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Anakwenze C, Bhatia R, Rate W, Bakwenabatsile L, Ngoni K, Rayne S, Dhillon P, Narasimhamurthy M, Ho-Foster A, Ramogola-Masire D, Grover S. Factors Related to Advanced Stage of Cancer Presentation in Botswana. J Glob Oncol 2019; 4:1-9. [PMID: 30532993 PMCID: PMC6818282 DOI: 10.1200/jgo.18.00129] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Botswana, a country with a high prevalence of HIV, has an increasing
incidence of cancer-related mortality in the post–antiretroviral
therapy era. Despite universal access to free health care, the majority of
Botswana patients with cancer present at advanced stages. This study was
designed to explore the factors related to advanced-stage cancer
presentation in Botswana. Methods Patients attending an oncology clinic between December 2015 and January 2017
at Princess Marina Hospital in Gaborone, Botswana, completed a questionnaire
on sociodemographic and clinical factors as well as cancer-related fears,
attitudes, beliefs, and stigma. Odds ratios (ORs) were calculated to
identify factors significantly associated with advanced stage (stage III and
IV) at diagnosis. Results Of 214 patients, 18.7% were men and 81.3% were women. The median age at
diagnosis was 46 years, with 71.9% of patients older than 40 years. The most
commonly represented cancers included cervical (42.3%), breast (16%), and
head and neck (15.5%). Cancer stages represented in the study group included
8.4% at stage I, 19.2% at stage II, 24.1% at stage III, 11.9% at stage IV,
and 36.4% at an unknown stage. Patients who presented at advanced stages
were significantly more likely to not be afraid of having cancer (OR, 3.48;
P < .05), believe that their family would not care
for them if they needed treatment (OR, 6.35; P = .05), and
believe that they could not afford to develop cancer (OR, 2.73;
P < .05). The perception that symptoms were less
serious was also significantly related to advanced stage (P
< .05). Patients with non–female-specific cancers were more likely
to present in advanced stages (OR, 5.67; P < .05). Conclusion Future cancer mortality reduction efforts should emphasize cancer symptom
awareness and early detection through routine cancer screening, as well as
increasing the acceptability of care-seeking, especially among male
patients.
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Affiliation(s)
- Chidinma Anakwenze
- Chidinma Anakwenze, MD Anderson Cancer Center, Houston, TX; Rohini Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile, Ari Ho-Foster, and Surbhi Grover, Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Philadelphia, PA; Kebatshabile Ngoni, Mohan Narasimhamurthy, and Doreen Ramogola-Masire, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; Preet Dhillon, Public Health Foundation of India, Gurgaon, Haryana, India; and Ari Ho-Foster, Doreen Ramogola-Masire and Surbhi Grover, University of Pennsylvania, Philadelphia, PA
| | - Rohini Bhatia
- Chidinma Anakwenze, MD Anderson Cancer Center, Houston, TX; Rohini Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile, Ari Ho-Foster, and Surbhi Grover, Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Philadelphia, PA; Kebatshabile Ngoni, Mohan Narasimhamurthy, and Doreen Ramogola-Masire, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; Preet Dhillon, Public Health Foundation of India, Gurgaon, Haryana, India; and Ari Ho-Foster, Doreen Ramogola-Masire and Surbhi Grover, University of Pennsylvania, Philadelphia, PA
| | - William Rate
- Chidinma Anakwenze, MD Anderson Cancer Center, Houston, TX; Rohini Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile, Ari Ho-Foster, and Surbhi Grover, Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Philadelphia, PA; Kebatshabile Ngoni, Mohan Narasimhamurthy, and Doreen Ramogola-Masire, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; Preet Dhillon, Public Health Foundation of India, Gurgaon, Haryana, India; and Ari Ho-Foster, Doreen Ramogola-Masire and Surbhi Grover, University of Pennsylvania, Philadelphia, PA
| | - Lame Bakwenabatsile
- Chidinma Anakwenze, MD Anderson Cancer Center, Houston, TX; Rohini Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile, Ari Ho-Foster, and Surbhi Grover, Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Philadelphia, PA; Kebatshabile Ngoni, Mohan Narasimhamurthy, and Doreen Ramogola-Masire, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; Preet Dhillon, Public Health Foundation of India, Gurgaon, Haryana, India; and Ari Ho-Foster, Doreen Ramogola-Masire and Surbhi Grover, University of Pennsylvania, Philadelphia, PA
| | - Kebatshabile Ngoni
- Chidinma Anakwenze, MD Anderson Cancer Center, Houston, TX; Rohini Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile, Ari Ho-Foster, and Surbhi Grover, Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Philadelphia, PA; Kebatshabile Ngoni, Mohan Narasimhamurthy, and Doreen Ramogola-Masire, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; Preet Dhillon, Public Health Foundation of India, Gurgaon, Haryana, India; and Ari Ho-Foster, Doreen Ramogola-Masire and Surbhi Grover, University of Pennsylvania, Philadelphia, PA
| | - Sarah Rayne
- Chidinma Anakwenze, MD Anderson Cancer Center, Houston, TX; Rohini Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile, Ari Ho-Foster, and Surbhi Grover, Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Philadelphia, PA; Kebatshabile Ngoni, Mohan Narasimhamurthy, and Doreen Ramogola-Masire, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; Preet Dhillon, Public Health Foundation of India, Gurgaon, Haryana, India; and Ari Ho-Foster, Doreen Ramogola-Masire and Surbhi Grover, University of Pennsylvania, Philadelphia, PA
| | - Preet Dhillon
- Chidinma Anakwenze, MD Anderson Cancer Center, Houston, TX; Rohini Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile, Ari Ho-Foster, and Surbhi Grover, Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Philadelphia, PA; Kebatshabile Ngoni, Mohan Narasimhamurthy, and Doreen Ramogola-Masire, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; Preet Dhillon, Public Health Foundation of India, Gurgaon, Haryana, India; and Ari Ho-Foster, Doreen Ramogola-Masire and Surbhi Grover, University of Pennsylvania, Philadelphia, PA
| | - Mohan Narasimhamurthy
- Chidinma Anakwenze, MD Anderson Cancer Center, Houston, TX; Rohini Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile, Ari Ho-Foster, and Surbhi Grover, Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Philadelphia, PA; Kebatshabile Ngoni, Mohan Narasimhamurthy, and Doreen Ramogola-Masire, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; Preet Dhillon, Public Health Foundation of India, Gurgaon, Haryana, India; and Ari Ho-Foster, Doreen Ramogola-Masire and Surbhi Grover, University of Pennsylvania, Philadelphia, PA
| | - Ari Ho-Foster
- Chidinma Anakwenze, MD Anderson Cancer Center, Houston, TX; Rohini Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile, Ari Ho-Foster, and Surbhi Grover, Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Philadelphia, PA; Kebatshabile Ngoni, Mohan Narasimhamurthy, and Doreen Ramogola-Masire, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; Preet Dhillon, Public Health Foundation of India, Gurgaon, Haryana, India; and Ari Ho-Foster, Doreen Ramogola-Masire and Surbhi Grover, University of Pennsylvania, Philadelphia, PA
| | - Doreen Ramogola-Masire
- Chidinma Anakwenze, MD Anderson Cancer Center, Houston, TX; Rohini Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile, Ari Ho-Foster, and Surbhi Grover, Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Philadelphia, PA; Kebatshabile Ngoni, Mohan Narasimhamurthy, and Doreen Ramogola-Masire, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; Preet Dhillon, Public Health Foundation of India, Gurgaon, Haryana, India; and Ari Ho-Foster, Doreen Ramogola-Masire and Surbhi Grover, University of Pennsylvania, Philadelphia, PA
| | - Surbhi Grover
- Chidinma Anakwenze, MD Anderson Cancer Center, Houston, TX; Rohini Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile, Ari Ho-Foster, and Surbhi Grover, Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Philadelphia, PA; Kebatshabile Ngoni, Mohan Narasimhamurthy, and Doreen Ramogola-Masire, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; Preet Dhillon, Public Health Foundation of India, Gurgaon, Haryana, India; and Ari Ho-Foster, Doreen Ramogola-Masire and Surbhi Grover, University of Pennsylvania, Philadelphia, PA
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