2020; 14:1097. [PMID: 33082847 PMCID: PMC7532027 DOI: 10.3332/ecancer.2020.1097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Indexed: 12/24/2022] Open
Abstract
Background Access and availability of radiotherapy treatment is limited in most low- and middle-income countries, which leads to long waiting times and poor clinical outcomes. The aim of our study is to determine the magnitude of waiting times for radiotherapy in a resource-limited setting. Methods This is a retrospective cohort study of patients with the five most commonly treated cancers managed with radiotherapy between 2010 and 2014. Data includes diagnosis, patients’ demographics and treatment provided. The waiting time was categorised into intervals (1) between diagnosis and first radiation consultation (2) First consultation to radiotherapy treatment (3) Decision-to-treat to treatment and (4) Diagnosis to treatment. Results A total of 258 cases were involved, including cervical (50%; 129/258), breast (27.5%; 71/258), nasopharynx (12.8%; 33/258), colorectal (5%; 13/258) and prostate cancers (4.7%; 12/258). Mean age was 48 (±12.9) years. Treatment with radical intent comprised 67% (178/258) of cases, while 33% (80/258) had palliative treatment. The median time from diagnosis to first radiation consultation was 40 (IQR 17–157.75) days for all the patients, with prostate cancer having the longest time – 305 days (IQR 41–393.8). The median time between the first radiation oncology consultations and first radiotherapy treatment was 130.5 (IQR 14–211.5) days; cervical cancer patients waited a median of 139 (IQR 13–195.5) days. The median time between diagnosis and first radiotherapy for breast cancer patients was 329 (IQR 207–464) days, compared to 213 (IQR 101.5–353.5) days for all the patients. Conclusion The study shows that waiting time for radiotherapy in Nigeria was generally longer than what is recommended internationally. This reflects the need to improve access to radiotherapy in order to improve cancer treatment outcomes in resource-limited settings.
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Affiliation(s)
- Nuhu Tumba
- Department of Radiology, Division of Radiation/Clinical Oncology Bingham University Teaching Hospital, Jos 930214, Nigeria
| | - Sunday Adeyemi Adewuyi
- Department of Radiotherapy & Oncology Ahmadu Bello University Teaching Hospital, Zaria 810105, Nigeria
| | - Kelechi Eguzo
- Department of Obstetrics & Gynaecology, University of Saskatchewan, S4N 2B7, Canada
| | - Adeniyi Adenipekun
- Department of Radiation Oncology, University College Hospital, Ibadan 200284, Nigeria
| | - Rasaaq Oyesegun
- Department of Radiotherapy & Oncology, National Hospital Abuja 900211, Nigeria
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10
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Orunmuyi AT, Lawal IO, Omofuma OO, Taiwo OJ, Sathekge MM. Underutilisation of nuclear medicine scans at a regional hospital in Nigeria: need for implementation research. Ecancermedicalscience 2020; 14:1093. [PMID: 33014135 PMCID: PMC7498276 DOI: 10.3332/ecancer.2020.1093] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Indexed: 12/14/2022] Open
Abstract
Background Nuclear medicine needs better integration into the Nigerian health system. To understand the relevant public health initiatives that will be required, this study assessed the pattern of nuclear medicine imaging services at the first nuclear medicine centre in Nigeria from January 2010 to December 2018. Methods The data of consecutive nuclear medicine (NM) scans performed between 1st January 2010 and 31st December 2018 at the NM department in a tertiary hospital in Nigeria were extracted from patient records and analysed using SAS version 9.4 (SAS Institute, Cary, NC). The National Cancer Institute’s Joinpoint software and QCIS (QGIS project) were used to estimate imaging trends and geographical spread of patients. Results An average of 486 scans per year was performed during the study period. Patients travelled from 32 of Nigeria’s 36 states, and the majority (65%) travelled more than 100 km to obtain NM scans. Bone scans accounted for 88.1% of the studies. The remainder were renal scintigraphy (7.3%), thyroid scans (2.5%), whole-body iodine scans (1.7%) and others (0.4%). Conclusions NM in Nigeria appears underutilised. Furthermore, the studies to characterise the access gaps and implementation needs will contribute to the design of practical strategies to strengthen NM services in Nigeria.
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Affiliation(s)
- Akintunde T Orunmuyi
- Department of Radiation Oncology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ismaheel O Lawal
- Department of Nuclear Medicine, Steve Biko Academic Hospital and University of Pretoria, Pretoria, South Africa
| | - Omonefe O Omofuma
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, USA
| | - Olalekan J Taiwo
- Department of Geography, Faculty of the Social Sciences, University of Ibadan, Ibadan, Nigeria
| | - Mike M Sathekge
- Department of Nuclear Medicine, Steve Biko Academic Hospital and University of Pretoria, Pretoria, South Africa
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11
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Dulal S, Adeniji AA, Martin MG. Feasibility of Fewer Fraction Palliative Radiotherapy in Resource-Limited Setting. World J Oncol 2020; 11:76-77. [PMID: 32284776 PMCID: PMC7141159 DOI: 10.14740/wjon1271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 03/04/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- Soniya Dulal
- Department of Clinical Oncology, National Academy of Medical Sciences (NAMS), Bir Hospital, Kanti Path, Kathmandu, Nepal
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12
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Knapp GC, Tansley G, Olasehinde O, Alatise OI, Wuraola F, Olawole MO, Arije OO, Gali BM, Kingham TP. Mapping Geospatial Access to Comprehensive Cancer Care in Nigeria. J Glob Oncol 2020; 5:1-8. [PMID: 31634049 PMCID: PMC6825250 DOI: 10.1200/jgo.19.00283] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To address the increasing burden of cancer in Nigeria, the National Cancer Control Plan outlines the development of 8 public comprehensive cancer centers. We map population-level geospatial access to these eight centers and explore equity of access and the impact of future development. METHODS Geospatial methods were used to estimate population-level travel times to the 8 cancer centers. A cost distance model was built using open source road infrastructure data with verified speed limits. Geolocated population estimates were amalgamated with this model to calculate travel times to cancer centers at a national and regional level for both the entire population and the population living on < US$2 per day. RESULTS Overall, 68.9% of Nigerians have access to a comprehensive cancer center at 4 hours of continuous vehicular travel. However, there is significant variability in access between geopolitical zones (P < .001). The North East has the lowest access at 4 hours (31.4%) and the highest mean travel times (268 minutes); this is significantly lower than the proportion with 4-hour access in the South East (31.4% v 85.0%, respectively; P < .001). The addition of a second comprehensive cancer center in the North East, in either Bauchi or Gombe, would significantly improve access to this underserved region. CONCLUSION The Federal Ministry of Health endorses investment in 8 public comprehensive cancer centers. Strengthening these centers will allow the majority of Nigerians to access the full complement of multidisciplinary care within a reasonable time frame. However, geospatial access remains inequitable, and the impact on outcomes is unclear. This must be considered as the cancer control system matures and expands.
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Affiliation(s)
- Gregory C Knapp
- Memorial Sloan Kettering Cancer Center, New York, NY.,University of Calgary, Calgary, Alberta, Canada
| | | | | | - Olusegun I Alatise
- College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Funmilola Wuraola
- College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Moses O Olawole
- College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olujide O Arije
- College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
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13
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Leng J, Ntekim AI, Ibraheem A, Anakwenze CP, Golden DW, Olopade OI. Infrastructural Challenges Lead to Delay of Curative Radiotherapy in Nigeria. JCO Glob Oncol 2020; 6:269-276. [PMID: 32083951 PMCID: PMC7051797 DOI: 10.1200/jgo.19.00286] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In low- and middle-income countries, there has been an exponential increase in cancer incidence. According to the International Atomic Energy Agency, the biggest gap in radiotherapy availability and need is in Nigeria, where each machine serves an estimated 25.7 million people. This study aimed to characterize the barriers to radiotherapy and to identify areas for intervention. METHODS This was a cross-sectional study conducted at the University College Hospital in Ibadan, Nigeria, from June 2017 to August 2017. Demographic, sociocultural, and infrastructural factors relating to radiotherapy were collected through a questionnaire (N = 186). Ordinal logistic regression was used to identify the factors leading to delays in referral and delays in treatment initiation. RESULTS Patients traveled from 20 of Nigeria's 36 states. The median age was 50 years (range, 19-79 years). The most common cancers treated were breast (37.5%), cervical (16.3%), head and neck (11.9%), and prostate (10.9%). In ordinal logistic regression, sociocultural factors, including the inability to pay (odds ratio [OR], 1.99; P = .034), a bad hospital experience (OR, 7.05; P = .001), and travel time (OR, 1.36; P = .001), increased the odds of referral delay to radiotherapy. In contrast, there was no significant relationship between time to treatment initiation and sociocultural factors including age, education, and inability to pay. Infrastructural barriers, including machine breakdown (OR, 2.92; P = .001), worker strikes (OR, 2.64; P = .001), and power outages (OR, 2.81; P = .022), increased the odds of treatment delay. CONCLUSION Although delays caused by patient factors are reported extensively, patients overcame these barriers in the hopes of curative treatment. However, staff and equipment malfunctions prevented patients from receiving timely radiotherapy. Policies aimed at addressing machine maintenance, health care worker satisfaction, and the aging power grid in Nigeria must be implemented in the future to strengthen the health care system to care for patients with cancer.
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Affiliation(s)
- Jim Leng
- University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Atara I. Ntekim
- Department of Radiation Oncology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Chidinma P. Anakwenze
- Division of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Daniel W. Golden
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL
| | - Olufunmilayo I. Olopade
- Center for Clinical Cancer Genetics & Global Health, Department of Medicine, University of Chicago, Chicago, IL
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14
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Sharma A, Alatise OI, Adisa AO, Arowolo OA, Olasehinde O, Famurewa OC, Omisore AD, Komolafe AO, Olaofe O, Katung IA, Ibikunle DA, Egberongbe AA, Olatoke SA, Agodirin SO, Adesiyun AO, Adeyeye A, Ibrahim K, Kolawole OA, Idris OL, Adejumobi MO, Ajayi IA, Olakanmi A, Constable JC, Seier K, Gonen M, Brennan M, Kingham T. Treatment of colorectal cancer in Sub-Saharan Africa: Results from a prospective Nigerian hospital registry. J Surg Oncol 2020; 121:342-349. [PMID: 31742699 PMCID: PMC7405945 DOI: 10.1002/jso.25768] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 11/02/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) is the third most common cancer worldwide. Mortality for CRC is improving in high income countries, but in low and middle income countries, rates of disease and death from disease are rising. In Sub-Saharan Africa, the ratio of CRC mortality to incidence is the highest in the world. This study investigated the nature of CRC treatment currently being offered and received in Nigeria. METHODS Between April 2013 and October 2017, a prospective study of consecutively diagnosed cases of CRC was conducted. Patient demographics, clinical features, and treatment recommended and received was recorded for each case. Patients were followed during the study period every 3 months or until death. RESULTS Three hundred patients were included in our analysis. Seventy-one percent of patients received a recommended surgical operation. Of those that didn't undergo surgery as recommended, 37% cited cost as the main reason, 30% declined due to personal reasons, and less than 5% absconded or were lost to follow up. Approximately half of patients (50.5%) received a chemotherapy regimen when it was recommended, and 4.1% received radiotherapy when this was advised as optimal treatment. With therapy, the median overall survival for patients diagnosed with stage III and stage IV CRC was 24 and 10.5 months respectively. Overall, we found significantly better median survival for patients that received the recommended treatment (25 vs 7 months; P < .01). CONCLUSIONS A number of patients were unable to receive the recommended treatment, reflecting some of the burden of untreated CRC in the region. Receiving the recommended treatment was associated with a significant difference in outcome. Improved healthcare financing, literacy, training, access, and a better understanding of tumor biology will be necessary to address this discrepancy.
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Affiliation(s)
- A. Sharma
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - A. O. Adisa
- Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | | | | | | | | | - O. Olaofe
- Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | | | | | | | | | | | - A. Adeyeye
- University Teaching Hospital, Ilorin, Nigeria
| | - K. Ibrahim
- University Teaching Hospital, Ilorin, Nigeria
| | | | - O. L. Idris
- Lautech University Hospital, Osogbo, Nigeria
| | | | - I. A. Ajayi
- Lautech University Hospital, Osogbo, Nigeria
| | - A.O. Olakanmi
- Department of Surgery, University of Medical Sciences Teaching Hospitals’ Complex, Ondo, Nigeria
| | - J. C. Constable
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - K. Seier
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - M. Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - M.F Brennan
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - T.P Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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