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Lovane L, Tulsidás S, Carrilho C, Karlsson C. PD-L1 expression in squamous cervical carcinomas of Mozambican women living with or without HIV. Sci Rep 2024; 14:12974. [PMID: 38839923 PMCID: PMC11153591 DOI: 10.1038/s41598-024-63595-7] [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: 02/09/2024] [Accepted: 05/30/2024] [Indexed: 06/07/2024] Open
Abstract
Programmed death-ligand 1 (PD-L1) is overexpressed in squamous cervical cancer (SCC) and can be used for targeted immunotherapy. The highest mortality rates of SCC are reported in sub-Saharan Africa, where Human immunodeficiency virus (HIV) prevalence is high. In Mozambique most SCC patients present at advanced stages. Thus, there is a need to introduce new treatment options. However, immunocompromised patients were frequently excluded in previous clinical trials. Our aim was to determine if PD-L1 expression in SCC is as prevalent among women living with HIV (WLWH) as among other patients. 575 SCC from Maputo Central Hospital were included. HIV status was available in 266 (46%) cases PD-L1 expression was scored through tumour proportion score (TPS) and combined positive score (CPS). PD-L1 was positive in 20.1% of the cases (n = 110), TPS (score ≥ 25%) and in 26.3% (n = 144), CPS (score ≥ 1). Stratifying according to the HIV status, WLWH were TPS positive in 16.7%, compared to 20.9%, p = 0.43, and concerning CPS 21.1% versus 28.7%, p = 0.19, respectively. PD-L1 status was not influenced by stage, Ki-67 or p16, CD8 expression influenced only CPS status. Our data indicates that the documented effect of PD-L1 therapy on SCC should be confirmed in randomized clinical trials in an HIV endemic milieu.
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Affiliation(s)
- Lucília Lovane
- Pathology Department, Maputo Central Hospital, Maputo, Mozambique.
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique.
| | - Satish Tulsidás
- Medical Oncology Service, Maputo Central Hospital, Maputo, Mozambique
| | - Carla Carrilho
- Pathology Department, Maputo Central Hospital, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Christina Karlsson
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Mwenda V, Mwangi M, Gathecha G, Kibachio J, Too R, Gura Z, Temmerman M. Factors associated with late diagnosis of cervical cancer at two national referral hospitals, Kenya 2017: A case control study. Gynecol Oncol Rep 2024; 52:101355. [PMID: 38500641 PMCID: PMC10945120 DOI: 10.1016/j.gore.2024.101355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/01/2023] [Accepted: 02/27/2024] [Indexed: 03/20/2024] Open
Abstract
Background Cervical cancer is the leading cause of cancer mortality among women in Kenya. Two thirds of cervical cancer cases in Kenya are diagnosed in advanced stages. We aimed to identify factors associated with late diagnosis of cervical cancer, to guide policy interventions. Methods An unmatched case control study (ratio 1:2) was conducted among women aged ≥ 18 years with cervical cancer at Kenyatta National and Moi Teaching and Referral Hospitals. We defined a case as patients with International Federation of Gynecology and Obstetrics (FIGO) stage ≥ 2A and controls as those with stage ≤ 1B. A structured questionnaire was used to document exposure variables. We calculated adjusted odds ratio (aOR) to identify any associations. Results We enrolled 192 participants (64 cases, 128 controls). Mean age 39.2 (±9.3) years, 145 (76 %) were married, 77 (40 %) had primary level education, 168 (88 %) had their first pregnancy ≤ 24 years of age, 85 (44 %) were > para 3 and 150 (78 %) used contraceptives. Late diagnosis of cervical cancer was associated with cost of travel to cancer centres > USD 6.1 (aOR 6.43 95% CI [1.30, 31.72]), age > 50 years (aOR 4.71; 95% CI [1.18, 18.80]), anxiety over cost of cancer care (aOR 5.6; 95% CI [1.05, 32.72]) and ultrasound examination during evaluation of symptoms (aOR 4.89; 95% CI [1.07-22.42]). Previous treatment for gynecological infections (aOR 0.10; 95% CI [0.02, 0.47]) was protective against late diagnosis. Conclusion Cost of seeking care and the quality of the diagnostic process were important factors in this study. Decentralization of care, innovative health financing solutions and clear diagnostic and referral algorithms for women presenting with gynecological symptoms could reduce late-stage diagnosis in Kenya.
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Affiliation(s)
- Valerian Mwenda
- Department of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
| | - Martin Mwangi
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
| | - Gladwell Gathecha
- Department of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
| | - Joseph Kibachio
- Department of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
| | - Robert Too
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
- School of Public Health, Moi University, Eldoret, Kenya
| | - Zeinab Gura
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
| | - Marleen Temmerman
- Department of Obstetrics and Gynaecology, Aga Khan University Hospital, Nairobi, Kenya
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Dau H, Nankya E, Naguti P, Basemera M, Payne BA, Vidler M, Singer J, McNair A, AboMoslim M, Smith L, Orem J, Nakisige C, Ogilvie G. The economic burden of cervical cancer on women in Uganda: Findings from a cross-sectional study conducted at two public cervical cancer clinics. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002554. [PMID: 38489259 PMCID: PMC10942052 DOI: 10.1371/journal.pgph.0002554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 02/25/2024] [Indexed: 03/17/2024]
Abstract
There is limited research on how a cervical cancer diagnosis financially impacts women and their families in Uganda. This analysis aimed to describe the economic impact of cervical cancer treatment, including how it differs by socio-economic status (SES) in Uganda. We conducted a cross-sectional study from September 19, 2022 to January 17, 2023. Women were recruited from the Uganda Cancer Institute and Jinja Regional Referral Hospital, and were eligible if they were ≥ of 18 years and being treated for cervical cancer. Participants completed a survey that included questions about their out-of-pocket costs, unpaid labor, and family's economic situation. A wealth index was constructed to determine their SES. Descriptive statistics were reported. Of the 338 participants, 183 were from the lower SES. Women from the lower SES were significantly more likely to be older, have ≤ primary school education, and have a more advanced stage of cervical cancer. Over 90% of participants in both groups reported paying out-of-pocket for cervical cancer. Only 15 participants stopped treatment because they could not afford it. Women of a lower SES were significantly more likely to report borrowing money (higher SES n = 47, 30.5%; lower SES n = 84, 46.4%; p-value = 0.004) and selling possessions (higher SES n = 47, 30.5%; lower SES n = 90, 49.7%; p-value = 0.006) to pay for care. Both SES groups reported a decrease in the amount of time that they spent caring for their children since their cervical cancer diagnosis (higher SES n = 34, 31.2%; lower SES n = 36, 29.8%). Regardless of their SES, women in Uganda incur out-of-pocket costs related to their cervical cancer treatment. However, there are inequities as women from the lower SES groups were more likely to borrow funds to afford treatment. Alternative payment models and further economic support could help alleviate the financial burden of cervical cancer care in Uganda.
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Affiliation(s)
- Hallie Dau
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
| | | | | | - Miriam Basemera
- Cancer Unit, Jinja Regional Referral Hospital, Jinja, Uganda
| | - Beth A. Payne
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joel Singer
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Advancing Health Outcomes, St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Avery McNair
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
| | - Maryam AboMoslim
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
| | - Laurie Smith
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
- BC Cancer, Vancouver, British Columbia, Canada
| | | | | | - Gina Ogilvie
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Women’s Health Research Institute, Vancouver, British Columbia, Canada
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
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Mulchandani R, Lyngdoh T, Gandotra S, Isser HS, Dhamija RK, Kakkar AK. Field based research in the era of the pandemic in resource limited settings: challenges and lessons for the future. Front Public Health 2024; 12:1309089. [PMID: 38487184 PMCID: PMC10938915 DOI: 10.3389/fpubh.2024.1309089] [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: 10/07/2023] [Accepted: 01/30/2024] [Indexed: 03/17/2024] Open
Abstract
The coronavirus pandemic that began in December 2019, has had an unprecedented impact on the global economy, health systems and infrastructure, in addition to being responsible for significant mortality and morbidity worldwide. The "new normal" has brought along, unforeseen challenges for the scientific community, owing to obstructions in conducting field-based research in lieu of minimizing exposure through in-person contact. This has had greater ramifications for the LMICs, adding to the already existing concerns. As a response to COVID-19 related movement restrictions, public health researchers across countries had to switch to remote data collections methods. However, impediments like lack of awareness and skepticism among participants, dependence on paper-based prescriptions, dearth of digitized patient records, gaps in connectivity, reliance on smart phones, concerns with participant privacy at home and greater loss to follow-up act as hurdles to carrying out a research study virtually, especially in resource-limited settings. Promoting health literacy through science communication, ensuring digitization of health records in hospitals, and employing measures to encourage research participation among the general public are some steps to tackle barriers to remote research in the long term. COVID-19 may not be a health emergency anymore, but we are not immune to future pandemics. A more holistic approach to research by turning obstacles into opportunities will not just ensure a more comprehensive public health response in the coming time, but also bolster the existing infrastructure for a stronger healthcare system for countries.
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Affiliation(s)
- Rubina Mulchandani
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurgaon, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Tanica Lyngdoh
- Division of Reproductive, Child Health and Nutrition, Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Sheetal Gandotra
- Institute of Genomics and Integrative Biology, Council of Scientific and Industrial Research (CSIR), New Delhi, India
| | - H. S. Isser
- Department of Cardiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Rajinder K. Dhamija
- Department of Neurology, Institute of Human Behaviour and Allied Sciences, University of Delhi, New Delhi, India
| | - Ashish Kumar Kakkar
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Zewdie A, Shitu S, Kebede N, Gashaw A, Eshetu HB, Eseyneh T, Kasahun AW. Determinants of late-stage cervical cancer presentation in Ethiopia: a systematic review and meta-analysis. BMC Cancer 2023; 23:1228. [PMID: 38097989 PMCID: PMC10720221 DOI: 10.1186/s12885-023-11728-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/08/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Behind breast, colorectal, and lung cancers, cervical cancer is the fourth most common cancer affecting females. Despite, it is a preventable form of cancer both the incidence and mortality figures reflect it as a major reproductive health problem. Late-stage cervical cancer diagnosis is associated with complicated clinical presentation which can result in short survival time and increased mortality. Several factors contribute to the late-stage presentation of cervical cancer patients. In Ethiopia nationally summarized evidence on the level and the factors contributing to late-stage cervical cancer diagnosis is scarce. Therefore, this systematic review and meta-analysis aimed to assess the pooled prevalence of late-stage cervical cancer diagnosis and its determinants in Ethiopia. METHOD A systematic review and meta-analysis were conducted using PRISMA guidelines. Comprehensive literature was searched in PubMed, Embase, Google Scholar, and African Online Journal to retrieve eligible articles. A weighted inverse variance random effect model was used to estimate pooled prevalence. Cochrane Q-test and I2 statistics were computed to assess heterogeneity among studies. Funnel plot and Egger's regression test were done to assess publication bias. RESULT Overall, 726 articles were retrieved and finally 10 articles were included in this review. The pooled prevalence of late-stage cervical cancer diagnosis in Ethiopia was 60.45% (95%CI; 53.04%-67.85%). Poor awareness about cervical cancer and its treatment (AOR = 1.55, 95% CI: (1.03 - 2.33, longer delay to seek care (AOR = 1.02, 95% CI: (1.01 - 1.03)) and rural residence (AOR = 2.07, 95% CI:( 1.56 - 2.75)) were significantly associated to late-stage diagnosis. CONCLUSION In Ethiopia, six in every ten cervical cancer cases are diagnosed at the late stage of the disease. Poor awareness about cervical cancer and its treatment, long patient delay to seek care, and rural residence were positively associated with late-stage diagnosis. Therefore intervention efforts should be made to improve public awareness about cervical cancer, minimize patient delay to seek care, and expand screening services specifically in the rural residing segment of the population to detect the disease early and improve survival.
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Affiliation(s)
- Amare Zewdie
- Department of Public Health, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia.
| | - Solomon Shitu
- Department of Midwifery, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
| | - Natnael Kebede
- Department of Health Promotion, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Anteneh Gashaw
- Department of Midwifery, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Habitu Birhan Eshetu
- Department of Health Promotion and Health Behaviour, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, PO.Box.196, Gondar, Ethiopia
| | - Tenagnework Eseyneh
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Abebaw Wasie Kasahun
- Department of Public Health, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia
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Christensen AJ, Mwayi J, Mbabazi J, Juncker M, Kallestrup P, Kraef C. Fighting cervical cancer in Africa: a cross-sectional study on prevalence and risk factors for precancerous lesions in rural Uganda. Public Health 2023; 225:87-95. [PMID: 37922591 DOI: 10.1016/j.puhe.2023.09.023] [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: 05/15/2023] [Revised: 09/06/2023] [Accepted: 09/26/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To identify risk factors for precancerous cervical lesions and factors associated with treatment delay among women in the rural Busoga Region, Uganda. STUDY DESIGN A retrospective cross-sectional study from a regional cervical cancer screening program and from cervical cancer patients enrolled in a region-wide palliative care program. METHODS Logistic regression analysis was conducted to assess risk factors for screening positive for precancerous lesions. In a separate analysis, factors associated with treatment delay were assessed among women enrolled in the palliative care program. RESULTS Three thousand nine hundred forty-six women were included from the screening program and 334 from the palliative care program. In total, 7.6% of screening participants had precancerous lesions. Within Busoga Region, the highest positivity rate was found in Bugweri and Namayingo Districts. Abnormal vaginal bleeding (adjusted odds ratio [aOR] 1.60; 95% confidence interval [CI] 1.15-2.21; p = 0.005) and older age at first menstrual period (aOR 1.08; 95% CI 1.01-1.16; p = 0.03) were associated with having a precancerous lesion. Among palliative care patients, a history of previous contact with the health care system was associated with a delay in enrolment (≥12 months from first symptom presentation until commencement in palliative care; aOR 5.23; 95% CI 1.16-36.54; p = 0.047). CONCLUSIONS The results underline an unmet need for broad-scale cervical cancer screening focusing on all women in the reproductive age. Abnormal bleeding was the only substantial risk factor for precancerous lesions, indicating that specific algorithms to identify high-risk populations may not be applicable in this population. Increased awareness, resources, and funding are still necessary to achieve global cervical cancer elimination.
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Affiliation(s)
| | - J Mwayi
- Rays of Hope Hospice Jinja, Uganda
| | | | | | - P Kallestrup
- Department of Public Health, Aarhus University, Denmark; Danish Non-Communicable-Disease Alliance, Denmark
| | - C Kraef
- Department of Infectious Diseases, Rigshospitalet Copenhagen, Denmark; Heidelberg Institute of Global Health, University of Heidelberg, Germany; Centre of Excellence for Health, Immunity and Infections (CHIP), Copenhagen University Hospital - Rigshospitalet, Denmark
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Lacika JL, Wabinga H, Kagaayi J, Opito R, Orach CG, Mwaka AD. Diagnostic and pre-treatment intervals among patients with cervical cancer attending care at the Uganda Cancer Institute: a cross-sectional study. BMC Womens Health 2023; 23:633. [PMID: 38012615 PMCID: PMC10683271 DOI: 10.1186/s12905-023-02785-3] [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: 07/27/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Majority of patients with cervical cancer in the low- and middle-income countries experience long diagnostic and pre-treatment intervals. This study sought to determine the factors associated with the diagnostic and pre-treatment intervals among patients with cervical cancer. METHODS This was a cross-sectional study conducted at the Uganda Cancer Institute (UCI) during October 2019 to January 2020. Patients aged ≥ 18 years with histological diagnosis of cervical cancer were consecutively sampled. Data were collected using a pre-tested semi-structured questionnaire and a data abstraction form. Diagnostic intervals, defined as the time between first visit of a patient to a primary healthcare provider to time of getting confirmed diagnosis, of ≤ 3 months was defined as early & >3 months as late. Pre-treatment intervals, which is the time from histological diagnosis to starting cancer chemo-radiotherapy of ≤ 1 month was defined as early and > 1 month as late. Data were analysed using STATA version 14.0. We used modified Poisson regression models with robust variance to determine socio-demographic and clinical factors associated with the intervals. RESULTS The mean age of the participants was 50.0 ± 11.7 years. The median diagnostic and pre-treatment intervals were 3.1 (IQR: 1.4-8.2) months and 2.4 (IQR: 1.2-4.1) months respectively. Half of the participants, 49.6% (200/403) were diagnosed early; one in 5 patients, 20.1% (81/403) promptly (within one month) initiated cancer chemo-radiotherapy. Participants more likely to be diagnosed early included those referred from district hospitals (level 5) (aPR = 2.29; 95%CI: 1.60-3.26) and with squamous cell carcinomas (aPR = 1.55; 95%CI: 1.07-2.23). Participants more likely to be diagnosed late included those who first discussed their symptoms with relatives, (aPR = 0.77; 95%CI: (0.60-0.98), had > 2 pre-referral visits (aPR = 0.75; 95%CI (0.61-0.92), and had advanced stage (stages 3 or 4) (aPR = 0.68; 95%CI: 0.55-0.85). Participants more likely to initiate cancer chemo-radiotherapy early included older patients (≥ 60 years) (aPR = 2.44; 95%CI: 1.18-5.03). Patients likely to start treatment late were those who had ≥2 pre-referral visits (aPR = 0.63; 95%CI: 0.41-0.98) and those that took 3 - 6 months with symptoms before seeking healthcare (aPR = 0.52;95%CI: 0.29 - 0.95). CONCLUSION Interventions to promote prompt health-seeking and early diagnosis of cervical cancer need to target primary healthcare facilities and aim to enhance capacity of primary healthcare professionals to promptly initiate diagnostic investigations. Patients aged < 60 years require targeted interventions to promote prompt initiation of chemo-radiation therapy.
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Affiliation(s)
- Jackie Lalam Lacika
- Department of Community Health & Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Henry Wabinga
- Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Joseph Kagaayi
- Department of Community Health & Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Ronald Opito
- Department of Public Health, School of Health Sciences, Soroti University, P.O Box 211, Soroti, Uganda
| | - Christopher Garimoi Orach
- Department of Community Health & Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Amos Deogratius Mwaka
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda.
- Department of Medicine, Faculty of Medicine, Gulu University, P.O Box 166, Gulu, Uganda.
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Achan J, Kasujja FX, Opito R, Wabinga H, Orach CG, Mwaka AD. Factors associated with diagnostic and pre-treatment intervals among breast cancer patients attending care at the Uganda Cancer Institute: A cross-sectional study. Cancer Med 2023; 12:19701-19713. [PMID: 37787090 PMCID: PMC10587984 DOI: 10.1002/cam4.6618] [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: 01/26/2023] [Revised: 08/09/2023] [Accepted: 09/23/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Most breast cancer (BC) patients in Uganda are diagnosed with advanced-stage disease and experience poor outcomes. This study examined the diagnostic and pre-treatment intervals and factors associated with these intervals among BC patients attending care at the Uganda Cancer Institute (UCI). METHODS This was a cross-sectional, facility-based study. Data were collected using structured questionnaire administered by trained research assistants and analyzed using STATA version 14.0. Modified Poisson regressions models were used to determine the strength of associations between independent variables and diagnostic and pre-treatment intervals. RESULTS The mean age (±SD) of the 401 participants was 47.1 ± 11.7 years. Four in 10 participants had stage III (41.9%; n = 168) and over a third (34.7%; n = 140) stage IV cancers. The median interval from first consultation to diagnosis, i.e. diagnostic interval (DI) was 5.6 months (IQR: 1.5-17.0), while the median interval from histological diagnosis to start of chemotherapy, i.e. pre-treatment interval (PTI) was 1.7 months (IQR: 0.7-4.5). Majority (85%, n = 341) of participants were diagnosed at ≥3 months from first consultation with clinicians. Participants with tertiary education and those who lived within 100-199 km from the UCI were about four times and twice more likely to be diagnosed early (DI <3 months from first consultation) ([aPR = 3.88; 95% CI: 1.15-13.0] and [aPR = 2.19; 95% CI: 1.06-4.55]), respectively. About half (48.3%; n = 176) of participants started chemotherapy within 1 month of cancer diagnosis. Patients who lived more than 300 km from the UCI were less likely to start chemotherapy within 1 month of histology diagnosis of cancer. [Correction added on October 17, 2023 after first online publication. The term ', i.e.' has been included in the results section in this version.] CONCLUSION: Majority of breast cancer patients are diagnosed late and in advanced stages. There is need to promote all efforts toward timely diagnosis when cancers are still in early stages by identifying factors responsible for prolonged diagnostic intervals among breast cancer patients.
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Affiliation(s)
- Jennifer Achan
- Department of Community Health & Behavioral Sciences, School of Public HealthCollege of Health Sciences, Makerere UniversityKampalaUganda
| | - Francis Xavier Kasujja
- Department of Community Health & Behavioral Sciences, School of Public HealthCollege of Health Sciences, Makerere UniversityKampalaUganda
| | - Ronald Opito
- Department of Public Health, School of Health SciencesSoroti UniversitySorotiUganda
| | - Henry Wabinga
- Department of Pathology, School of Biomedical SciencesCollege of Health Sciences, Makerere UniversityKampalaUganda
| | - Christopher Garimoi Orach
- Department of Community Health & Behavioral Sciences, School of Public HealthCollege of Health Sciences, Makerere UniversityKampalaUganda
| | - Amos Deogratius Mwaka
- Department of Medicine, School of MedicineCollege of Health Sciences, Makerere UniversityKampalaUganda
- Department of Medicine, Faculty of MedicineGulu UniversityGuluUganda
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Kajabwangu R, Ssedyabane F, Tusubira D, Maling S, Kakongi N, Turyakira E, Namuli A, Galiwango M, Randall TC. High Rate of Loss to Follow-Up Among Patients Undergoing Treatment for Premalignant Cervical Lesions at Mbarara Regional Referral Hospital, Southwestern Uganda: A Retrospective Cohort Study. Cureus 2023; 15:e46542. [PMID: 37927695 PMCID: PMC10625478 DOI: 10.7759/cureus.46542] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND For a cervical cancer control program to be effective in reducing the incidence of the disease, there should be high compliance to treatment and follow-up of women diagnosed with precursor lesions. Screening programs in low-resource countries such as Uganda are challenged by poor adherence to follow-up following treatment for premalignant cervical lesions. This study sought to describe the burden and factors associated with loss to follow-up among women undergoing treatment for premalignant cervical lesions at a tertiary hospital in southwestern Uganda. METHODS This was a retrospective cohort study. We reviewed the registers at the Mbarara Regional Referral Hospital (MRRH) cervical cancer clinic for a period of four years from January 2017 to December 2020. Data on age, district of residence, diagnosis, date of diagnosis, date and type of initial treatment, and date of follow-up visit were collected. We also captured data on whether patients returned on the scheduled follow-up date or within three months after the scheduled follow-up date. We defined loss to follow-up as failure to return for follow-up either on the scheduled date or within three months after the scheduled date. RESULTS Out of the 298 patients who underwent treatment for premalignant cervical lesions in the study period, 227 (76.2%) did not return for follow-up at one year. At bivariate analysis, failure to attend the review visit at six weeks predicted the loss to follow-up at one year following treatment for premalignant lesions almost perfectly (risk ratio (RR)=2.84, 95% confidence interval (CI): 2.18-3.71, p<0.001). Negative HIV serostatus and receiving thermocoagulation slightly increased the risk of getting lost to follow-up, while being more than 45 years old reduced the odds. At multivariate analysis, treatment with thermocoagulation (adjusted risk ratio (aRR)=1.21, 95% CI: 1.07-1.36, p=0.03) was associated with loss to follow-up at one year. CONCLUSION The proportion of women who did not return for follow-up at one year following treatment for premalignant cervical lesions at Mbarara Regional Referral Hospital is very high. There is a need to implement strategies such as telephone-aided reminders to prompt patients to return for follow-up following treatment for premalignant cervical lesions.
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Affiliation(s)
- Rogers Kajabwangu
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology, Mbarara, UGA
| | - Frank Ssedyabane
- Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara, UGA
| | - Deusdedit Tusubira
- Department of Biochemistry, Mbarara University of Science and Technology, Mbarara, UGA
| | - Samuel Maling
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, UGA
| | - Natthan Kakongi
- Department of Biochemistry, Mbarara University of Science and Technology, Mbarara, UGA
| | - Eleanor Turyakira
- Department of Community Health, Mbarara University of Science and Technology, Mbarara, UGA
| | - Alexcer Namuli
- Department of Obstetrics and Gynecology, Mbarara Regional Referral Hospital, Mbarara, UGA
| | - Martin Galiwango
- Department of Electrical and Electronics Engineering, Faculty of Applied Sciences and Technology, Mbarara University of Science and Technology, Mbarara, UGA
| | - Thomas C Randall
- Department of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School, Boston, USA
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Dozie UW, Ezeala OV, David CI, Dozie KCN, Chukwuocha UM, Iwuala CC, Osuoji NJ, Okoro CC, Chukwu OR, Eneh SC, Dozie INS. Factors associated with health seeking delay in the screening of cervical cancer among women in Imo state, south Eastern Nigeria. Cancer Treat Res Commun 2023; 37:100765. [PMID: 37806167 DOI: 10.1016/j.ctarc.2023.100765] [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: 06/29/2023] [Revised: 09/21/2023] [Accepted: 09/23/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND TO THE STUDY Cervical cancer is a curable disease if diagnosed early. The mortality rate due to cervical cancer is high worldwide, mainly because of the absence of a functioning screening process and the advanced stage of the disease at diagnosis. The aim of this study was to assess the factors associated with health-seeking delay in the screening of cervical cancer among women in Owerri Municipal LGA, Imo State. METHODS A descriptive cross-sectional research design was employed in this study on factors associated with health-seeking delay in the screening of cervical cancer among women in Owerri Municipal LGA. A semi-structured questionnaire was used for the study, and Statistical Package for the Social Sciences (SPSS) version 20 was used in the analysis of the data gotten from the study. A probability-based multi-stage sampling method was adopted for the study in recruiting 432 women who participated in it. RESULT Results from the study showed that most of the women, 117 (27.1 %), were between the ages of 22 and 27. The study found that a high percentage of the respondents, 350 (81.0 %), had heard about cervical cancer screening, and when they were asked who they thought should be screened for cervical cancer, 154 (35.6 %) said women between the ages of 15 and 40. Further findings revealed that, 420 (97.2 %) said they had not been screened for cervical cancer. The study also demonstrated that 260 (60.2 %) believe long distance has an impact on your access to health care. The findings of this study revealed that age (P = 0.0247), educational level of women (P = 0.0214), and monthly income of the women (P = 0.0062) were all significantly associated with health-seeking delay in cervical screening. CONCLUSION The study concluded that there is no limited knowledge about cervical cancer among women in Owerri Municipal. Long distance to screening facilities, educational background, and monthly income are significantly associated with the delay in seeking health services for cervical screening. RECOMMENDATION The study recommended that there should be massive awareness and participation in the screening program across the state.
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Affiliation(s)
- Ugonma Winnie Dozie
- Department of Public Health, Federal University of Technology Owerri Imo State, Nigeria.
| | | | | | | | | | | | - Nkechi Joy Osuoji
- Department of Public Health, Federal University of Technology Owerri Imo State, Nigeria
| | - Chisomuaga Chidinma Okoro
- Department of Environmental Health Science, Federal University of Technology Owerri Imo State, Nigeria
| | - Ogechi Rita Chukwu
- Department of Public Health, Federal University of Technology Owerri Imo State, Nigeria
| | - Stanley Chinedu Eneh
- Department of Community He4alth Department, Obafemi Awowolo University, Ile-Ife, Osun State, Nigeria
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11
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Deenadayalan SK, Balakrishnan K, Chidambaram S. Factors associated with knowledge of diagnosis, prognosis & distress in cancer patients receiving palliative care - A retrospective cohort analysis. Indian J Med Res 2023; 157:568-576. [PMID: 37530312 PMCID: PMC10466486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Indexed: 09/13/2023] Open
Abstract
Background & objectives Demographic attributes of cancer patients are associated with the awareness of diagnosis, the prognosis of cancer and their associated psychological distress. This study was aimed to assess the knowledge of diagnosis, prognosis and psychological distress among patients reporting to the pain and palliative care department in a tertiary cancer hospital, south India. Methods Data of all patients visiting the palliative care outpatient department of a tertiary cancer centre in south India between January and June 2018 were included in the study (n=754). A structured pro forma was used to collect information on the sociodemographic details and clinical aspects and a distress thermometer was used to assess the level of distress. Information, thus collected, were analysed using descriptive statistics and logistic regression. Results Around 16.2 per cent of the patients were unaware of their diagnosis while two third (68%) were unaware of the prognosis. More than half of the patients reported significant distress (54.1%). Gender, education, not working and being diagnosed with head-and-neck cancers were associated with knowledge of diagnosis, while educational level predicted the knowledge of prognosis. Younger age group, head-and-neck cancer, haematology cancer, state of being unaware of diagnosis and prognosis were found to be associated with distress. Interpretation & conclusions Higher educational levels and better socio-economic status increase the likelihood of patients being aware of their diagnosis and prognosis. Being unaware of the prognosis remains associated with the higher level of distress.
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Affiliation(s)
| | - Kalpana Balakrishnan
- Department of Palliative Care, Cancer Institute (WIA), Chennai, Tamil Nadu, India
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12
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Deenadayalan SK, Balakrishnan K, Chidambaram S. Factors associated with knowledge of diagnosis, prognosis & distress in cancer patients receiving palliative care - A retrospective cohort analysis. Indian J Med Res 2023; 157:568-576. [PMID: 37530312 PMCID: PMC10466486 DOI: 0.4103/ijmr.ijmr_2843_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Indexed: 07/08/2023] Open
Abstract
Background & objectives Demographic attributes of cancer patients are associated with the awareness of diagnosis, the prognosis of cancer and their associated psychological distress. This study was aimed to assess the knowledge of diagnosis, prognosis and psychological distress among patients reporting to the pain and palliative care department in a tertiary cancer hospital, south India. Methods Data of all patients visiting the palliative care outpatient department of a tertiary cancer centre in south India between January and June 2018 were included in the study (n=754). A structured pro forma was used to collect information on the sociodemographic details and clinical aspects and a distress thermometer was used to assess the level of distress. Information, thus collected, were analysed using descriptive statistics and logistic regression. Results Around 16.2 per cent of the patients were unaware of their diagnosis while two third (68%) were unaware of the prognosis. More than half of the patients reported significant distress (54.1%). Gender, education, not working and being diagnosed with head-and-neck cancers were associated with knowledge of diagnosis, while educational level predicted the knowledge of prognosis. Younger age group, head-and-neck cancer, haematology cancer, state of being unaware of diagnosis and prognosis were found to be associated with distress. Interpretation & conclusions Higher educational levels and better socio-economic status increase the likelihood of patients being aware of their diagnosis and prognosis. Being unaware of the prognosis remains associated with the higher level of distress.
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Affiliation(s)
| | - Kalpana Balakrishnan
- Department of Palliative Care, Cancer Institute (WIA), Chennai, Tamil Nadu, India
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13
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Lombe DC, Mwamba M, Msadabwe S, Bond V, Simwinga M, Ssemata AS, Muhumuza R, Seeley J, Mwaka AD, Aggarwal A. Delays in seeking, reaching and access to quality cancer care in sub-Saharan Africa: a systematic review. BMJ Open 2023; 13:e067715. [PMID: 37055211 PMCID: PMC10106057 DOI: 10.1136/bmjopen-2022-067715] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
OBJECTIVES Late presentation and delays in diagnosis and treatment consistently translate into poor outcomes in sub-Saharan Africa (SSA). The aim of this study was to collate and appraise the factors influencing diagnostic and treatment delays of adult solid tumours in SSA. DESIGN Systematic review with assessment of bias using Risk of Bias in Non-randomised Studies of Exposures (ROBINS-E) tool. DATA SOURCES PubMed and Embase, for publications from January 1995 to March 2021. ELIGIBILITY CRITERIA Inclusion criteria: quantitative or mixed-method research, publications in English, on solid cancers in SSA countries. EXCLUSION CRITERIA paediatric populations, haematologic malignancies, and assessments of public perceptions and awareness of cancer (since the focus was on patients with a cancer diagnosis and treatment pathways). DATA EXTRACTION AND SYNTHESIS Two reviewers extracted and validated the studies. Data included year of publication; country; demographic characteristics; country-level setting; disease subsite; study design; type of delay, reasons for delay and primary outcomes. RESULTS 57 out of 193 full-text reviews were included. 40% were from Nigeria or Ethiopia. 70% focused on breast or cervical cancer. 43 studies had a high risk of bias at preliminary stages of quality assessment. 14 studies met the criteria for full assessment and all totaled to either high or very high risk of bias across seven domains. Reasons for delays included high costs of diagnostic and treatment services; lack of coordination between primary, secondary and tertiary healthcare sectors; inadequate staffing; and continued reliance on traditional healers and complimentary medicines. CONCLUSIONS Robust research to inform policy on the barriers to quality cancer care in SSA is absent. The focus of most research is on breast and cervical cancers. Research outputs are from few countries. It is imperative that we investigate the complex interaction of these factors to build resilient and effective cancer control programmes.
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Affiliation(s)
| | | | - Susan Msadabwe
- Department of Radiation Oncology, Cancer Diseases Hospital, Lusaka, Zambia
| | - Virginia Bond
- Social Science, London School of Hygiene & Tropical Medicine and ZAMBART, Lusaka, Zambia
| | | | - Andrew Sentoogo Ssemata
- The Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Kampala, Uganda
| | - Richard Muhumuza
- The Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Kampala, Uganda
| | - Janet Seeley
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, UK
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14
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Plaisy MK, Boni SP, Coffie PA, Tanon A, Innocent A, Horo A, Dabis F, Bekelynck A, Jaquet A. Barriers to early diagnosis of cervical cancer: a mixed-method study in Côte d'Ivoire, West Africa. BMC Womens Health 2023; 23:135. [PMID: 36973736 PMCID: PMC10044424 DOI: 10.1186/s12905-023-02264-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 03/07/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Cervical cancer, a major public health problem in many developing countries, is usually associated with a poor survival related to an advanced disease at diagnosis. In Côte d'Ivoire and other developing countries with high cervical cancer prevalence, little is known about factors associated with advanced cervical cancer stages in a context of limited access to screening services. METHODS From May to July 2019, we conducted a cross-sectional study using a mixed, quantitative and qualitative method. Information on socio-demographic and history of the disease was extracted from a rapid case ascertainement study performed by the cancer registry of Côte d'Ivoire that enrolled all women diagnosed with cervical cancer between July 2018 and June 2019. In-depth semi-structured interviews were conducted among a subset of these women (12 women) and six healthcare providers to further capture barriers to early cervical cancer diagnosis. Factors associated with an advanced stage III, IV (according to FIGO classification) were estimated by a logistic regression model. Qualitative data were analyzed using a thematic analysis technique guided by the treatment pathway model and triangulated with quantitative data. RESULTS In total, 95 women with cervical cancer [median age = 51 (IQR 42-59)] years, were included. Among them, 18.9% were living with HIV and only 9.5% were covered by a health insurance. The majority (71.5%) were diagnosed with advanced cervical cancer. Being HIV-uninfected (aOR = 5.4; [1.6-17.8], p = 0.006) and being uninsured (aOR = 13.1; [2.0-85.5], p = 0.007) were independently associated with advanced cervical cancer in multivariable analysis. Qualitative data raised additional factors potentially related to advanced cervical cancer stages at diagnosis, including the lack of patient information on cervical cancer by healthcare providers and inadequate national awareness and screening campaigns. CONCLUSION In a context of challenges in access to systematic cervical cancer screening in Côte d'Ivoire, access to health insurance or integrated healthcare program appear to be key determinants of early diagnosis of cervical cancer.
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Affiliation(s)
- Marie K Plaisy
- Research Institute for Sustainable Development (IRD) EMR 271, University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Bordeaux Population Health Centre, Bordeaux, France.
| | - Simon P Boni
- National Cancer Control Program, Abidjan, Côte d'Ivoire
| | - Patrick A Coffie
- PACCI Program, National Agency for Scientific Research (ANRS) site in Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Aristophane Tanon
- Tropical and Infectious Diseases Department, University Hospital of Treichville, Abidjan, Côte d'Ivoire
| | - Adoubi Innocent
- Oncology Department, University Hospital of Treichville, Abidjan, Côte d'Ivoire
| | - Apollinaire Horo
- Gyneco-Obstetrics Department, University Hospital of Yopougon, Abidjan, Côte d'Ivoire
| | - François Dabis
- Research Institute for Sustainable Development (IRD) EMR 271, University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Bordeaux Population Health Centre, Bordeaux, France
| | - Anne Bekelynck
- PACCI Program, National Agency for Scientific Research (ANRS) site in Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Antoine Jaquet
- Research Institute for Sustainable Development (IRD) EMR 271, University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Bordeaux Population Health Centre, Bordeaux, France
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15
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George S. Being sick to a cancer patient: pathways of delay in help seeking and diagnosis of cancer in India. JOURNAL OF SOCIAL AND ECONOMIC DEVELOPMENT 2022; 25:52-69. [PMID: 36466373 PMCID: PMC9685046 DOI: 10.1007/s40847-022-00221-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 06/03/2023]
Abstract
There is evidence that cancer mortality and morbidity could be reduced when the disease is diagnosed and treated at an early stage. The paper examines the pathways of delay of cancer diagnosis in an Indian setting. It draws on a qualitative study conducted among cancer survivors and family members of cancer patients in the city of Bengaluru, South India. The results show that a substantial part of the delay occurred at the stage of initial formal help seeking wherein patient and family-led, disease-related and systemic factors together played a major role. Patient-led factors included trivialisation and normalisation of symptoms as part of general fatigue and aging; unrealistic risk perceptions that linked causality of cancer merely to heredity and behavioural risk factors; fear of being diagnosed as cancer patient; gender related reasons including family's gender performance expectation, lower agency of women to seek help and lower prioratisation of women's health in the household and access related issues including financial constraints and unavailability of specialised hospitals nearby. Disease-related factors included the presence of comorbidity, cancer's mimicking of symptoms of other diseases and absence of distinguishable symptoms at the initial stage for certain types of cancers. The practitioner-led and system-led factors such as trivialisation of symptoms by general practitioners, non cancer-specific referrals, and lack of cancer screening facilities accounted for a major part of delay after the formal help seeking. The paper argues that the mere knowledge of cancer symptoms did not always lead to early diagnosis due to the interplay of these factors. The ongoing cancer prevention and control interventions in India need to be informed of these micro level factors while developing strategies to prevent avoidable delays in cancer diagnosis.
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Affiliation(s)
- Sobin George
- Centre for the Study of Social Change and Development, Institute for Social and Economic Change, Bengaluru, India
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16
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Pan S, Yan N, Zhao Y, Li Z. Marital status as an independent prognostic factor for patients of malignant pleural mesothelioma. Front Med (Lausanne) 2022; 9:955619. [PMID: 36341233 PMCID: PMC9633843 DOI: 10.3389/fmed.2022.955619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives The prognostic impact of marital status on malignant pleural mesothelioma (MPM) is not investigated. This paper probes into the relationship between the prognosis of MPM and marital status. Materials and methods The Surveillance, Epidemiology, and End Results (SEER) database of American had been applied to choose eligible patients over the 2004–2015 periods. Moreover, cancer-specific survival (CSS) and overall survival (OS) of unmarried and married groups were compared. Results A total of 3,997 patients in total had been identified, including 2,735 (68.43%) married patients. In comparison to unmarried patients, married ones tended to be younger, male, white, and received active treatment (surgery, chemotherapy, or radiotherapy). In addition, the 1, 3, and 5-year CSS rates were 44.40, 12.09, and 6.88% in married patients, while 35.75, 12.12, and 6.37% in unmarried group (p = 0.0014). At the same time, the 1, 3, and 5-year OS rates were 41.84, 10.56, and 5.91% in married patients, while 33.67, 10.44, and 4.93%, respectively, in the unmarried group (p < 0.0001). As revealed by the multivariate analysis results, the marital status was an independent favorable prognostic factor, in which the married groups showed better CSS [hazard ratio (HR): 0.870; 95% confidence interval (CI): 0.808–0.938; p < 0.001] as well as OS (HR: 0.871; 95% CI: 0.810–0.936; p < 0.001). According to the results of subgroup analysis, the CSS and OS survival of married groups were better than the unmarried groups in almost all the subgroups. Conclusion Marital status is an independent favorable prognostic indicator of MPM. Poor prognosis in unmarried patients is likely to be related to insufficient treatments and socioeconomic and psychosocial factors.
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17
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Elgoraish A, Alnory A. Associated predictor covariates of cervical cancer stage and impact on survival at Khartoum oncology hospital, Sudan. F1000Res 2022; 10:114. [PMID: 36312527 PMCID: PMC9585357 DOI: 10.12688/f1000research.43590.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Cervical cancer can be invasive and advanced at diagnosis causing devastating suffering and premature death. The cancer stage at presentation is related to survival evaluation and several factors determine stage. The aim of the study was to examine predictors covariates associated with cervical cancer stage at diagnosis and its impact on patient prognosis and survival. Methods: This retrospective cross-sectional study was carried out at Khartoum oncology hospital, Sudan. Participants were 239 cervical cancer patients diagnosed and treated between 2011-2015. Patients’ pathological and socio-demographic data were extracted from their medical files and survival times were calculated from follow-up. Chi-square, Kaplan-Meier, Log-rank test and Cox regression model were used to examine relationships between demographic and clinical variables and survival outcome. Results: The mean age of the participants was 56.91 years and the majority were ≥45 years. Cancer survival analysis showed that the stage at diagnosis had limited association with socio-demographic factors, except where patients reside. Multivariate regression using the Cox proportional hazard model confirmed strongly that stage (p=0.035), chemotherapy (p=0.000) and radiotherapy (p=0.001) were the most likely predictor covariates of patient prognosis and survival time. Conclusions: The results of this study suggest cancer stage at diagnosis and certain treatments are the most important factors impacting the prognosis and survival of patients with cervical cancer. Early detection and vaccination of women against HPV infection provide enormous opportunities for early diagnosis, more effective treatment and better chances of survival.
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Affiliation(s)
- Amanda Elgoraish
- Epidemiology, Tropical Medicine Research Institute, National Centre for Research, Khartoum, Khartoum, P.O. Box 1304, Sudan
| | - Ahmed Alnory
- Applied Statistics and Demography, Faculty of Economics and Rural Development, University of Gezira, Medani, Gezira, P.O. Box 20, Sudan
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18
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Kombathula SH, Cree A, Joshi PV, Akturk N, Barraclough LH, Haslett K, Choudhury A, Hoskin P. Palliative radiotherapy in cancers of female genital tract: Outcomes and prognostic factors. Radiother Oncol 2022; 175:42-46. [PMID: 35964765 DOI: 10.1016/j.radonc.2022.07.023] [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: 06/03/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND PURPOSE Metastatic and incurable cancers of the gynaecological tract (FGTC) represent a major global health burden. Systemic treatment has modest efficacy and radiotherapy is often used for local symptoms. This study combines experience from two large UK centres in palliative radiotherapy for gynaecological cancers. MATERIALS AND METHODS Pooled data from two major centres was analysed. Advanced FGTC patients who received at least one fraction of palliative radiotherapy to the pelvis between 2013 and 2018 were included. Data collected included demographic and tumour details, radiotherapy dose fractionation and details of previous and subsequent treatment. Response was defined in terms of toxicity, symptomatic response and survival. Comorbidities were recorded using a modified ACE 27 score which is adjusted for the presence of uncontrolled FGTC in all the patients. RESULTS A total of 184 patients were included for treatment response and toxicity; survival data was available for 165 patients. Subjective response in pre-radiotherapy symptoms was documented in 80.4%. Grade 3 or worse gastrointestinal, urinary and other (vomiting, fatigue, pain) toxicity incidence was 2.2%, 3.8%, and 2.7% respectively. No statistically significant correlation between the prescribed EQD210 and symptom control or toxicity was seen. 1 year overall survival was 25.1% (median 5.9 months). Absent distant metastases, completion of the intended course of radiotherapy, response to radiotherapy, and receipt of further lines of treatment were independent prognostic factors. CONCLUSION Palliative radiotherapy is effective for symptoms of advanced FGTC with low toxicity. The absence of a dose response argues for short low dose palliative radiotherapy schedules to be used.
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Affiliation(s)
| | - Anthea Cree
- The Christie NHS Foundation Trust, Clinical Oncology, Manchester; The Clatterbridge Cancer Centre, Clinical Oncology, Liverpool
| | - Priya V Joshi
- Mount Vernon Cancer Centre, Clinical Oncology, Northwood, United Kingdom
| | - Nesrin Akturk
- The Christie NHS Foundation Trust, Clinical Oncology, Manchester
| | | | - Kate Haslett
- The Christie NHS Foundation Trust, Clinical Oncology, Manchester
| | - Ananya Choudhury
- The Christie NHS Foundation Trust, Clinical Oncology, Manchester; Department of Cancer Sciences, University of Manchester
| | - Peter Hoskin
- The Christie NHS Foundation Trust, Clinical Oncology, Manchester; Department of Cancer Sciences, University of Manchester; Mount Vernon Cancer Centre, Clinical Oncology, Northwood, United Kingdom.
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Zibako P, Tsikai N, Manyame S, Ginindza TG. Cervical cancer management in Zimbabwe (2019–2020). PLoS One 2022; 17:e0274884. [PMID: 36129898 PMCID: PMC9491541 DOI: 10.1371/journal.pone.0274884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/06/2022] [Indexed: 11/19/2022] Open
Abstract
Background Globally, cervical cancer is the fourth most commonly diagnosed cancer amongst women, and it is especially common in low- and middle-income countries (LMICs). The aim of the study was to determine the current patterns and characteristics of CC management in Zimbabwe in the HIV pandemic era, including the knowledge, attitude and practice of patience. Methods The study was a mixed method which incorporated a cross-sectional survey of 408 CC patients which was conducted from October 2019 to September 2020 using an interviewer administered paper questionnaire. The study was conducted at Parirenyatwa hospital, the only cancer treating public health facility in Harare, Zimbabwe. Differences in study outcome by categorical variables were assessed using the Person Chi-square (χ2) test. Odds ratios (unadjusted and adjusted) and 95%CIs for potential risk factors associated with the outcome were estimated using logistic regression model. Results From a total of 408 CC patients recruited into the study no prevention mechanism was available or known to these patients and only 13% knew that CC is caused by Human papillomavirus. Only 87 (21%) had ever been screened for CC and 83 (97%) of those who had been screened had the visual inspection with acetic acid procedure done. Prevention (screening uptake) is statistically high among the educated (with secondary education OR = 9.497, 95%CI: 2.349–38.390; with tertiary OR = 59.381, 95%CI: 11.937–295.380). Late presentation varied statistically significantly with marital status (high among the divorced, OR = 2.866; 95% CI: 1.549–5.305 and widowed OR = 1.997; 95% CI: 1.112–3.587), was low among the educated (Tertiary OR = .393; 95% CI: .166-.934), low among those living in the rural (OR = .613; 95% CI: .375-.987), high among those with higher parity OR = 1.294; 95% CI: 1.163–1.439). Less than 1% of the patients had surgery done as a means of treatment. Radiotherapy was administered to 350 (86%) of the patients compared to chemotherapy administered to 155 (38%). A total of 350 (86%) have failed to take medication due to its unavailability, while 344 (85%) missed taking medication due to unaffordability. Complementary and alternative medicines were utilized by 235 (58%). Majority, 278 (68%) were HIV positive, mainly pronounced within age (36–49 years OR = 12.673; 95% CI: 2.110–76.137), among those with higher education (secondary education OR = 4.981; 95%CI: 1.394–17.802 and in those with no co-morbidities (893.956; 95%CI: 129.611–6165.810). Conclusion CC management was inadequate from prevention, screening, diagnosis, treatment and palliative care hence there is need to improve CC management in Zimbabwe if morbidity and mortality are to be reduced to acceptable levels. Education helped improve prevention, but reduces chances of diagnosis, working as a doubled edged sword in CC management Prevention was high among the educated. Those in rural areas experience poor CC management. It should be noted that general education is good; however it must be complimented by CC awareness to improve CC management outcomes holistically. Cervical cancer management services need to be decentralized so that those in rural areas have easy access. Given that those with co-morbidities and high parity have better CC management, CC services need to be tied to co-morbidity and antenatal/post-natal care and management services.
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Affiliation(s)
- Petmore Zibako
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- * E-mail:
| | - Nomsa Tsikai
- College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Sarah Manyame
- College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Themba G. Ginindza
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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20
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McMahon DE, Chemtai L, Grant M, Singh R, Semeere A, Byakwaga H, Laker-Oketta M, Maurer T, Busakhala N, Martin J, Bassett IV, Butler L, Freeman EE. Understanding Diagnostic Delays for Kaposi Sarcoma in Kenya: A Qualitative Study. J Acquir Immune Defic Syndr 2022; 90:494-503. [PMID: 35499523 PMCID: PMC9283252 DOI: 10.1097/qai.0000000000003011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Although HIV-associated Kaposi sarcoma (KS) is frequently diagnosed at an advanced stage in sub-Saharan Africa, reasons for diagnostic delays have not been well described. METHODS We enrolled patients >18 years with newly diagnosed KS between 2016 and 2019 into the parent study, based in western Kenya. We then purposively selected 30 participants with diversity of disease severity and geographic locations to participate in semistructured interviews. We used 2 behavioral models in developing the codebook for this analysis: situated Information, Motivation, and Behavior framework and Andersen model of total patient delay. We then analyzed the interviews using framework analysis. RESULTS The most common patient factors that delayed diagnosis were lack of KS awareness, seeking traditional treatments, lack of personal efficacy, lack of social support, and fear of cancer, skin biopsy, amputation, and HIV diagnosis. Health system factors that delayed diagnosis included previous negative health care interactions, incorrect diagnoses, lack of physical examination, delayed referral, and lack of tissue biopsy availability. Financial constraints were prominent barriers for patients to access and receive care. Facilitators for diagnosis included being part of an HIV care network, living near health facilities, trust in the health care system, desire to treat painful or disfiguring lesions, and social support. CONCLUSIONS Lack of KS awareness among patients and providers, stigma surrounding diagnoses, and health system referral delays were barriers in reaching KS diagnosis. Improved public health campaigns, increased availability of biopsy and pathology facilities, and health provider training about KS are needed to improve early diagnosis of KS.
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Affiliation(s)
- Devon E McMahon
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | | | - Rhea Singh
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Virginia Commonwealth University School of Medicine, Richmond, VA
| | | | | | | | - Toby Maurer
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN
| | | | | | - Ingrid V Bassett
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Esther E Freeman
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Zibako P, Hlongwa M, Tsikai N, Manyame S, Ginindza TG. Mapping Evidence on Management of Cervical Cancer in Sub-Saharan Africa: Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159207. [PMID: 35954564 PMCID: PMC9367747 DOI: 10.3390/ijerph19159207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023]
Abstract
Cervical cancer (CC) is the most common viral infection of the reproductive tract and in Sub-Saharan Africa (SSA), its morbidity and mortality rates are high. The aim of this review was to map evidence on CC management in SSA. The scoping review was conducted in accordance with Arksey and O’Malley’s scoping review framework. The review included studies on different aspects of CC management. The review was also done following the steps and guidelines outlined in the PRISMA-Extension for Scoping Reviews (PRISMA-ScR) checklist. The following databases were searched: PubMed, EBSCOhost, Scopus and Cochrane Database of Systematic Review. A total of 1121 studies were retrieved and 49 which were eligible for data extraction were included in the review. The studies were classifiable in 5 groups: 14 (28.57%) were on barriers to CC screening, 10 (20.41%) on factors associated with late-stage presentation at diagnosis, 11 (22.45%) on status of radiotherapy, 4 (8.20%) on status of chemotherapy and 10 (20.41%) on factors associated with high HPV coverage. High HPV vaccine coverage can be achieved using the class school-based strategy with opt-out consent form process. Barriers to CC screening uptake included lack of knowledge and awareness and unavailability of screening services. The reasons for late-stage presentation at diagnosis were unavailability of screening services, delaying whilst using complementary and alternative medicines and poor referral systems. The challenges in chemotherapy included unavailability and affordability, low survival rates, treatment interruption due to stock-outs as well as late presentation. Major challenges on radiotherapy were unavailability of radiotherapy, treatment interruption due to financial constraints, and machine breakdown and low quality of life. A gap in understanding the status of CC management in SSA has been revealed by the study implying that, without full knowledge of the extent of CC management, the challenges and opportunities, it will be difficult to reduce infection, improve treatment and palliative care. Research projects assessing knowledge, attitude and practice of those in immediate care of girls at vaccination age, situational analysis with health professionals and views of patients themselves is important to guide CC management practice.
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Affiliation(s)
- Petmore Zibako
- Discipline of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4000, South Africa; (M.H.); (T.G.G.)
- Correspondence:
| | - Mbuzeleni Hlongwa
- Discipline of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4000, South Africa; (M.H.); (T.G.G.)
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town 7505, South Africa
| | - Nomsa Tsikai
- College of Health Sciences, University of Zimbabwe, MT Pleasant, Harare P.O. Box MP167, Zimbabwe; (N.T.); (S.M.)
| | - Sarah Manyame
- College of Health Sciences, University of Zimbabwe, MT Pleasant, Harare P.O. Box MP167, Zimbabwe; (N.T.); (S.M.)
| | - Themba G. Ginindza
- Discipline of Public Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4000, South Africa; (M.H.); (T.G.G.)
- Cancer & Infectious Diseases Epidemiology Research Unit (CIDERU), College of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa
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Baluku JB, Bogere N, Namiiro S, Walusansa V, Andia-Biraro I, Worodria W, Kirenga B. HIV-related lung cancer in Uganda: a cohort study. Infect Agent Cancer 2022; 17:24. [PMID: 35668439 PMCID: PMC9169266 DOI: 10.1186/s13027-022-00439-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/24/2022] [Indexed: 11/15/2022] Open
Abstract
Background There are few reports on lung cancer among people with HIV (PWH) in Sub-Saharan Africa. In this report, we describe a cohort of PWH and lung cancer at the Uganda Cancer Institute.
Methods This retrospective cohort of PWH and lung cancer was managed at the Uganda Cancer Institute between 2008 and 2018. Sociodemographic and clinical data were abstracted from the patient charts. The median survival from diagnosis to death, loss-to-follow up or 31st December 2018, was estimated.
Results There were 18 people with HIV and lung cancer. The median (interquartile range, IQR) age was 49.5 (38.8–56.0) years, 11 (61.1%) were women and 5 (27.8%) were smokers. Of the 18 PWH, 13 (72.2%) were on antiretroviral therapy and the median (IQR) CD4 count (n = 13) was 380 (243.5–595) cells per mm3. Difficulty in breathing (88.9%), chest pain (78.6%, n = 11), cough (76.5%, n = 17) and weight loss (72.2%) were the commonest symptoms while pleural effusions were observed in 12 (66.7%). In this cohort, 8 (44.4%) were presumptively treated for tuberculosis before the diagnosis of lung cancer. Seven (38.9%) had an Eastern Cooperative Oncology Group performance status of 3. Non-small cell lung cancer was the predominant histological type observed in 17 (94.4%) of whom 14 (82.4%) had adenocarcinoma. Majority of PWH had stage IV disease (88.9%). The median (IQR) survival was 3.3 (1.1–13.2) months and all were either dead (72.2%) or lost-to-follow up (27.8%) at five years from diagnosis. Conclusion People with HIV and lung cancer in Uganda report low rates of smoking, present with advanced disease and post very poor survival rates. There is need for biomarkers for early detection of lung cancer in HIV.
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Affiliation(s)
- Joseph Baruch Baluku
- Makerere University Lung Institute, PO Box 26343, Kampala, Uganda. .,Kiruddu National Referral Hospital, Kampala, Uganda.
| | | | - Sharon Namiiro
- Makerere University Lung Institute, PO Box 26343, Kampala, Uganda
| | | | | | - William Worodria
- Makerere University College of Health Sciences, Kampala, Uganda.,Mulago National Referral Hospital, Kampala, Uganda
| | - Bruce Kirenga
- Makerere University Lung Institute, PO Box 26343, Kampala, Uganda.,Makerere University College of Health Sciences, Kampala, Uganda
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23
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Tekalign T, Teshome M. Prevalence and determinants of late-stage presentation among cervical cancer patients, a systematic review and meta-analysis. PLoS One 2022; 17:e0267571. [PMID: 35476851 PMCID: PMC9045598 DOI: 10.1371/journal.pone.0267571] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 04/11/2022] [Indexed: 01/21/2023] Open
Abstract
Background An estimated 570,000 women were diagnosed with cervical cancer worldwide, and about 311,000 women died from the disease. Cervical cancer is possibly the most curable human cancer; if detected at the precancerous stage. Additionally, early diagnosis and management other factors are essential to decrease mortality rate among those patients. So this review was aimed to identify the prevalence and determinants of late-stage presentation among cervical cancer patients. Methods A systematic search had carried out on PubMed, EMBASE, MEDLINE, Cochrane, Scopus, Web of Science CINAHL, and manually on Google Scholar. This meta-analysis follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The modified Newcastle-Ottawa Scale (NOS) was used to assess the quality of each study. A meta-analysis was done using a random-effects method using the STATA™ Version 14 software. Result Twenty-five studies from 3 world regions with 53,233 participants were enrolled in this meta-analysis. The overall estimated global pooled prevalence of late-stage presentation among cervical cancer patients with a random-effects model was 60.66% (95% CI: 56.27, 65.06). The subgroup analysis revealed that the prevalence of late-stage presentation was 62.60% in Africa, 69.30% in Asia, 46.51% in Europe, and 50.16% in North America. Educational status (p = 0.031) and place of residence (p = 0.004) are determinants of late-stage presentation. Conclusion The results of this meta-analysis indicated that the prevalence of late-stage presentation of cervical cancer is substantially high. Place of residence and educational status were significantly associated with late-stage presentation. Health care organizations should work on early screening, management, and on increasing community awareness to minimize late stage at presentation among those patients.
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Affiliation(s)
- Tiwabwork Tekalign
- School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita, Ethiopia
- * E-mail:
| | - Mister Teshome
- School of Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita, Ethiopia
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24
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Akokuwebe ME, Idemudia ES, Lekulo AM, Motlogeloa OW. Determinants and levels of cervical Cancer screening uptake among women of reproductive age in South Africa: evidence from South Africa Demographic and health survey data, 2016. BMC Public Health 2021; 21:2013. [PMID: 34740352 PMCID: PMC8571865 DOI: 10.1186/s12889-021-12020-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 09/30/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Cervical cancer (CC) is the cancer with the most incidents and the leading cause of cancer mortality among women in South Africa. CC screening is one of the most cost-effective control approaches for the disease burden. This study assessed the determinants and individual-level indicators of cervical cancer screening uptake among women of reproductive age in South Africa. METHODS We analyzed data from the 2016 South Africa Demographic Health Survey. Our analysis focused on 5903 women (15-49 years). We conducted Chi-square test for bivariate analysis, and multivariate binary logistics regression was used to analyze independent association between individual-level factors and women who have had Pap smear testing. Statistical significance was set at p < 0.05. RESULTS The mean age at cervical cancer screening uptake among women in South Africa was 40.8 years (SD 18.6, range 15-95 years). A majority of the women (39.3%) were aged 45 years and above and 54.6% of them resides in urban settlements. About 35.4% of women (n = 2098) have had a Pap smear test, with 66.5% of them who had a Pap smear test resides in Western Cape province. The proportion of women who had a Pap smear test was significantly higher among those with higher educational attainment (68.7%, p = 0.000), in the rich wealth index (50.1%, p = 0.000), and those with health insurance cover (60.3%, p = 0.000). Pap smear testing was found to be more prevalent among women aged 45+ years, were in the white population group, had higher education, were divorced, and had health insurance cover. The predominance of Pap smear test was 14% higher among women who are working in the professional/formal sector (AOR; 1.38, 95% CI; 1.14-1.69). The uptake of Pap smear test was also higher among women aged 35-44 years. CONCLUSIONS The prevalence of cervical cancer uptake is substantially low among women aged 15-24 years in South Africa and shows a degree of between-provinces differences. Therefore, heath educational interventions aimed at increasing the uptake of cervical cancer screening services in South Africa are critically needed.
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Affiliation(s)
- Monica Ewomazino Akokuwebe
- grid.25881.360000 0000 9769 2525North-West University Faculty of Humanities, North-West University, Mafikeng, South Africa
| | - Erhabor Sunday Idemudia
- grid.25881.360000 0000 9769 2525North-West University Faculty of Humanities, North-West University, Mafikeng, South Africa
| | - Abiel M. Lekulo
- grid.25881.360000 0000 9769 2525North-West University Faculty of Humanities, North-West University, Mafikeng, South Africa
| | - Ogone Warona Motlogeloa
- grid.25881.360000 0000 9769 2525North-West University Faculty of Humanities, North-West University, Mafikeng, South Africa
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25
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Dereje N, Addissie A, Worku A, Assefa M, Abraha A, Tigeneh W, Kantelhardt EJ, Jemal A. Extent and Predictors of Delays in Diagnosis of Cervical Cancer in Addis Ababa, Ethiopia: A Population-Based Prospective Study. JCO Glob Oncol 2021; 6:277-284. [PMID: 32109158 PMCID: PMC7055465 DOI: 10.1200/jgo.19.00242] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
PURPOSE A substantial proportion of cervical cancers are diagnosed at advanced stage in Ethiopia. Therefore, the aim of this study was to determine the extent and predictors of delays in cervical cancer diagnosis in Addis Ababa. PATIENTS AND METHODS We prospectively recruited 231 patients with cervical cancer diagnosed from January 1, 2017, to June 30, 2018, in 7 health facilities in Addis Ababa, representing 99% of all cervical cancers recorded in the Addis Ababa population-based cancer registry. A structured questionnaire on patients’ experience was administered face to face by trained interviewers. Health-seeking intervals > 90 days (date from recognition of symptoms to medical consultation) and diagnostic intervals > 30 days (dates from medical consultation to diagnostic confirmation) were categorized as delayed. Factors associated with these delays were assessed using multivariable binary logistic regression models. RESULTS The median health-seeking and diagnostic intervals for patients with cervical cancer in Addis Ababa were 10 and 97 days, respectively. Approximately one quarter of the patients were delayed in seeking medical consultation, and three fourths of the patients had delayed diagnostic confirmation. Factors associated with health-seeking delays included poor cervical cancer awareness, practicing of religious rituals, and waiting for additional symptoms before visiting a health facility. Factors associated with diagnostic delays included first contact with primary health care units and visits to ≥ 4 different health facilities before diagnosis. CONCLUSION A considerable proportion of patients with cervical cancer in Addis Ababa have delays in seeking medical care and diagnostic conformation. These findings reinforce the need for programs to enhance awareness about cervical cancer signs and symptoms and the importance of early diagnosis in the community and among health care providers.
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Affiliation(s)
- Nebiyu Dereje
- School of Public Health, Wachemo University, Hosanna, Ethiopia.,Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adamu Addissie
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mathewos Assefa
- Department of Oncology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Aynalem Abraha
- Department of Oncology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wondemagegnehu Tigeneh
- Department of Oncology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eva Johanna Kantelhardt
- Department of Gynaecology and Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle-Wittenberg, Germany
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
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26
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Clinical and sociodemographic factors associated with late stage cervical cancer diagnosis in Botswana. BMC WOMENS HEALTH 2021; 21:267. [PMID: 34229672 PMCID: PMC8259023 DOI: 10.1186/s12905-021-01402-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/22/2021] [Indexed: 01/22/2023]
Abstract
Background Cervical cancer is the leading cause of female cancer mortality in Botswana with the majority of cervical cancer patients presenting with late-stage disease. The identification of factors associated with late-stage disease could reduce the cervical cancer burden. This study aims to identify potential patient level clinical and sociodemographic factors associated with a late-stage diagnosis of cervical cancer in Botswana in order to help inform future interventions at the community and individual levels to decrease cervical cancer morbidity and mortality. Results There were 984 women diagnosed with cervical cancer from January 2015 to March 2020 at two tertiary hospitals in Gaborone, Botswana. Four hundred forty women (44.7%) presented with late-stage cervical cancer, and 674 women (69.7%) were living with HIV. The mean age at diagnosis was 50.5 years. The association between late-stage (III/IV) cervical cancer at diagnosis and patient clinical and sociodemographic factors was evaluated using multivariable logistic regression with multiple imputation. Women who reported undergoing cervical cancer screening had lower odds of late-stage disease at diagnosis (OR: 0.63, 95% CI 0.47–0.84) compared to those who did not report screening. Women who had never been married had increased odds of late-stage disease at diagnosis (OR: 1.35, 95% CI 1.02–1.86) compared to women who had been married. Women with abnormal vaginal bleeding had higher odds of late-stage disease at diagnosis (OR: 2.32, 95% CI 1.70–3.16) compared to those without abnormal vaginal bleeding. HIV was not associated with a diagnosis of late-stage cervical cancer. Rural women who consulted a traditional healer had increased odds of late-stage disease at diagnosis compared to rural women who had never consulted a traditional healer (OR: 1.61, 95% CI 1.02–2.55). Conclusion Increasing education and awareness among women, regardless of their HIV status, and among providers, including traditional healers, about the benefits of cervical cancer screening and about the importance of seeking prompt medical care for abnormal vaginal bleeding, while also developing support systems for unmarried women, may help reduce cervical cancer morbidity and mortality in Botswana.
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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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Yuan R, Zhang C, Li Q, Ji M, He N. The impact of marital status on stage at diagnosis and survival of female patients with breast and gynecologic cancers: A meta-analysis. Gynecol Oncol 2021; 162:778-787. [PMID: 34140180 DOI: 10.1016/j.ygyno.2021.06.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/08/2021] [Indexed: 12/24/2022]
Abstract
The aim of this meta-analysis is to evaluate the effect of marital status on the stage at diagnosis and survival of female patients with breast and gynecologic cancers. A systematic literature search was conducted on electronic databases (PubMed, Cochrane and EMBASE) till December 31, 2020. Publications investigating the association of marital status with stage at diagnosis and/or cancer-specific mortality (CSM) and/or overall survival (OS) in female patients with breast or gynecologic cancers were retrieved. After studies were selected according to inclusion criteria, data extraction, quality assessment and data analysis were performed. 55 articles were eligible for inclusion, consisting of 1,195,773 female cancer patients with breast, vulvar, cervical, endometrial and ovarian cancers. Unmarried female cancer patients had higher odds of being diagnosed at later stage [odds ratio (OR) = 1.28, 95% confidence interval (CI): 1.22-1.36)] and worse survival outcomes in CSM [hazard ratio (HR) = 1.22, 95% CI: 1.16-1.28] and OS (HR = 1.20, 95% CI: 1.14-1.25). This estimate did not vary by level of social support, number of adjustment factors, or between America and Europe. Being married is associated with timely diagnosis and favorable prognosis in most women's cancers. Unmarried female cancer patients have a higher risk of late-stage diagnosis and worse survival outcomes than the married. Greater concern shall be demonstrated towards unmarried female cancer patients. Furthermore, the impact of lacking economic and emotional support on survival outcomes in unmarried female cancer patients deserves particular attention.
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Affiliation(s)
- Ruixia Yuan
- Clinical Big Data Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chao Zhang
- Center for Evidence-Based Medicine and Clinical Research, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Qi Li
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mei Ji
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Nannan He
- Department of Gynecology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Moodley J, Constant D, Mwaka AD, Scott SE, Walter FM. Anticipated help seeking behaviour and barriers to seeking care for possible breast and cervical cancer symptoms in Uganda and South Africa. Ecancermedicalscience 2021; 15:1171. [PMID: 33680085 PMCID: PMC7929770 DOI: 10.3332/ecancer.2021.1171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Indexed: 12/23/2022] Open
Abstract
Objectives Breast and cervical cancers are leading causes of cancer morbidity and mortality in sub-Saharan Africa. Most women present with advanced-stage disease and have poor outcomes. This study aimed to describe anticipated help-seeking behaviour for possible breast and cervical cancer symptoms, barriers to accessing health care and factors associated with less timely anticipated help-seeking in urban and rural settings in Uganda and South Africa (SA). Methods We conducted a cross-sectional community-based survey between August and December 2018. Data were collected from one randomly selected woman per household using the African Women Awareness of CANcer breast and cervical cancer tool. Anticipated help-seeking behaviour was dichotomised into waiting <1week or ≥1 week to seek care. Multivariable analysis identified factors associated with anticipated help-seeking behaviour. Results One thousand, seven hundred fifty-eight women participated (Uganda 873, SA 885, median age 34, interquartile ranges 26-47). Most would discuss symptoms with someone close to them (87.7% for breast, 83.0% for cervical symptoms). The majority anticipated seeking care from a health facility in <1 week: 86.1% and 88.0%, respectively, for breast and cervical symptoms. 38.7% of women expected to encounter at least 1 barrier when seeking care. Lack of money for transport or clinic costs was the most common barrier (24.6% of participants). For both cancers and in both countries, women who reported more barriers were significantly less likely to anticipate seeking timely care. In SA, rural location was also associated with longer anticipated time to seek care, adjusted prevalence ratio (aPR) 2.92, 95% confidence interval (CI) 1.48-5.76 and aPR 2.42, 95% CI 1.08-5.45 for breast and cervical cancer, respectively. Conclusion Interventions that improve community level cancer knowledge and highlight the importance of prompt help-seeking for possible symptoms are important to promote timely care seeking. In addition, addressing financial barriers by reducing transport and clinic costs and tackling geographical inequities in access to care could support women in seeking timely care for possible symptoms.
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Affiliation(s)
- Jennifer Moodley
- Women's Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, 7925, South Africa.,Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, 7925, South Africa.,South African Medical Research Council Gynaecology Cancer Research Centre, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, 7925, South Africa.,https://orcid.org/0000-0002-9398-5202
| | - Deborah Constant
- Women's Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, 7925, South Africa.,https://orcid.org/0000-0002-7176-9963
| | - Amos Deogratius Mwaka
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Upper Mulago Jill Road PO Box 7072, Kampala, +256, Uganda.,https://orcid.org/0000-0001-7952-2327
| | - Suzanne Emilie Scott
- Centre for Oral, Clinical and Translational Sciences, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, SE1 9RT, UK.,https://orcid.org/0000-0001-5536-9612
| | - Fiona Mary Walter
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, CB1 8RN, UK.,https://orcid.org/0000-0002-7191-6476
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30
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Ilic I, Babic G, Dimitrijevic A, Ilic M, Sipetic Grujicic S. Internal consistency and validity of the Hospital Anxiety and Depression Scale (HADS) in women with abnormal Pap smear in Serbia. Women Health 2021; 61:363-371. [PMID: 33641629 DOI: 10.1080/03630242.2021.1893244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Receiving a report of an abnormal finding of Pap screening test in women often leads to anxiety and depression. The purpose of this study was to investigate the construct validity and internal consistency reliability of the Serbian version of the Hospital Anxiety and Depression Scale (HADS) in women with abnormal Pap smear results. In 2017, a cross-sectional study was done involving 142 consecutive women attending cervical cancer screening who had received abnormal Pap smear results at one University clinical center in Serbia. We used exploratory factor analysis to establish the structure of the HADS and Cronbach's alpha coefficient was used for assessing the internal consistency. In our study, the HADS demonstrated high internal consistency, for both subscales (Cronbach's alpha coefficient for subscale Anxiety was 0.862, and for subscale Depression was 0.851). The intra-class correlation coefficients for the two components were significant (0.860 and 0.843, p < .001). Principal component analysis with Oblimin rotation indicated a two-factor structure that explained 56.4% of variance. In conclusion, the Serbian version of the HADS showed satisfactory internal consistency reliability and construct validity and could be useful as a screening questionnaire for the assessment of anxiety and depression among women with abnormal Pap smear results.
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Affiliation(s)
- Irena Ilic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Goran Babic
- Department of Gynecology and Obstetrics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Aleksandra Dimitrijevic
- Department of Gynecology and Obstetrics, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Milena Ilic
- Department of Epidemiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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Mwaka AD, Walter FM, Scott S, Harries J, Wabinga H, Moodley J. Symptom appraisal, help-seeking and perceived barriers to healthcare seeking in Uganda: an exploratory study among women with potential symptoms of breast and cervical cancer. BMJ Open 2021; 11:e041365. [PMID: 33550241 PMCID: PMC7925866 DOI: 10.1136/bmjopen-2020-041365] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 12/30/2020] [Accepted: 01/19/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE We assessed the process of recognising abnormal bodily changes, interpretations and attributions, and help-seeking behaviour among community-based Ugandan women with possible symptoms of breast and cervical cancer, in order to inform health interventions aiming to promote timely detection and diagnosis of cancer. DESIGN Qualitative in-depth interviews. SETTING Rural and urban communities in Uganda. PARTICIPANTS Women who participated in the African Women Awareness of CANcer cross-sectional survey who disclosed potential breast and cervical cancer symptoms were eligible; recruitment was purposive. Interviews were conducted in women's homes, lasted between 40 and 90 min, were audio-recorded, transcribed verbatim and translated to English. Thematic analysis was used to identify themes and subthemes, underpinned by the conceptual framework of the Model of Pathways to Treatment. RESULTS 23 women were interviewed: 10 had potential symptoms of breast cancer and 13 of cervical cancer. Themes regarding symptom appraisal and help-seeking included the: (1) detection and interpretation of abnormal bodily sensations; (2) lay consultations regarding bodily changes; (3) iterative process of inferring and attributing illnesses to the bodily changes; (4) restricted disclosure of symptoms to lay people due to concerns about privacy and fear of stigmatisation; (5) help-seeking from multiple sources including both traditional and biomedical health practitioners, and (6) multiple perceived barriers to help-seeking including long waiting times, lack of medicines, absenteeism of healthcare professionals, and lack of money for transport and medical bills. CONCLUSION Women with potential symptoms of breast and cervical cancer undergo complex processes of symptom interpretation, attributing symptoms or inferring illness, and lay consultations before undertaking help-seeking and management. Increasing community understanding of breast and cervical cancer symptoms, and tackling perceived barriers to health-seeking, could lead to prompt and appropriate symptom appraisal and help-seeking, and contribute to improving cancer outcomes.
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Affiliation(s)
- Amos Deogratius Mwaka
- Department of Medicine, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Fiona M Walter
- The Primary Care Unit, Department of Public Health and Primary Care, Cambridge University, Cambridge, UK
- University of Melbourne, Centre for Cancer Research, Faculty of Medicine, Dentistry & Health Sciences, Melbourne, Victoria, Australia
| | - Suzanne Scott
- Centre for Oral, Clinical and TranslationalSciences, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Jane Harries
- Women's Health Research Unit, University of Cape Town School of Public Health & Family Medicine, Faculty of Health Sciences, Cape Town, South Africa
| | - Henry Wabinga
- Department of Medicine, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Jennifer Moodley
- Women's Health Research Unit, University of Cape Town School of Public Health & Family Medicine, Faculty of Health Sciences, Cape Town, South Africa
- Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- South African Medical Research Council Gynaecology Cancer Research Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Obol JH, Lin S, Obwolo MJ, Harrison R, Richmond R. Knowledge, attitudes, and practice of cervical cancer prevention among health workers in rural health centres of Northern Uganda. BMC Cancer 2021; 21:110. [PMID: 33535977 PMCID: PMC7860193 DOI: 10.1186/s12885-021-07847-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 01/27/2021] [Indexed: 11/25/2022] Open
Abstract
Background Cervical cancer is a leading cancer and cause of premature death among women in Uganda aged 15 to 44 years. To address the increasing burden of cervical cancer in Uganda, the Ministry of Health has adopted several strategies which include public education and advocacy. This study aims to assess knowledge, attitudes, and practice of cervical cancer prevention among health workers employed in rural health centres (HCs) III and IV in the Acholi sub-region of Northern Uganda. Methods We conducted a cross-sectional survey of nurses, midwives, and clinical officers between February and April 2019 using self-administered questionnaire. We sampled fifty-four HCs III and eight HCs IV. In Uganda, HCs are structured from HC I to HC IV and the health care package provided increases with increasing level of the HC. We used Epidata version 3.1 to create database and analysis was performed using Stata 16. Descriptive and logistic regression analyses were performed. Factors with p-values ≤ 0.05 were considered as predictors of outcome. Results There were 286 participants who completed the questionnaire: Majority (188, 66%) were females. Nurses were 153 (54%). 141 (75%) female participants self-reported to have been screened for cervical cancer. 171 (60%) participants had adequate knowledge of cervical cancer. 187 (66%) participants had positive attitudes. Participants who indicated not to have ever received training on cervical cancer screening were less likely to have adequate knowledge (AOR = 0.39, 95% CI 0.21–0.71). Participants who indicated not to have ever been trained on cervical cancer screening were less likely to have positive attitudes (AOR = 0.52, 95% CI 0.28–0.97). Conclusion Health workers from rural HCs in Uganda play crucial role in cervical cancer prevention as they can reach a wider community. Their significance in the prevention of cervical cancer points to the need for Uganda and other sub-Sahara Africa (SSA) countries to establish training to improve their knowledge, attitudes, and practical skills on cervical cancer screening. Furthermore, Uganda government should develop and disseminate guidelines for cervical cancer prevention to rural health workers to promote standardised cervical cancer prevention activities. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-07847-z.
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Affiliation(s)
- James Henry Obol
- University of New South Wales School of Public Health and Community Medicine, Kensington, NSW, 2033, Australia. .,Gulu University, Faculty of Medicine, P. O Box 166, Gulu, Uganda.
| | - Sophia Lin
- University of New South Wales School of Public Health and Community Medicine, Kensington, NSW, 2033, Australia
| | | | - Reema Harrison
- University of New South Wales School of Public Health and Community Medicine, Kensington, NSW, 2033, Australia
| | - Robyn Richmond
- University of New South Wales School of Public Health and Community Medicine, Kensington, NSW, 2033, Australia
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Jatho A, Mugisha NM, Kafeero J, Holoya G, Okuku F, Niyonzima N, Orem J. Capacity building for cancer prevention and early detection in the Ugandan primary healthcare facilities: Working toward reducing the unmet needs of cancer control services. Cancer Med 2020; 10:745-756. [PMID: 33319508 PMCID: PMC7877353 DOI: 10.1002/cam4.3659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 11/25/2022] Open
Abstract
Background In 2018, approximately 60,000 Ugandans were estimated to be suffering from cancer. It was also reported that only 5% of cancer patients access cancer care and 77% present with late‐stage cancer coupled with low level of cancer health literacy in the population despite a wide coverage of primary healthcare facilities in Uganda. We aimed to contribute to reducing the unmet needs of cancer prevention and early detection services in Uganda through capacity building. Methods In 2017, we conducted two national and six regional cancer control stakeholders’ consultative meetings. In 2017 and 2018, we trained district primary healthcare teams on cancer prevention and early detection. We also developed cancer information materials for health workers and communities and conducted a follow‐up after the training. Results A total of 488 primary healthcare workers from 118 districts were trained. Forty‐six health workers in the pilot East‐central subregion were further trained in cervical, breast, and prostate cancer early detection (screening and early diagnosis) techniques. A total of 32,800 cancer information, education and communication materials; breast, cervical, prostate childhood and general cancer information booklets; health education guide, community cancer information flipcharts for village health teams and referral guidelines for suspected cancer were developed and distributed to 122 districts. Also, 16 public and private‐not‐for‐profit regional hospitals, and one training institution received these materials. Audiovisual clips on breast, cervical, and prostate cancer were developed for mass and social media dissemination. A follow‐up after six months to one year indicated that 75% of the districts had implemented at least one of the agreed actions proposed during the training. Conclusions In Uganda, the unmet needs for cancer control services are enormous. However, building the capacity of primary healthcare workers to integrate prevention and early detection of cancer into primary health care based on low‐cost options for low‐income countries could contribute to reducing the unmet needs of cancer prevention and early detection in Uganda. In Uganda, the unmet needs for cancer control services are enormous. We engaged district leaders and healthcare managers, developed cancer information materials, and trained the district PHC workers to integrate prevention and early detection of cancer into the primary healthcare system. This could contribute to reducing the unmet needs of cancer control services in Uganda.
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Affiliation(s)
- Alfred Jatho
- National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea.,Uganda Cancer Institute, Kampala, Uganda
| | | | | | | | - Fred Okuku
- Uganda Cancer Institute, Kampala, Uganda
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Swanson M, Nakalembe M, Chen LM, Ueda S, Namugga J, Nakisige C, Huchko MJ. Surgical candidacy and treatment initiation among women with cervical cancer at public referral hospitals in Kampala, Uganda: a descriptive cohort study. BMJ Open 2020; 10:e039946. [PMID: 33310800 PMCID: PMC7735119 DOI: 10.1136/bmjopen-2020-039946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES This study aimed to report the proportion of women with a new diagnosis of cervical cancer recommended for curative hysterectomy as well as associated factors. We also report recommended treatments by stage and patterns of treatment initiation. DESIGN This was an observational cohort study. Inperson surveys were followed by a phone call. SETTING Participants were recruited at the two public tertiary care referral hospitals in Kampala, Uganda. PARTICIPANTS Adult women with a new diagnosis of cervical cancer were eligible: 332 were invited to participate, 268 met the criteria and enrolled, and 255 completed both surveys. PRIMARY AND SECONDARY OUTCOMES MEASURES The primary outcome of interest was surgical candidacy; a secondary outcome was treatment initiation. Descriptive and multivariate statistical analyses examined the associations between predictors and outcomes. Sensitivity analyses were performed to examine outcomes in subgroups, including stage and availability of radiation. RESULTS Among 268 participants, 76% were diagnosed at an advanced stage (IIB-IVB). In total, 12% were recommended for hysterectomy. In adjusted analysis, living within 15 km of Kampala (OR 3.10, 95% CI 1.20 to 8.03) and prior screening (OR 2.89, 95% CI 1.22 to 6.83) were significantly associated with surgical candidacy. Radiotherapy availability was not significantly associated with treatment recommendations for early-stage disease (IA-IIA), but was associated with recommended treatment modality (chemoradiation vs primary chemotherapy) for locally advanced stage (IIB-IIIB). Most (67%) had started treatment. No demographic or health factor, treatment recommendation, or radiation availability was associated with treatment initiation. Among those recommended for hysterectomy, 55% underwent surgery. Among those who had initiated treatment, 82% started the modality that was recommended. CONCLUSION Women presented to public referral centres in Kampala with mostly advanced-stage cervical cancer and few were recommended for surgery. Most were able to initiate treatment. Lack of access to radiation did not significantly increase the proportion of early-stage cancers recommended for hysterectomy.
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Affiliation(s)
- Megan Swanson
- Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Miriam Nakalembe
- Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Lee-May Chen
- Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Stefanie Ueda
- Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California, USA
| | - Jane Namugga
- Obstetrics and Gynaecology, Mulago National Referral Hospital, Kampala, Uganda
| | | | - Megan J Huchko
- Duke Global Health Institute, Durham, North Carolina, USA
- Obstetrics and Gynecology, Duke University School of Medicine, Durham, North Carolina, USA
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Adoch W, Garimoi CO, Scott SE, Okeny GG, Moodley J, Komakech H, Walter FM, Mwaka AD. Knowledge of cervical cancer risk factors and symptoms among women in a refugee settlement: a cross-sectional study in northern Uganda. Confl Health 2020; 14:85. [PMID: 33292345 PMCID: PMC7713037 DOI: 10.1186/s13031-020-00328-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/24/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND There are limited data on awareness of cervical cancer risk factors and symptoms among refugee populations living in Uganda. In this study, we sought to determine the awareness and knowledge of cervical cancer risk factors and symptoms among women in Palabek refugee settlement, northern Uganda. METHODS We conducted a cross-sectional study. 815 women (aged 18-60 years) were randomly selected using multistage sampling in Palabek refugee settlement. Data were collected using pre-tested, structured questionnaires. Logistic regression models were used to determine magnitudes of association between socio-demographic and health system factors, and knowledge on cervical cancer risk factors and symptoms. RESULTS The majority of participants (53%, n = 433) were young (18-29 years), married (68%, n = 553), and did not have formal employment (93%, n = 759). Less than half (40%, n = 325) had heard of cervical cancer. Of those who had heard, most recognized multiple male sexual partners, early onset of sexual intercourse and HPV infections as risk factors for cervical cancer (93%, n = 295; 89%, n = 283; and 86%, n = 271 respectively). Median knowledge score for risk factor recognition = 7 (IQR: 3-9). Median knowledge score for symptoms recognition = 7 (IQR: 1-10). Half of women (50%, n = 409) correctly recognized 7 to 11 symptoms of cervical cancer, with vaginal bleeding between menstrual periods, pelvic pain, and vaginal bleeding during/after sexual intercourse recognized by 58, 52 and 54% respectively. Single women (OR = 0.59 (95%CI: 0.38-0.94), and women that lived farther than 1 kilo meter from nearest health facility in South Sudan (OR = 0.36-0.49 (95%CI: 0.26-0.84) were less likely to be knowledgeable of symptoms of cervical cancer. CONCLUSION A significant proportion of women in Palabek refugee settlement had not heard about cervical cancer. Refugee health services providers could increase awareness of cervical cancer risk factors and symptoms through health education in order to promote risk reduction behaviours and guide women during symptoms appraisal. Single women and those who lived more than one kilo metre from nearest health facility in home country could be a priority group for awareness intervention in the settlement.
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Affiliation(s)
- Winnie Adoch
- School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Christopher Orach Garimoi
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Suzanne E. Scott
- Centre for Oral, Clinical & Translational Sciences, Faculty of Dentistry, Oral & Craniofacical Sciences, King’s College London, London, UK
| | - Geoffrey Goddie Okeny
- School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Jennifer Moodley
- Women’s Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road. Observatory, Cape Town, 7925 South Africa
- Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925 South Africa
| | - Henry Komakech
- Department of Community Health and Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Fiona M. Walter
- The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Amos Deogratius Mwaka
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
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Sengayi-Muchengeti M, Joko-Fru WY, Miranda-Filho A, Egue M, Akele-Akpo MT, N'da G, Mathewos A, Buziba N, Korir A, Manraj S, Lorenzoni C, Carrilho C, Hansen R, Finesse A, Somdyala NIM, Wabinga H, Chingonzoh T, Borok M, Chokunonga E, Liu B, Singh E, Kantelhardt EJ, Parkin DM. Cervical cancer survival in sub-Saharan Africa by age, stage at diagnosis and Human Development Index: A population-based registry study. Int J Cancer 2020; 147:3037-3048. [PMID: 32449157 DOI: 10.1002/ijc.33120] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 03/31/2020] [Accepted: 04/21/2020] [Indexed: 11/06/2022]
Abstract
Cervical cancer is the leading cause of cancer death in African women. We sought to estimate population-based survival and evaluate excess hazards for mortality in African women with cervical cancer, examining the effects of country-level Human Development Index (HDI), age and stage at diagnosis. We selected a random sample of 2760 incident cervical cancer cases, diagnosed in 2005 to 2015 from 13 population-based cancer registries in 11 countries (Benin, Cote d'Ivoire, Ethiopia, Kenya, Mauritius, Mozambique, Namibia, Seychelles, South Africa, Uganda and Zimbabwe) through the African Cancer Registry Network. Of these, 2735 were included for survival analyses. The 1-, 3- and 5-year observed and relative survival were estimated by registry, stage and country-level HDI. We used flexible Poisson regression models to estimate the excess hazards for death adjusting for age, stage and HDI. Among patients with known stage, 65.8% were diagnosed with Stage III-IV disease. The 5-year relative survival for Stage I-II cervical cancer in high HDI registry areas was 67.5% (42.1-83.6) while it was much lower (42.2% [30.6-53.2]) for low HDI registry areas. Independent predictors of mortality were Stage III-IV disease, medium to low country-level HDI and age >65 years at cervical cancer diagnosis. The average relative survival from cervix cancer in the 11 countries was 69.8%, 44.5% and 33.1% at 1, 3 and 5 years, respectively. Factors contributing to the HDI (such as education and a country's financial resources) are critical for cervical cancer control in SSA and there is need to strengthen health systems with timely and appropriate prevention and treatment programmes.
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Affiliation(s)
- Mazvita Sengayi-Muchengeti
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Walburga Yvonne Joko-Fru
- The African Cancer Registry Network, INCTR African Registry Programme, Oxford, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | | | | | - Guy N'da
- Abidjan Cancer Registry, Abidjan, Ivory Coast
| | | | | | | | | | - Cesaltina Lorenzoni
- Maputo Cancer Registry, Maputo Central Hospital and Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Carla Carrilho
- Maputo Cancer Registry, Maputo Central Hospital and Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | | | - Anne Finesse
- Seychelles Cancer Registry, Victoria, Seychelles
| | | | - Henry Wabinga
- Kampala Cancer Registry and Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | | | | | - Biying Liu
- The African Cancer Registry Network, INCTR African Registry Programme, Oxford, UK
| | - Elvira Singh
- National Cancer Registry, National Health Laboratory Service, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Eva Johanna Kantelhardt
- Department of Gynaecology and Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenburg, Halle, Germany
| | - Donald Maxwell Parkin
- The African Cancer Registry Network, INCTR African Registry Programme, Oxford, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- International Agency for Research on Cancer, Lyon, France
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Dereje N, Gebremariam A, Addissie A, Worku A, Assefa M, Abraha A, Tigeneh W, Kantelhardt EJ, Jemal A. Factors associated with advanced stage at diagnosis of cervical cancer in Addis Ababa, Ethiopia: a population-based study. BMJ Open 2020; 10:e040645. [PMID: 33051237 PMCID: PMC7554500 DOI: 10.1136/bmjopen-2020-040645] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To describe the patterns and factors associated with advanced stage at diagnosis of cervical cancer among Addis Ababa residents, Ethiopia. DESIGN A population-based cross-sectional study. SETTING Seven major hospitals or diagnostic facilities in Addis Ababa, Ethiopia. PARTICIPANTS All histopathology-confirmed patients with incident cervical cancer diagnosed from 1 January 2017 to 30 June 2018 among Addis Ababa residents. OUTCOME MEASURES The proportion of patients with cervical cancer diagnosed at early stage (stage I/II) and advanced stage (stage III/IV) of the disease according to International Federation of Gynaecology and Obstetrics staging criteria, and adjusted prevalence ratio (APR) for factors associated with advanced-stage diagnosis using a Poisson regression with robust variance model. RESULTS The mean age of the study participants was 52.9 (±13.3) years. Nearly two-thirds (60.4%, 95% CI: 53.8% to 66.5%) of patients with cervical cancer were diagnosed at an advanced stage. Advanced stage at diagnosis was significantly associated with paying medical bill out of pocket (APR=1.44, 95% CI: 1.08 to 1.91), diagnostic interval >90 days (APR=1.31, 95% CI: 1.04 to 1.71), practicing religion as a remedy or not taking immediate action following symptom recognition (APR=1.25, 95% CI: 1.08 to 1.91) and visiting more than three different health facilities prior to diagnostic confirmation (APR=1.24, 95% CI: 1.07 to 1.51). CONCLUSIONS Our findings of the high proportion of advanced-stage diagnosis of cervical cancer in Addis Ababa and its strong associations with out-of-pocket medical bill, seeking care out of conventional medicine settings and multiple visits to healthcare facilities before diagnostic confirmations underscore the need for public policies to improve the affordability of cancer care and enhance community awareness about the severity of the disease and referral system, in addition to expanding cervical cancer screening.
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Affiliation(s)
- Nebiyu Dereje
- Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
- Public Health, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia
| | - Alem Gebremariam
- Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
- Public Health, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
| | - Adamu Addissie
- Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mathewos Assefa
- Oncology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Aynalem Abraha
- Oncology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Eva Johanna Kantelhardt
- Department of Gynaecology, Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-Universitat Halle-Wittenberg, Halle, Saxony-Anhalt, Germany
| | - Ahmedin Jemal
- Surveillance & Health Services Research, American Cancer Society, Atlanta, Georgia, USA
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Jatho A, Tran BT, Cambia JM, Nanyingi M, Mugisha NM. Cancer Risk Studies and Priority Areas for Cancer Risk Appraisal in Uganda. Ann Glob Health 2020; 86:78. [PMID: 32704483 PMCID: PMC7350938 DOI: 10.5334/aogh.2873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Research into aetiologies and prevention of the commonest cancers and implementation of primary and secondary prevention can reduce cancer risk and improve quality of life. Moreover, monitoring the prevalence of cancer risk factors in a specific population helps guide cancer prevention and early detection efforts and national cancer control programming. Objective This article aims to provide the scope and findings of cancer risk studies conducted in Uganda to guide researchers, health-care professionals, and policymakers. Methods Between November 2019 to January 2020, we searched peer-reviewed published articles in Pubmed, EMBASE and Cochrane Library (Cochrane central register of controlled trials-CENTRAL). We followed the recommendation of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses - the PRISMA. The primary focus was to identify cancer risk and prevention studies conducted in Uganda and published in peer-reviewed journals from January 2000 and January 2020. We used key Boolean search terms with their associated database strings. Results We identified 416 articles, screened 269 non-duplicate articles and obtained 77 full-text articles for review. Out of the 77 studies, we identified one (1%) randomized trial, two (2.5%) retrospective cohort studies and 14 (18%) case-control studies, 46 (60%) cross-sectional studies, five (6.4%) ecological studies, three panel studies (4%) and six (8%) qualitative studies. Cervical cancer was the most studied type of cancer in Uganda (23.4%, n = 18 studies), followed by lymphomas - both Hodgkin and Non-Hodgkin sub-types (20.7%), n = 16 studies) and breast cancer (15.6%, n = 12 studies). In lymphoma studies, Burkitt lymphoma was the most studied type of lymphoma (76%, n = 13 studies). The studies concentrated on specific cancer risk awareness, risk perceptions, attitudes, uptake of screening, uptake of human papillomavirus vaccination, the prevalence of some of the known cancer risk factors and obstacles to accessing screening services. Conclusion The unmet need for comprehensive cancer risk and prevention studies is enormous in Uganda. Future studies need to comprehensively investigate the known and putative cancer risk factors and prioritize the application of the higher-hierarchy evidence-generating epidemiological studies to guide planning of the national cancer control program.
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Affiliation(s)
- Alfred Jatho
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, KR
- Uganda Cancer Institute, Kampala, UG
| | - Binh Thang Tran
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, KR
- Institute of Research and Development, Duy Tan University, Da Nang, VN
| | - Jansen Marcos Cambia
- Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, KR
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Jedy-Agba E, Joko WY, Liu B, Buziba NG, Borok M, Korir A, Masamba L, Manraj SS, Finesse A, Wabinga H, Somdyala N, Parkin DM. Trends in cervical cancer incidence in sub-Saharan Africa. Br J Cancer 2020; 123:148-154. [PMID: 32336751 PMCID: PMC7341858 DOI: 10.1038/s41416-020-0831-9] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 02/17/2020] [Accepted: 03/18/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cervical cancer is the second most common cancer and the leading cause of cancer death in women in sub-Saharan Africa (SSA). METHODS Trends in the incidence of cervical cancer are examined for a period of 10-25 years in 10 population-based cancer registries across eight SSA countries (Gambia, Kenya, Malawi, Mauritius, Seychelles, South Africa, Uganda and Zimbabwe). A total of 21,990 cases of cervical cancer were included in the analyses. RESULTS Incidence rates had increased in all registries for some or all of the periods studied, except for Mauritius with a constant annual 2.5% decline. Eastern Cape and Blantyre (Malawi) registries showed significant increases over time, with the most rapid being in Blantyre (7.9% annually). In Kampala (Uganda), a significant increase was noted (2.2%) until 2006, followed by a non-significant decline. In Eldoret, a decrease (1998-2002) was followed by a significant increase (9.5%) from 2002 to 2016. CONCLUSION Overall, cervical cancer incidence has been increasing in SSA. The current high-level advocacy to reduce the burden of cervical cancer in SSA needs to be translated into support for prevention (vaccination against human papillomavirus and population-wide screening), with careful monitoring of results through population-based registries.
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Affiliation(s)
- Elima Jedy-Agba
- International Research Center of Excellence, Institute of Human Virology, Abuja, Nigeria.
| | - Walburga Yvonne Joko
- Clinical Trials Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Biying Liu
- African Cancer Registry Network, Prama House, 267 Banbury Road, Oxford, UK
| | | | - Margaret Borok
- Zimbabwe National Cancer Registry, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Anne Korir
- Nairobi Cancer Registry, Kenya Medical Research Institute, Nairobi, Kenya
| | - Leo Masamba
- University of Malawi College of Medicine and Queen Elizabeth Central Hospital Cancer Unit, Blantyre, Malawi
| | - Shyam Shunker Manraj
- Mauritius National Cancer Registry, Mauritius Institute of Health, Pamplemousses, Mauritius
| | - Anne Finesse
- Seychelles National Cancer Registry, Ministry of Health, Victoria, Seychelles
| | - Henry Wabinga
- Department of Pathology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Nontuthuzelo Somdyala
- Eastern Cape Cancer Registry, Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Donald Maxwell Parkin
- Clinical Trials Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- International Agency for Research on Cancer, Lyon, France
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Mwaka AD, Abbo C, Kinengyere AA. Traditional and Complementary Medicine Use Among Adult Cancer Patients Undergoing Conventional Treatment in Sub-Saharan Africa: A Scoping Review on the Use, Safety and Risks. Cancer Manag Res 2020; 12:3699-3712. [PMID: 32547206 PMCID: PMC7246319 DOI: 10.2147/cmar.s251975] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 04/29/2020] [Indexed: 12/30/2022] Open
Abstract
Background Use of traditional and complementary medicine (T&CM) is very common among patients in sub-Saharan Africa (SSA). However, there are limited data on concurrent use of T&CM with conventional cancer therapies. In this scoping review, we sought to describe the (i) prevalence of use, (ii) types of medicine, (iii) reasons for taking T&CM, (iv) current knowledge on safety and risks, (v) characteristics of adult cancer patients who use T&CM, and (vi) perceived treatment outcomes among cancer patients undergoing conventional cancer treatment in SSA. Methods We conducted a systematic literature search for articles published in the English language in three scientific databases (PubMed, Embase and Web of Science). We used a scoping review approach to map relevant literature on T&CM use among cancer patients undergoing conventional cancer treatments. We assessed 96 articles based on titles and abstracts, and 23 articles based on full text. Twelve articles fulfilled preset eligibility criteria. Results More than half of the included articles were from only two countries in SSA: Nigeria and Uganda. Median prevalence of use of T&CM was 60.0% (range: 14.1-79.0%). Median percent disclosure of use of T&CM to attending healthcare professionals was low at 32% (range: 15.3-85.7%). The most common reasons for non-disclosure were: the doctor did not ask, the doctor would rebuke them for using T&CM, and the doctors do not know much about T&CM and so there is no need to share the issue of use with them. T&CM used by cancer patients included herbs, healing prayers and massage. Reported reasons for use of T&CM in 8 of 12 articles included the wish to get rid of cancer symptoms, especially pain, cure cancer, improve physical and psychological well-being, treat toxicity of conventional cancer therapies and improve immunity. There were limited data on safety and risk profiles of T&CM among cancer patients in SSA. Conclusion Use of traditional and complementary medicines is common among cancer patients undergoing conventional cancer treatments. Healthcare professionals caring for cancer patients ought to inquire and communicate effectively regarding the use of T&CM in order to minimize the risks of side effects from concurrent use of T&CM and biomedicines.
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Affiliation(s)
- Amos Deogratius Mwaka
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Catherine Abbo
- Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Alison Annet Kinengyere
- Albert Cook Medical Library, College of Health Sciences, Makerere University, Kampala, Uganda
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Psychological distress among women with abnormal pap smear results in Serbia: Validity and reliability of the Cervical Dysplasia Distress Questionnaire. PLoS One 2019; 14:e0218070. [PMID: 31188876 PMCID: PMC6561558 DOI: 10.1371/journal.pone.0218070] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 05/25/2019] [Indexed: 11/24/2022] Open
Abstract
Background Receiving report of an abnormal finding from a Pap screening test in women often leads to psychological distress. Objectives The purpose of this study was to assess the reliability and validity of the Cervical Dysplasia Distress Questionnaire (CDDQ) among women in Serbia. Methods In 2017, we conducted a cross-sectional study involving 154 consecutive women attending cervical cancer screening who had received abnormal Pap smear results. Results Reliability assessment showed good internal consistency for all CDDQ subscales (Tension and discomfort: Cronbach’s α = 0.844; Embarrassment: α = 0.864; Sexual and reproductive consequences: α = 0.867; and Health consequences: α = 0.913). The test-retest reliability showed that the correlation coefficients (between 0.805 and 0.983) were significant at the 0.01 level for all of the Serbian CDDQ subscales. Principal Axis Factoring with Direct Oblimin rotation indicated four main components that explain 55.0% of variance. Conclusion The Serbian version of the CDDQ scale is a valid and reliable instrument for the assessment of psychological distress among women with abnormal Pap smear results.
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Saeed S, Khan JA, Iqbal N, Irfan S, Shafique A, Awan S. Cancer and how the patients see it; prevalence and perception of risk factors: a cross-sectional survey from a tertiary care centre of Karachi, Pakistan. BMC Public Health 2019; 19:360. [PMID: 30935404 PMCID: PMC6444817 DOI: 10.1186/s12889-019-6667-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 03/18/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The incidence of cancer is rising but data available regarding prevalence of cancer and patient perception of the disease in Pakistan is limited. It is difficult to deal with Cancer if the main causes are negligence towards risk factors and bizarre myths. This study was aimed to investigate common cancer presentations at a government sector hospital and to gain insight into patient knowledge of the disease. METHODS This was a cross-sectional study conducted on cancer patients from Jinnah Postgraduate Medical Centre. A self-made questionnaire was used to assess the norms related to cancer prevalence in our society, associated myths, and the most common risk factors per them. RESULTS A total of 402 participants consented to participate in the study (mean age 42.3 ± 15.07 years), 204(50.7%) were females and 190(47.3%) were illiterate. Biomass exposure was found in 147(37%), drug abuse in 132(33%) and smoking in 63(16%). We found 103(25.6%) had positive family histories of cancer. The most common primary tumor site was breast for females 98(48%) and Head and neck 66(33.3%) for males. Patients considered fate 328(82%), gutka 284(71%) and injuries 282(70%) as the most common causes for cancer; while 222(55.5%) considered black magic and 236(58.75%) considered evil eye as a risk factor for cancer. Cancer treatment caused significant financial stress in 376(93.5%) patients. CONCLUSION Breast and head and neck cancers were found to be prevalent among patients. It was noted that patients are negligent in daily life regarding the consumption of substances that commonly cause cancer. Individuals had diminished knowledge and majority linked cancer to unrelated causes and myths like black magic and fate. Almost all the patients complained of severe financial stress imposed by the disease.
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Affiliation(s)
- Saira Saeed
- Jinnah Sindh Medical University, Karachi, Pakistan
| | - Javaid Ahmad Khan
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Nousheen Iqbal
- Jinnah Medical and Dental College, Aga Khan University Hospital, Karachi, Pakistan. .,Aga Khan University Hospital, Karachi, Pakistan.
| | - Sana Irfan
- Jinnah Sindh Medical University, Karachi, Pakistan
| | | | - Safia Awan
- Aga Khan University Hospital, Karachi, Pakistan
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Dunyo P, Effah K, Udofia EA. Factors associated with late presentation of cervical cancer cases at a district hospital: a retrospective study. BMC Public Health 2018; 18:1156. [PMID: 30285699 PMCID: PMC6171232 DOI: 10.1186/s12889-018-6065-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 09/24/2018] [Indexed: 11/25/2022] Open
Abstract
Background Cervical cancer is the leading and most common female cancer among women in Ghana. Although there are screening methods to detect premalignant lesions for treatment, screening coverage in Ghana is 2.8% and late presentation of cases complicates treatment efforts. This study examined the sociodemographic, clinical and histological characteristics associated with late presentation of cervical cancer cases attending Gynecological Oncology care at Catholic Hospital, Battor. Methods One hundred and fifty-seven medical records of confirmed cases of cervical cancer reporting to the Outpatient Obstetrics and Gynecology Department between 2012 and 2016 were reviewed. Relevant data were retrieved using abstraction forms. Socio demographic variables investigated were level of education attained, marital status, National Health Insurance Scheme membership, employment status, place of residence and distance from hospital. Clinical variables included intermenstrual/postmenopausal bleeding, previous screening history, previous smoking history, age at menarche and number of children. Histological variables included subtypes of tumour and characteristics of tumour. Pearson’s chi-square test and logistic regression analysis were used to determine correlates of late stage at presentation with cervical cancer. Sensitivity analysis was performed to assess the effect of missing data. Results Approximately two-thirds (65.97%) of the cases presented in advanced stages of cervical cancer. Level of education, age at menarche and previous screening history were included in a regression model and adjusted for age. Age at menarche (n = 66) was eliminated from the model after sensitivity analysis. Among the remaining variables, only previous screening history was predictive of late stage at presentation of cervical cancer cases. Previously unscreened cases of cervical cancer were nearly four times more likely to present late, compared to those who had been screened previously (OR 3.91; 95% CI 1.43–10.69). No association was observed with sociodemographic and histological characteristics. Conclusion Lack of previous screening was associated with late presentation of cervical cancer at Catholic Hospital, Battor. Efforts to promote early cervical cancer screening should be intensified and future studies may explore an association with age at menarche. Electronic supplementary material The online version of this article (10.1186/s12889-018-6065-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Priscilla Dunyo
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Kofi Effah
- Obstetric and Gynecological Department/Cervical Cancer Screening and Training Center, Catholic Hospital, Battor, Ghana
| | - Emilia Asuquo Udofia
- Department of Community Health, School of Public Health, University of Ghana, Legon, Accra, Ghana.
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Wanyenze RK, Bwanika JB, Beyeza-Kashesya J, Mugerwa S, Arinaitwe J, Matovu JKB, Gwokyalya V, Kasozi D, Bukenya J, Makumbi F. Uptake and correlates of cervical cancer screening among HIV-infected women attending HIV care in Uganda. Glob Health Action 2018; 10:1380361. [PMID: 29035163 PMCID: PMC5678455 DOI: 10.1080/16549716.2017.1380361] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background: Human immunodeficiency virus (HIV)-infected women are at high risk of cervical cancer. Objective: This study assessed uptake and correlates of cervical screening among HIV-infected women in care in Uganda. Methods: A nationally representative cross-sectional survey of HIV-infected women in care was conducted from August to November 2016. Structured interviews were conducted with 5198 women aged 15–49 years, from 245 HIV clinics. Knowledge and uptake of cervical screening and human papillomavirus (HPV) vaccination were determined. Correlates of cervical screening were assessed with modified Poisson regression to obtain prevalence ratios (PRs) using Stata version 12.0. Results: Overall, 94.0% (n = 4858) had ever heard of cervical screening and 66% (n = 3732) knew a screening site. However, 47.4% (n = 2302) did not know the schedule for screening and 50% (n = 2409) did not know the symptoms of cervical cancer. One-third (33.7%; n = 1719) rated their risk of cervical cancer as low. Uptake of screening was 30.3% (n = 1561). Women who had never been screened cited lack of information (29.6%; n = 1059) and no time (25.5%; n = 913) as the main reasons. Increased likelihood of screening was associated with receipt of HIV care at a level II health center [adj. PR 1.89, 95% confidence interval (CI) 1.29–2.76] and private facilities (adj. PR 1.68, 95% CI 1.16–3.21), knowledge of cervical screening (adj. PR 2.19, 95% CI 1.78–2.70), where to go for screening (adj. PR 6.47, 95% CI 3.69–11.36), and low perception of risk (adj. PR 1.52, 95% CI 1.14–2.03). HPV vaccination was 2%. Conclusions: Cervical screening and HPV vaccination uptake were very low among HIV-infected women in care in Uganda. Improved knowledge of cervical screening schedules and sites, and addressing fears and risk perception may increase uptake of cervical screening in this vulnerable population.
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Affiliation(s)
- Rhoda K Wanyenze
- a Department of Disease Control and Environmental Health, Makerere University School of Public Health , Kampala , Uganda
| | - John Baptist Bwanika
- b Department of Epidemiology and Statistics , Makerere University School of Public Health , Kampala , Uganda
| | - Jolly Beyeza-Kashesya
- b Department of Epidemiology and Statistics , Makerere University School of Public Health , Kampala , Uganda
| | - Shaban Mugerwa
- c AIDS Control Program, Ministry of Health , Kampala , Uganda
| | - Jim Arinaitwe
- d Global Fund Focal Coordination Office, Ministry of Health , Kampala , Uganda
| | - Joseph K B Matovu
- e Department of Community Health, Makerere University School of Public Health , Kampala , Uganda
| | - Violet Gwokyalya
- a Department of Disease Control and Environmental Health, Makerere University School of Public Health , Kampala , Uganda
| | - Dickson Kasozi
- a Department of Disease Control and Environmental Health, Makerere University School of Public Health , Kampala , Uganda
| | - Justine Bukenya
- a Department of Disease Control and Environmental Health, Makerere University School of Public Health , Kampala , Uganda
| | - Fred Makumbi
- b Department of Epidemiology and Statistics , Makerere University School of Public Health , Kampala , Uganda
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Marital status is an independent prognostic factor for tracheal cancer patients: an analysis of the SEER database. Oncotarget 2018; 7:77152-77162. [PMID: 27780931 PMCID: PMC5363576 DOI: 10.18632/oncotarget.12809] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 10/12/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Although marital status is an independent prognostic factor in many cancers, its prognostic impact on tracheal cancer has not yet been determined. The goal of this study was to examine the relationship between marital status and survival in patients with tracheal cancer. RESULTS Compared with unmarried patients (42.67%), married patients (57.33%) had better 5-year OS (25.64% vs. 35.89%, p = 0.009) and 5-year TCSS (44.58% vs. 58.75%, p = 0.004). Results of multivariate analysis indicated that marital status is an independent prognostic factor, with married patients showing better OS (hazard ratio [HR] = 0.78, 95% confidence interval [CI] 0.64-0.95, p = 0.015) and TCSS (HR = 0.70, 95% CI 0.54-0.91, p = 0.008). In addition, subgroup analysis suggested that marital status plays a more important role in the TCSS of patients with non-low-grade malignant tumors (HR = 0.71, 95% CI 0.53-0.93, p = 0.015). METHODS We extracted 600 cases from the Surveillance, Epidemiology, and End Results (SEER) database. Variables were compared by Pearson chi-squared test, t-test, log-rank test, and multivariate Cox regression analysis. Overall survival (OS) and tracheal cancer-specific survival (TCSS) were compared between subgroups with different pathologic features and tumor stages. CONCLUSIONS Marital status is an independent prognostic factor for survival in patients with tracheal cancer. For that reason, additional social support may be needed for unmarried patients, especially those with non-low-grade malignant tumors.
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Marital status is an independent prognostic factor for pancreatic neuroendocrine tumors patients: An analysis of the Surveillance, Epidemiology, and End Results (SEER) database. Clin Res Hepatol Gastroenterol 2017; 41:476-486. [PMID: 28416359 DOI: 10.1016/j.clinre.2017.02.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 02/08/2017] [Accepted: 02/28/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Marital status's prognostic impact on pancreatic neuroendocrine tumors (PNET) has not been rigorously studied. We aimed to explore the relationship between marital status and outcomes of PNET. METHODS We retrospectively investigated 2060 PNET cases between 2004 and 2010 from Surveillance, Epidemiology, and End Results (SEER) database. Variables were compared by Chi2 test, t-test as appropriate. Kaplan-Meier methods and COX proportional hazard models were used to ascertain independent prognostic factors. RESULTS Married patients had better 5-year overall survival (OS) (53.37% vs. 42.27%, P<0.001) and 5-year pancreatic neuroendocrine tumor specific survival (PNSS) (67.76% vs. 59.82%, P=0.001) comparing with unmarried patients. Multivariate analysis revealed marital status is an independent prognostic factor, with married patients showing better OS (HR=0.74; 95% CI: 0.65-0.84; P<0.001) and PNSS (HR=0.78; 95% CI: 0.66-0.92; P=0.004). Subgroup analysis suggested marital status plays a more important role in the PNET patients with distant stage rather than regional or localized disease. CONCLUSIONS Marital status is an independent prognostic factor for survival in PNET patients. Poor prognosis in unmarried patients may be associated with a delayed diagnosis with advanced tumor stage, psychosocial and socioeconomic factors. Further studies are needed.
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Scheel JR, Molina Y, Anderson BO, Patrick DL, Nakigudde G, Gralow JR, Lehman CD, Thompson B. Breast Cancer Beliefs as Potential Targets for Breast Cancer Awareness Efforts to Decrease Late-Stage Presentation in Uganda. J Glob Oncol 2017; 4:1-9. [PMID: 30241166 PMCID: PMC6180808 DOI: 10.1200/jgo.2016.008748] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose To assess breast cancer beliefs in Uganda and determine whether these beliefs
are associated with factors potentially related to nonparticipation in early
detection. Methods A survey with open- and close-ended items was conducted in a community sample
of Ugandan women to assess their beliefs about breast cancer. Linear
regression was used to ascertain associations between breast cancer beliefs
and demographic factors potentially associated with early detection,
including socioeconomic factors, health care access, prior breast cancer
knowledge, and personal detection practices. Results Of the 401 Ugandan women surveyed, most had less than a primary school
education and received medical care at community health centers. Most women
either believed in or were unsure about cultural explanatory models for
developing breast cancer (> 82%), and the majority listed these
beliefs as the most important causes of breast cancer (69%). By comparison,
≤ 45% of women believed in scientific explanatory risks for
developing breast cancer. Although most believed that regular screening and
early detection would find breast cancer when it is easy to treat (88% and
80%, respectively), they simultaneously held fatalistic attitudes toward
their own detection efforts, including belief or uncertainty that a cure is
impossible once they could self-detect a lump (54%). Individual beliefs were
largely independent of demographic factors. Conclusion Misconceptions about breast cancer risks and benefits of early detection are
widespread in Uganda and must be addressed in future breast cancer awareness
efforts. Until screening programs exist, most breast cancer will be
self-detected. Unless addressed by future awareness efforts, the high
frequency of fatalistic attitudes held by women toward their own detection
efforts will continue to be deleterious to breast cancer early detection in
sub-Saharan countries like Uganda.
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Affiliation(s)
- John R Scheel
- John R. Scheel, Benjamin O. Anderson, Julie R. Gralow, Fred Hutchinson Cancer Center and University of Washington; Donald L. Patrick, University of Washington; Beti Thompson, Fred Hutchinson Cancer Research Center, Seattle, WA; Yamile Molina, University of Illinois at Chicago, Chicago, IL; Gertrude Nakigudde, Uganda Women's Cancer Support Organization, Kampala, Uganda; and Constance D. Lehman, Massachusetts General Hospital, Boston, MA
| | - Yamile Molina
- John R. Scheel, Benjamin O. Anderson, Julie R. Gralow, Fred Hutchinson Cancer Center and University of Washington; Donald L. Patrick, University of Washington; Beti Thompson, Fred Hutchinson Cancer Research Center, Seattle, WA; Yamile Molina, University of Illinois at Chicago, Chicago, IL; Gertrude Nakigudde, Uganda Women's Cancer Support Organization, Kampala, Uganda; and Constance D. Lehman, Massachusetts General Hospital, Boston, MA
| | - Benjamin O Anderson
- John R. Scheel, Benjamin O. Anderson, Julie R. Gralow, Fred Hutchinson Cancer Center and University of Washington; Donald L. Patrick, University of Washington; Beti Thompson, Fred Hutchinson Cancer Research Center, Seattle, WA; Yamile Molina, University of Illinois at Chicago, Chicago, IL; Gertrude Nakigudde, Uganda Women's Cancer Support Organization, Kampala, Uganda; and Constance D. Lehman, Massachusetts General Hospital, Boston, MA
| | - Donald L Patrick
- John R. Scheel, Benjamin O. Anderson, Julie R. Gralow, Fred Hutchinson Cancer Center and University of Washington; Donald L. Patrick, University of Washington; Beti Thompson, Fred Hutchinson Cancer Research Center, Seattle, WA; Yamile Molina, University of Illinois at Chicago, Chicago, IL; Gertrude Nakigudde, Uganda Women's Cancer Support Organization, Kampala, Uganda; and Constance D. Lehman, Massachusetts General Hospital, Boston, MA
| | - Gertrude Nakigudde
- John R. Scheel, Benjamin O. Anderson, Julie R. Gralow, Fred Hutchinson Cancer Center and University of Washington; Donald L. Patrick, University of Washington; Beti Thompson, Fred Hutchinson Cancer Research Center, Seattle, WA; Yamile Molina, University of Illinois at Chicago, Chicago, IL; Gertrude Nakigudde, Uganda Women's Cancer Support Organization, Kampala, Uganda; and Constance D. Lehman, Massachusetts General Hospital, Boston, MA
| | - Julie R Gralow
- John R. Scheel, Benjamin O. Anderson, Julie R. Gralow, Fred Hutchinson Cancer Center and University of Washington; Donald L. Patrick, University of Washington; Beti Thompson, Fred Hutchinson Cancer Research Center, Seattle, WA; Yamile Molina, University of Illinois at Chicago, Chicago, IL; Gertrude Nakigudde, Uganda Women's Cancer Support Organization, Kampala, Uganda; and Constance D. Lehman, Massachusetts General Hospital, Boston, MA
| | - Constance D Lehman
- John R. Scheel, Benjamin O. Anderson, Julie R. Gralow, Fred Hutchinson Cancer Center and University of Washington; Donald L. Patrick, University of Washington; Beti Thompson, Fred Hutchinson Cancer Research Center, Seattle, WA; Yamile Molina, University of Illinois at Chicago, Chicago, IL; Gertrude Nakigudde, Uganda Women's Cancer Support Organization, Kampala, Uganda; and Constance D. Lehman, Massachusetts General Hospital, Boston, MA
| | - Beti Thompson
- John R. Scheel, Benjamin O. Anderson, Julie R. Gralow, Fred Hutchinson Cancer Center and University of Washington; Donald L. Patrick, University of Washington; Beti Thompson, Fred Hutchinson Cancer Research Center, Seattle, WA; Yamile Molina, University of Illinois at Chicago, Chicago, IL; Gertrude Nakigudde, Uganda Women's Cancer Support Organization, Kampala, Uganda; and Constance D. Lehman, Massachusetts General Hospital, Boston, MA
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