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Sutherland EK, Smith JD, Ofori-Boateng M, Kushitor SB, Sarkwah HN, Kwanin BA, Sward KA, Gouripeddi R, Manortey SO, Price MD, Rositch A, Ngwa W, Alder SC, Joshu C, Price RR. Study protocol for the development of a real-time interface showing the availability of breast and cervical cancer services in Ghana. PLoS One 2024; 19:e0312150. [PMID: 39418299 PMCID: PMC11486384 DOI: 10.1371/journal.pone.0312150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 09/24/2024] [Indexed: 10/19/2024] Open
Abstract
BACKGROUND The 5-year survival rates for breast and cervical cancers in Ghana are low in comparison to rates in developed countries. This striking disparity is attributed to numerous factors, including limited access and navigability to appropriate services. A one-time cross-sectional, hospital-based survey was performed by the University of Utah in collaboration with Ghana Health Services (GHS) and Health Facilities Regulatory Agency (HeFRA) from November, 2020 to October, 2021 so as to determine existing hospital-based breast and cervical cancer care services capacity and their geographic availability nationwide. This related information remains dynamic in nature and time. The current project employs a public-academic implementation science and research configuration to explore and develop a real-time interface (RTIF) showing the availability of breast and cervical cancer care services at hospital facilities in-country so as to anchor up-to-date data products for the government, private-sector, and patient-centric consumption. METHODS AND ANALYSIS Multiple methods will be employed to achieve the study objectives between December 2023 to November 2024. The first three objectives shall focus on contextual, needs, and feasibility assessments guided by the domains and constructs within the updated Consolidated Framework for Implementation Research (CFIR) during coding and thematic qualitative analysis. Using purposive sampling, breast and cervical cancer care service stakeholders shall be identified for individual in-depth interviews. The fourth objective will involve creating the RTIF prototype and piloting it in the Eastern Region of Ghana. The final and fifth objective shall employ the systems usability scale (SUS) amongst ten randomly selected individual stakeholders to assess the technical functionality of the interface. A nationwide scale-up shall follow this.
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Affiliation(s)
- Edward Kofi Sutherland
- Center for Global Surgery, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, United States of America
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Community Health, Ensign Global College, Kpong, Ghana
| | - Justin Dean Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, United States of America
| | | | - Sandra Boatemaa Kushitor
- Department of Community Health, Ensign Global College, Kpong, Ghana
- Center for Sustainability Transitions, Stellenbosch University, Stellenbosch, South Africa
| | - Hammond Nii Sarkwah
- Department of Community Health, Ensign Global College, Kpong, Ghana
- Department of Information and Communication Technology, Ghana Health Services, Accra, Ghana
| | | | - Katherine Ann Sward
- Department of Biomedical Informatics, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, United States of America
| | - Ramkiran Gouripeddi
- Department of Biomedical Informatics, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, United States of America
| | | | - Matthew Dean Price
- Center for Global Surgery, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, United States of America
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Anne Rositch
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Wil Ngwa
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Stephen Craig Alder
- Department of Community Health, Ensign Global College, Kpong, Ghana
- Center for Business, Health and Prosperity, University of Utah, Salt Lake City, Utah, United States of America
| | - Corrine Joshu
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Raymond Richard Price
- Center for Global Surgery, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, United States of America
- Department of Surgery, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah, United States of America
- Intermountain Health, Salt Lake City, Utah, United States of America
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Price MD, Mali ME, Ernest A, Abrahams AOD, Goold E, Elvira L, Dedey F, Rositch AF, Price RR, Sutherland EK. Availability and geographic access to breast cancer pathology services in Ghana. PLoS One 2024; 19:e0305901. [PMID: 39141634 PMCID: PMC11324111 DOI: 10.1371/journal.pone.0305901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 06/06/2024] [Indexed: 08/16/2024] Open
Abstract
INTRODUCTION Breast cancer poses a significant health challenge in Sub-Saharan Africa, particularly in Ghana, where late-stage diagnoses and limited healthcare access contribute to elevated mortality rates. This study focuses on the crucial role of pathology and laboratory medical (PALM) services in the timely diagnosis of breast cancer within Ghana. METHODS A cross-sectional survey of hospitals was completed from November 2020 to October 2021, with 94.8% of identified in-country hospitals participating. Pathology service-related parameters assessed included whether pathology was available for the diagnosis of breast cancer on-site or via external referral, the number of pathology personnel, additional breast cancer diagnostic capabilities including estrogen and progesterone and/or HER2 testing, and the time from biopsy to patients receiving their results. Geospatial mapping was used to identify areas of limited access. RESULTS Of the 328 participating hospitals, 136 (41%) reported breast cancer pathology services, with only 6 having on-site capabilities. Pathology personnel, comprising 15 consultants and 15 specialists, were concentrated in major referral centers, particularly in Greater Accra and Kumasi. An assessment of referral patterns suggested that 75% of the population reside within an hour of breast cancer pathology services. Among the 136 hospitals with access to breast cancer pathology, only a limited number reported that results included ER/PR (38%) and HER2 testing (33%). CONCLUSION Ghana has been able to ensure significant pathology service availability through robust referral pathways with centralized labs. Despite this, difficulties persist with the majority of pathology results not including hormone receptor testing which is important in providing tumor specific treatment.
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Affiliation(s)
- Matthew D. Price
- Center for Global Surgery, The University of Utah, Salt Lake City, UT, United States of America
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Meghan E. Mali
- Center for Global Surgery, The University of Utah, Salt Lake City, UT, United States of America
- Department of Surgery, The University of Utah School of Medicine, Salt Lake City, UT, United States of America
| | - Adjei Ernest
- Department of Pathology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Eric Goold
- Department of Pathology, The University of Utah School of Medicine, Salt Lake City, UT, United States of America
| | - Liz Elvira
- Center for Global Surgery, The University of Utah, Salt Lake City, UT, United States of America
| | | | - Anne F. Rositch
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Diagnostics Division, Hologic, Inc, San Diego, CA, United States of America
| | - Raymond R. Price
- Center for Global Surgery, The University of Utah, Salt Lake City, UT, United States of America
- Department of Surgery, The University of Utah School of Medicine, Salt Lake City, UT, United States of America
- Intermountain Health, Salt Lake City, UT, United States of America
| | - Edward K. Sutherland
- Center for Global Surgery, The University of Utah, Salt Lake City, UT, United States of America
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Ensign Global College, Kpong, Ghana
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Price MD, Mali ME, Dedey F, Dzefi-Tettey K, Li Y, Almeida C, Brownson KE, Price RR, Sutherland EK. Mammography and Breast Ultrasonography Services in Ghana, Availability, and Geographic Access. JCO Glob Oncol 2024; 10:e2400218. [PMID: 39208381 PMCID: PMC11462162 DOI: 10.1200/go.24.00218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 07/11/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
PURPOSE Breast cancer is the leading type of cancer diagnosed and the second leading cause of cancer-related death in Ghana. Mammography and ultrasound have proven benefits in the early detection of breast cancer. This study evaluates mammography, breast ultrasound, and radiology work force availability throughout Ghana. METHODS A survey was administered to all hospitals in Ghana from November 2020 to October 2021. Mammography, breast ultrasound services, and the number of radiologists were assessed. For mammography, the number performed per month, cost incurred by the patient, where images were read, and how long it took to receive reports were also assessed. Health Facilities Regulatory Authority records on diagnostic centers were obtained to identify additional in-country breast imaging services. RESULTS Three hundred and twenty-eight of 346 hospitals participated in the survey (95%). Only 21 hospitals reported on-site mammography. One hospital reported performing >100 mammographies per month. The average cost to the patient ranged from 100 to 500 Cedis ($17-87 US dollars [USD]), although three hospitals performed mammography at no cost. An additional 10 mammography machines were identified at diagnostic centers throughout the country, with 41.3% of the female population living within 1 hour of mammography services. There were 135 hospital-based breast ultrasound services identified with 69.5% of the female population living within 1 hour of these services. There were an additional 190 ultrasound machines at diagnostic centers. There were 96 in-country radiologists identified. CONCLUSION Although there is limited availability and utilization of mammography in Ghana, there is more readily available ultrasonography. A focus on increasing breast cancer early diagnostic capabilities with breast ultrasound should be prioritized in addition to further expansion of the radiology workforce.
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Affiliation(s)
- Matthew D. Price
- The University of Utah, Center for Global Surgery, Salt Lake City, UT
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Meghan E. Mali
- The University of Utah, Center for Global Surgery, Salt Lake City, UT
- Department of Surgery, The University of Utah School of Medicine, Salt Lake City, UT
| | - Florence Dedey
- Department of Surgery, University of Ghana Medical School, Accra, Ghana
| | | | - Yao Li
- Department of Geography & Earth Sciences, The University of North Carolina at Charlotte, Charlotte, NC
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Cameron Almeida
- University of Alabama Birmingham School of Medicine, Birmingham, AL
| | - Kirstyn E. Brownson
- The University of Utah, Center for Global Surgery, Salt Lake City, UT
- Department of Surgery, The University of Utah School of Medicine, Salt Lake City, UT
- Huntsman Cancer Institute, Salt Lake City, UT
| | - Raymond R. Price
- The University of Utah, Center for Global Surgery, Salt Lake City, UT
- Department of Surgery, The University of Utah School of Medicine, Salt Lake City, UT
- Intermountain Health, Salt Lake City, UT
| | - Edward Kofi Sutherland
- The University of Utah, Center for Global Surgery, Salt Lake City, UT
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Ensign Global College, Kpong, Ghana
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Badu-Peprah A, Otoo OK, Amamoo M, Quarshie F, Adomako B. Breast imaging reporting and data system for sonography: Positive and negative predictive values of sonographic features in Kumasi, Ghana. Transl Oncol 2024; 45:101976. [PMID: 38697004 PMCID: PMC11070917 DOI: 10.1016/j.tranon.2024.101976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 04/15/2024] [Accepted: 04/27/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND Breast cancer is the most common female cancer globally. The method of choice for screening and diagnosing breast cancer is mammography, which is not widely available in Ghana as compared to ultrasonography. This study aimed to evaluate the sonographic features of solid breast lesions using the new sonographic Breast Imaging- Reporting and Data System (BI-RADS-US) lexicon for malignancy with histopathology as the gold standard. METHODS This was a prospective quantitative study that sonographically scanned female patients with breast masses and consecutively selected cases recommended for core biopsy from May 2018 to May 2021. Sixty (60) solid breast masses were described using the sonographic BI-RADS lexicon features. Lesion description and biopsy results from histopathology were compared and analyzed using Pearson's Chi-square test. Odds ratios, sensitivity, specificity, and predictive values were also calculated. Statistical significance level was set at p ≤ 0.05. RESULTS Irregular shape (p < 0.0001), spiculated mass margins (p < 0.0001), and not parallel mass orientation (p= 0.0007) were more commonly associated with malignant masses. The sensitivity of breast ultrasound for malignancy was 93.9 % and the specificity was 55.6 % with an overall accuracy rate of 76.6 %. The negative predictive value was 88.7 % and the positive predictive value was 72.1 %. Descriptors like irregular shape, non-parallel orientation, angular and spiculated margins, echogenic halo, and markedly hypoechoic internal content, demonstrated higher odds ratios for malignancy. CONCLUSIONS This study adds valuable insights to the diagnosis of breast cancer using the sonographic BI-RADS lexicon features. The results demonstrate that specific sonographic descriptors can effectively differentiate between benign and malignant breast masses.
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Affiliation(s)
- Augustina Badu-Peprah
- Radiology Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana; Radiology Department, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Obed Kojo Otoo
- Radiology Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Mansa Amamoo
- Radiology Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Frank Quarshie
- Research Directorate, Klintaps College of Health and Allied Sciences, Klagon-Tema,Ghana
| | - Benjamin Adomako
- Research and Development Unit, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Price MD, Rositch AF, Dedey F, Mali ME, Brownson KE, Nsaful J, Tounkara M, Price RR, Sutherland EK. Availability and Geographic Access to Hospital-Based Breast Cancer Diagnostic Services in Ghana. JCO Glob Oncol 2024; 10:e2300231. [PMID: 38330275 PMCID: PMC10860977 DOI: 10.1200/go.23.00231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/10/2023] [Accepted: 12/01/2023] [Indexed: 02/10/2024] Open
Abstract
PURPOSE Breast cancer is the most frequent cancer and second most common cause of cancer-related death in Ghana. Early detection and access to diagnostic services are vital for early treatment initiation and improved survival. This study characterizes the geographic access to hospital-based breast cancer diagnostic services in Ghana as a framework for expansion. METHODS A cross-sectional hospital-based survey was completed in Ghana from November 2020 to October 2021. Early diagnostic services, as defined by the National Comprehensive Cancer Network (NCCN) Framework for Resource Stratification, was assessed at each hospital. Services were characterized as available >80% of the time in the previous year, <80%, or not available. ArcGIS was used to identify the proportion of the population within 20 and 45 km of services. RESULTS Most hospitals in Ghana participated in this survey (95%; 328 of 346). Of these, 12 met full NCCN Basic criteria >80% of the time, with 43% of the population living within 45 km. Ten of the 12 met full NCCN Core criteria, and none met full NCCN Enhanced criteria. An additional 12 hospitals were identified that provide the majority of NCCN Basic services but lack select services necessary to meet this criterion. Expansion of services in these hospitals could result in an additional 20% of the population having access to NCCN Basic-level early diagnostic services within 45 km. CONCLUSION Hospital-based services for breast cancer early diagnosis in Ghana are available but sparse. Many hospitals offer fragmented aspects of care, but only a limited number of hospitals offer the full NCCN Basic or Core level of care. Understanding current availability and geographical distribution of services provides a framework for potential targeted expansion of services.
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Affiliation(s)
- Matthew D. Price
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
- The University of Utah, Center for Global Surgery, Salt Lake City, UT
| | - Anne F. Rositch
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Meghan E. Mali
- The University of Utah, Center for Global Surgery, Salt Lake City, UT
- Department of Surgery, The University of Utah, Salt Lake City, UT
| | - Kirstyn E. Brownson
- The University of Utah, Center for Global Surgery, Salt Lake City, UT
- Department of Surgery, The University of Utah, Salt Lake City, UT
- Huntsman Cancer Institute, Salt Lake City, UT
| | | | - Mamadou Tounkara
- The University of Utah, Center for Global Surgery, Salt Lake City, UT
| | - Raymond R. Price
- The University of Utah, Center for Global Surgery, Salt Lake City, UT
- Department of Surgery, The University of Utah, Salt Lake City, UT
- Intermountain Healthcare, Salt Lake City, UT
| | - Edward Kofi Sutherland
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- The University of Utah, Center for Global Surgery, Salt Lake City, UT
- Ensign Global College Ghana, Kpong, Ghana
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Schoenhals S, Mali ME, Sutherland EK, Sorenson J, Dedey F, Nellermoe J, Flores-Huidobro Martinez A, Tounkara MD, Price RR, Brownson KE. Geospatial availability of breast cancer treatment modalities and hypothetical access improvement in Ghana: A nationwide survey. PLoS One 2023; 18:e0291454. [PMID: 37713441 PMCID: PMC10503733 DOI: 10.1371/journal.pone.0291454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 08/28/2023] [Indexed: 09/17/2023] Open
Abstract
Breast cancer in Ghana is a growing public health problem with increasing incidence and poor outcomes. Lack of access to comprehensive treatment in Ghana may be a contributing factor to its high mortality. The purpose of this study was to evaluate the availability of treatments nationwide and systematically identify high yield areas for targeted expansion. We conducted a cross-sectional, nationwide hospital-based survey from November 2020-October 2021. Surveys were conducted in person with trained research assistants and described hospital availability of all breast cancer treatments and personnel. All individual treatment services were reported, and hospitals were further stratified into levels of multi-modal treatment modeled after the National Comprehensive Cancer Network (NCCN) Framework treatment recommendations for low-resource settings. Level 3 included Tamoxifen and surgery (mastectomy with axillary lymph node sampling); Level 2 included Level 3 plus radiation, aromatase inhibitors, lumpectomy, and sentinel lymph node biopsy; Level 1 included Level 2 plus Her2 therapy and breast reconstruction. Hospitals were identified that could expand to these service levels based on existing services, location and personnel. The distance of the total population from treatment services before and after hypothetical expansion was determined with a geospatial analysis. Of the 328 participating hospitals (95% response rate), 9 hospitals had Level 3 care, 0 had Level 2, and 2 had Level 1. Twelve hospitals could expand to Level 3, 1 could expand to Level 2, and 1 could expand to Level 1. With expansion, the population percentage within 75km of Level 1, 2 and 3 care would increase from 42% to 50%, 0 to 6% and 44% to 67%, respectively. Multi-modal breast cancer treatment is available in Ghana, but it is not accessible to most of the population. Leveraging the knowledge of current resources and population proximity provides an opportunity to identify high-yield areas for targeted expansion.
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Affiliation(s)
- Sarah Schoenhals
- Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- Department of Surgery, University of Utah Health, Salt Lake City, Utah, United States of America
| | - Meghan E. Mali
- Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- Department of Surgery, University of Utah Health, Salt Lake City, Utah, United States of America
| | - Edward K. Sutherland
- Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- Ensign Global College, Kpong, Eastern Region, Ghana
| | - Justin Sorenson
- J.Willard Marriot Library, University of Utah, Salt Lake City, Utah, United States of America
| | - Florence Dedey
- Department of Surgery, University of Ghana Medical School, Accra, Greater Accra, Ghana
- Department of Surgery, Korle Bu Teaching Hospital, Accra, Greater Accra, Ghana
| | - Jonathan Nellermoe
- Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | | | - Mamadou D. Tounkara
- Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Raymond R. Price
- Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- General Surgery, Intermountain Medical Center, Murray, Utah, United States of America
| | - Kirstyn E. Brownson
- Center for Global Surgery, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
- Department of Surgery, Huntsman Cancer Institute at University of Utah, Salt Lake City, Utah, United States of America
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Beltrán Ponce SE, Abunike SA, Bikomeye JC, Sieracki R, Niyonzima N, Mulamira P, Kibudde S, Ortiz de Choudens S, Siker M, Small C, Beyer KMM. Access to Radiation Therapy and Related Clinical Outcomes in Patients With Cervical and Breast Cancer Across Sub-Saharan Africa: A Systematic Review. JCO Glob Oncol 2023; 9:e2200218. [PMID: 36795990 PMCID: PMC10166435 DOI: 10.1200/go.22.00218] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
PURPOSE To better understand the barriers to accessing standard-of-care radiation therapy (RT) for breast and cervical cancer in sub-Saharan Africa and their impact on outcomes. METHODS A comprehensive literature search was completed with a medical librarian. Articles were screened by title, abstract, and full text. Included publications were analyzed for data describing barriers to RT access, available technology, and disease-related outcomes, and further grouped into subcategories and graded according to predefined criteria. RESULTS A total of 96 articles were included: 37 discussed breast cancer, 51 discussed cervical cancer, and eight discussed both. Financial access was affected by health care system payment models and combined burdens of treatment-related costs and lost wages. Staffing and technology shortages limit the ability to expand service locations and/or increase capacity within existing centers. Patient factors including use of traditional healers, fear of stigma, and low health literacy decrease the likelihood of early presentation and completion of therapies. Survival outcomes are worse than most high- and middle-income countries and are affected by many factors. Side effects are similar to other regions, but these findings are limited by poor documentation capabilities. Access to palliative RT is more expeditious than definitive management. RT was noted to lead to feelings of burden, lower self-esteem, and worsened quality of life. CONCLUSION Sub-Saharan Africa represents a diverse region with barriers to RT that differ on the basis of funding, available technology and staff, and community populations. Although long-term solutions must focus on building capacity by increasing the number of treatment machines and providers, short-term improvements should be implemented, such as interim housing for traveling patients, increased community education to reduce late-stage diagnoses, and use of virtual visits to avoid travel.
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Affiliation(s)
| | - Sarah Adamma Abunike
- Division of Epidemiology & Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | - Jean C Bikomeye
- Division of Epidemiology & Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
| | - Rita Sieracki
- Medical College of Wisconsin Libraries, Milwaukee, WI
| | | | | | | | | | - Malika Siker
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Christina Small
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Kirsten M M Beyer
- Division of Epidemiology & Social Sciences, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI
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