"From the Time You Start With them Until the Lord Calls You": A Qualitative Study on the Experiences and Expectations of People Living with Advanced Cancer Interacting With Palliative Care Services in Uganda, Nigeria and Zimbabwe

Remote Symptom Monitoring to Enhance the Delivery of Palliative Cancer Care in Low-Resource Settings: Emerging Approaches from Africa

This paper brings together researchers, clinicians, technology developers and digital innovators to outline current applications of remote symptom monitoring being developed for palliative cancer care delivery in Africa. We outline three remote symptom monitoring approaches from three countries, highlighting their models of delivery and intended outcomes, and draw on their experiences of implementation to guide further developments and evaluations of this approach for palliative cancer care in the region. Through highlighting these experiences and priority areas for future research, we hope to steer efforts to develop and optimise remote symptom monitoring for palliative cancer care in Africa.

Pathways to health outcomes after cancer diagnosis: A systematic review of cancer survivorship in Nigeria

OBJECTIVE

With advancements in medicine and technology, more people are surviving cancers. However, cancer mortality in Nigeria remains high. The yearly estimate is 72,000 cancer-related deaths, making cancer one of the leading causes of death in Nigeria. The current study aimed to identify and synthesize factors that facilitate or hinder cancer survivorship in Nigeria and add to our understanding of the patterns of cancer survivorship in LMICs, such as Nigeria.

METHOD

Following preferred reporting items for systematic reviews and meta-analyses guidelines, a systematic review was conducted across PubMed, Cochrane, and Scopus databases. We identified 31 peer-reviewed studies that examined cancer treatment, management, care, and survivorship in Nigeria.

RESULTS

Eight themes emerged from 31 peer-reviewed studies that examined the factors that facilitate or hinder cancer survivorship among Nigerians. They include themes such as self-care and management, treatment options, availability of pseudo-doctors/pharmacists, and the desire to live. The themes were further grouped into three overarching themes: psychosocial, economic, and health care.

CONCLUSION

Cancer survivors in Nigeria face many unique experiences that impact their health outcomes and chances of survivorship. Therefore, understanding cancer survivorship in Nigeria must involve studies on diagnosis, treatment, remission, surveillance, after-cancer care, and end-of-life. With enhanced support, cancer survivors will have improved health, thereby reducing the cancer mortality rate in Nigeria.

The Prevalence of Cancer Patients Requiring Palliative Care and Its Associated Factors at St. Paul Hospital, Addis Ababa, Ethiopia: A Cross-Sectional Study

Background

Cancer has been the leading cause of death worldwide with its various enormous socio-economic impacts. Hence, early palliative care implementation is a potent addition to oncology for the treatment of physical, mental, and psychological pain in cancer patients. Therefore, this article aims to assess the prevalence of patients requiring palliative care and its associated factors among admitted cancer patients.

Methods

A cross-sectional study was conducted among cancer patients who were admitted to oncology wards during the data collection period at St. Paul Hospital, Ethiopia. The Palliative Care Indicators Tool in Low-Income Settings (SPICT-LIS) was used to determine the need for palliative care. The collected data was entered into EpiData version 3.1 and exported to Statistical Package for the Social Sciences (SPSS) version 26 for analysis. A multivariable logistic regression was used to analyze the predictors of palliative care need.

Results

A total of 301 cancer patients were included in this study, with a mean age of 42 years (SD=1.38). The prevalence of palliative care needs among the patients in this study was 10.6% (n=32). The study revealed that the need for palliative care increases as the age of the patient increases and suggested that cancer patients who were above 61 years old were two times (AOR=2.39 95% CI=0.34-16.55) more likely to need palliative care than others. Male patients had a significantly higher requirement for palliative care compared to female patients (AOR=5.31, 95% CI=1.68-11.79).

Conclusion

The manuscript describes the palliative care needs of patients with cancer admitted to St. Paul Hospital in Ethiopia. The study revealed that the health status of a significant number of cancer patients in the hospital was deteriorating. Hence, the hospital administrators and the oncology ward staff are recommended to pay attention to the identified factors.

Quality of Dying and Death of Patients With Cancer in Hospice Care in Uganda

PURPOSE

Despite advances in palliative care in Uganda, there has been relatively little recent patient-centered research investigating end-of-life outcomes in this region. We assessed the quality of dying and death of patients with cancer in hospice care in Uganda.

METHODS

Bereaved caregivers of patients who received hospice care in Uganda and died 2-12 months earlier (N = 201) completed the Quality of Dying and Death Questionnaire, which includes 31 items and single-item ratings of overall quality of dying and moment of death, and the FAMCARE measure of family satisfaction with cancer care.

RESULTS

Caregivers reported low-intermediate overall quality of dying (mean [M] standard deviation [SD], 3.25 [2.98]) and overall quality of moment of death (M [SD], 3.59 [3.51]), with 47.0% of the ratings of these two outcomes in the poor range, but the mean family satisfaction with care was high (M [SD], 77.75 [10.26]). Most Quality of Dying and Death Questionnaire items (74.2%) were rated within the intermediate range. Items rated within the good range were religious-spiritual, interpersonal, and personal facets; two items within the poor range reflected physical functioning. Overall quality of dying was most strongly correlated with pain control (Spearman's rho [r_s] = 0.45, P < .001), and overall quality of moment of death with state of consciousness before death and being unafraid of dying (r_s = 0.42, P < .001). The FAMCARE score was not correlated with overall quality of dying or moment of death (P = .576-.813). Only one FAMCARE item, information on managing patient's pain, was correlated with overall quality of moment of death (r_s = -0.19, P = .008).

CONCLUSION

End-of-life care in hospices in Uganda requires further improvement, particularly with regard to symptom control. Patient-centered data could bolster advocacy efforts to support quality improvement of palliative care in this and other countries.