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Wuraola FO, Olasehinde O, Di Bernardo M, Aderounmu AA, Adisa AO, Omoyiola OZ, Omisore AD, Kingham TP, Mango V, Alatise OI. Clinicopathologic Profile and Psychosocial Experiences of Nigerian Breast Cancer Survivors. JCO Glob Oncol 2023; 9:e2300022. [PMID: 37769219 PMCID: PMC10581652 DOI: 10.1200/go.23.00022] [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: 02/04/2023] [Revised: 05/30/2023] [Accepted: 08/02/2023] [Indexed: 09/30/2023] Open
Abstract
PURPOSE Breast cancer survivors are a distinct category of patients with unique characteristics and needs. The population of survivors is expected to increase, given the rising incidence of breast cancer in Nigeria, and the improvements in breast cancer outcomes. This study evaluated the clinicopathologic characteristics and the psychosocial experiences of a cohort of Nigerian breast cancer survivors. METHODS From an institutional breast cancer database, patients managed between January 2010 and December 2016 were evaluated. Clinicopathologic characteristics, treatment details, and survival estimates were assessed. These were compared with nonsurvivors managed during the same period. Survivors were defined as those who have been alive for at least 5 years from the date of presentation. Qualitatively, a purposive sample of 20 survivors was evaluated using one-on-one in-depth interviews to assess their experiences and coping mechanisms after treatment. RESULTS Of the 355 patients in the database during the study period, there were 163 survivors (45.9%), while 192 (54.1%) died. Age, stage at presentation, tumor size, and receipt of multiple treatment modalities were significantly associated with survival. Five themes were identified in qualitative analysis: initial reaction to the diagnosis, experiences during treatment, social support, coping strategies, and advocacy. Strong family support and spirituality were prominent coping strategies identified in this cohort. CONCLUSION Despite obvious infrastructural and manpower limitations, Nigerian patients who present early and receive multimodal therapy and different breast cancer treatments have better odds of survival. Survivors have some unmet psychosocial and physical needs requiring intervention.
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Affiliation(s)
- Funmilola Olanike Wuraola
- Surgery Department, Obafemi Awolowo University, Ile-Ife, Nigeria
- Surgery Department, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Olalekan Olasehinde
- Surgery Department, Obafemi Awolowo University, Ile-Ife, Nigeria
- Surgery Department, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | | | | | - Adewale Oluseye Adisa
- Surgery Department, Obafemi Awolowo University, Ile-Ife, Nigeria
- Surgery Department, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Oluwatosin Zaniab Omoyiola
- Morbid Anatomy and Forensic Medicine Department, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | | | | | | | - Olusegun Isaac Alatise
- Surgery Department, Obafemi Awolowo University, Ile-Ife, Nigeria
- Surgery Department, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
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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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Petrova D, Garrido D, Špacírová Z, Fernández-Martínez NF, Ivanova G, Rodríguez-Barranco M, Pollán M, Barrios-Rodríguez R, Sánchez MJ. Duration of the patient interval in breast cancer and factors associated with longer delays in low-and middle-income countries: A systematic review with meta-analysis. Psychooncology 2023; 32:13-24. [PMID: 36345154 PMCID: PMC10100001 DOI: 10.1002/pon.6064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 10/02/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Breast cancer survival is lower in low- and middle-income countries (LMICs) partially due to many women being diagnosed with late-stage disease. The patient interval refers to the time elapsed between the detection of symptoms and the first consultation with a healthcare provider and is considered one of the core indicators for early diagnosis and treatment. The goal of the current research was to conduct a meta-analysis of the duration of the patient interval in LMICs and investigate the socio-demographic and socio-cultural factors related to longer delays in presentation. METHODS We conducted a systematic review with meta-analysis (pre-registered protocol CRD42020200752). We searched seven information sources (2009-2022) and included 50 articles reporting the duration of patient intervals for 18,014 breast cancer patients residing in LMICs. RESULTS The longest patient intervals were reported in studies from the Middle East (3-4 months), followed by South-East Asia (2 months), Africa (1-2 months), Latin America (1 month), and Eastern Europe (1 month). Older age, not being married, lower socio-economic status, illiteracy, low knowledge about cancer, disregarding symptoms or not attributing them to cancer, fear, negative beliefs about cancer, and low social support were related to longer delays across most regions. Longer delays were also related to use of alternative medicine in the Middle East, South-East Asia, and Africa and distrust in the healthcare system in Eastern Europe. CONCLUSIONS There is large variation in the duration of patient intervals across LMICs in different geographical regions. Patient intervals should be reduced and, for this purpose, it is important to explore their determinants taking into account the social, cultural, and economic context.
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Affiliation(s)
- Dafina Petrova
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Escuela Andaluza de Salud Pública (EASP), Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Dunia Garrido
- Department of Developmental and Educational Psychology, University of Granada, Granada, Spain
| | - Zuzana Špacírová
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Escuela Andaluza de Salud Pública (EASP), Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Nicolás Francisco Fernández-Martínez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Escuela Andaluza de Salud Pública (EASP), Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Interlevel Clinical Management Unit for Prevention, Promotion and Health Surveillance, Reina Sofía University Hospital, Córdoba, Spain
| | - Ganka Ivanova
- Department of Applied Psychology, College of Education, Social Sciences and Humanities, Al-Ain University, Abu Dhabi, United Arab Emirates
| | - Miguel Rodríguez-Barranco
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Escuela Andaluza de Salud Pública (EASP), Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Marina Pollán
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,National Center for Epidemiology, Health Institute Carlos III, Madrid, Spain
| | - Rocío Barrios-Rodríguez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Maria José Sánchez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Escuela Andaluza de Salud Pública (EASP), Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Olaogun JG, Agodirin OS. Breast cancer screening: can the iBreastExam bridge the gap? THE LANCET GLOBAL HEALTH 2022; 10:e461-e462. [DOI: 10.1016/s2214-109x(22)00078-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 02/14/2022] [Indexed: 01/20/2023] Open
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Dare AJ, Knapp GC, Romanoff A, Olasehinde O, Famurewa OC, Komolafe AO, Olatoke S, Katung A, Alatise OI, Kingham TP. High-burden Cancers in Middle-income Countries: A Review of Prevention and Early Detection Strategies Targeting At-risk Populations. Cancer Prev Res (Phila) 2021; 14:1061-1074. [PMID: 34507972 DOI: 10.1158/1940-6207.capr-20-0571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/06/2021] [Accepted: 08/23/2021] [Indexed: 12/09/2022]
Abstract
Cancer incidence is rising in low- and especially middle-income countries (MIC), driven primarily by four high-burden cancers (breast, cervix, lung, colorectal). By 2030, more than two-thirds of all cancer deaths will occur in MICs. Prevention and early detection are required alongside efforts to improve access to cancer treatment. Successful strategies for decreasing cancer mortality in high-income countries are not always effective, feasible or affordable in other countries. In this review, we evaluate strategies for prevention and early detection of breast, cervix, lung, and colorectal cancers, focusing on modifiable risk factors and high-risk subpopulations. Tobacco taxation, human papilloma virus vaccination, cervical cancer screen-and-treat strategies, and efforts to reduce patient and health system-related delays in the early detection of breast and colorectal cancer represent the highest yield strategies for advancing cancer control in many MICs. An initial focus on high-risk populations is appropriate, with increasing population coverage as resources allow. These strategies can deliver significant cancer mortality gains, and serve as a foundation from which countries can develop comprehensive cancer control programs. Investment in national cancer surveillance infrastructure is needed; the absence of national cancer data to identify at-risk groups remains a barrier to the development of context-specific cancer control strategies.
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Affiliation(s)
- Anna J Dare
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gregory C Knapp
- Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Surgery, Division of General Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anya Romanoff
- Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Akinwumi O Komolafe
- Department of Morbid Anatomy and Forensic Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Samuel Olatoke
- Department of Surgery, University of Ilorin, Ilorin, Nigeria
| | - Aba Katung
- Department of Surgery, Federal Medical College - Owo, Owo, Nigeria
| | | | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York. .,Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York
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Gbenonsi G, Boucham M, Belrhiti Z, Nejjari C, Huybrechts I, Khalis M. Health system factors that influence diagnostic and treatment intervals in women with breast cancer in sub-Saharan Africa: a systematic review. BMC Public Health 2021; 21:1325. [PMID: 34229634 PMCID: PMC8259007 DOI: 10.1186/s12889-021-11296-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/15/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Breast cancer patients in sub-Saharan Africa experience long time intervals between their first presentation to a health care facility and the start of cancer treatment. The role of the health system in the increasing treatment time intervals has not been widely investigated. This review aimed to identify existing information on health system factors that influence diagnostic and treatment intervals in women with breast cancer in sub-Saharan Africa to contribute to the reorientation of health policies in the region. METHODS PubMed, ScienceDirect, African Journals Online, Mendeley, ResearchGate and Google Scholar were searched to identify relevant studies published between 2010 and July 2020. We performed a qualitative synthesis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Related health system factors were extracted and classified according to the World Health Organization's six health system building blocks. The quality of qualitative and quantitative studies was assessed by using the Critical Appraisal Skills Program Quality-Assessment Tool and the National Institute of Health Quality Assessment Tool, respectively. In addition, we used the Confidence in the Evidence from Reviews of Qualitative Research tool to assess the evidence for each qualitative finding. RESULTS From 14,184 identified studies, this systematic review included 28 articles. We identified a total of 36 barriers and 8 facilitators that may influence diagnostic and treatment intervals in women with breast cancer. The principal health system factors identified were mainly related to human resources and service delivery, particularly difficulty accessing health care, diagnostic errors, poor management, and treatment cost. CONCLUSION The present review shows that diagnostic and treatment intervals among women with breast cancer in sub-Saharan Africa are influenced by many related health system factors. Policy makers in sub-Saharan Africa need to tackle the financial accessibility to breast cancer treatment by adequate universal health coverage policies and reinforce the clinical competencies for health workers to ensure timely diagnosis and appropriate care for women with breast cancer in this region.
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Affiliation(s)
- Gloria Gbenonsi
- International School of Public Health, Mohammed VI University of Health Sciences, Casablanca, Morocco.
| | - Mouna Boucham
- International School of Public Health, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | | | - Chakib Nejjari
- International School of Public Health, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | | | - Mohamed Khalis
- International School of Public Health, Mohammed VI University of Health Sciences, Casablanca, Morocco
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7
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Agodirin O, Aremu I, Rahman G, Olatoke S, Olaogun J, Akande H, Romanoff A. Determinants of Delayed Presentation and Advanced-Stage Diagnosis of Breast Cancer in Africa: A Systematic Review and Meta-Analysis. Asian Pac J Cancer Prev 2021; 22:1007-1017. [PMID: 33906291 PMCID: PMC8325140 DOI: 10.31557/apjcp.2021.22.4.1007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Indexed: 12/26/2022] Open
Abstract
Background/Objective: Breast cancer (BC) mortality is exceptionally high in Africa due to late presentation and advanced-stage diagnosis. Previous studies examining barriers to early BC presentation are markedly inconsistent, showing conflicting findings within and between African regions, making resource allocation and designing interventional campaigns challenging. Our objective was to assess the strength or magnitude of the association between determinants/risk factors and delayed presentation/advanced-stage diagnosis of BC in Africa. Methods: Electronic searches in PubMed, AJOL, Google, ResearchGate, ScienceDirect, and PubMed Central found eligible articles between 2000 and 2020. The meta-analytical procedure in Meta-XL used the quality effect model. I-squared (I2) above 75% indicated high heterogeneity. The summary effect size was the odds ratio with 95% confidence intervals. Results: The effect of socio-economic and demographic determinants on delay varies across African regions. Low level of education (1.63, 95% CI 1.01-2.63), and not performing breast self examination (BSE) (13.59, 95% CI 3.33-55.4) were significantly associated with delayed presentation. Younger patients had more significant delays in West Africa (WA, 1.41, 95%CI 1.08-1.85), and the reverse occurred in North Africa (0.68, 95%CI 0.48-0.97). Lack of BC knowledge (1.59, 95% CI 1.29-1.97), not performing BSE, or no history of undergoing clinical breast examination (CBE) (2.45, 95% CI 1.60-3.40), were associated with advanced-stage disease at diagnosis. Older patients had significantly more advanced disease in WA, and the reverse occurred in South Africa. Aggressive molecular BC subtypes [Triple negative (OR 1.62, 95% CI 1.27-2.06) or HER2 positive (1.56, 95% CI 1.10-2.23)] were significant determinants of advanced-stage diagnosis. Conclusion: Promoting early presentation and reducing advanced-stage BC throughout Africa should focus on modifiable factors, including providing quality education, improving breast health awareness and BC knowledge, and developing strategies to increase BSE and CBE. Interventions targeting socio-demographic determinants should be context-specific.
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Affiliation(s)
- Olayide Agodirin
- Department of Surgery, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Kwara State. Nigeria
| | - Isiaka Aremu
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Kwara state. Nigeria
| | - Ganiyu Rahman
- Department of Surgery, University of Cape Coast and Cape Coast Teaching Hospital, Cape Coast. Ghana
| | - Samuel Olatoke
- Department of Surgery, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Kwara State. Nigeria
| | - Julius Olaogun
- Department of Surgery, Ekiti State University, and Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti state. Nigeria
| | - Halimat Akande
- Department of Radiology, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Kwara state. Nigeria
| | - Anya Romanoff
- Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Global Cancer Disparities Initiatives, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Agodirin O, Olatoke S, Rahman G, Olaogun J, Olasehinde O, Katung A, Kolawole O, Ayandipo O, Etonyeaku A, Habeeb O, Adeyeye A, Agboola J, Akande H, Oguntola S, Akanbi O, Fatudimu O. Presentation intervals and the impact of delay on breast cancer progression in a black African population. BMC Public Health 2020; 20:962. [PMID: 32560711 PMCID: PMC7304119 DOI: 10.1186/s12889-020-09074-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 06/08/2020] [Indexed: 01/28/2023] Open
Abstract
Background The help-seeking interval and primary-care interval are points of delays in breast cancer presentation. To inform future intervention targeting early diagnosis of breast cancer, we described the contribution of each interval to the delay and the impact of delay on tumor progression. Method We conducted a multicentered survey from June 2017 to May 2018 hypothesizing that most patients visited the first healthcare provider within 60 days of tumor detection. Inferential statistics were by t-test, chi-square test, and Wilcoxon-Signed Rank test at p-value 0.05 or 95% confidence limits. Time-to-event was by survival method. Multivariate analysis was by logistic regression. Results Respondents were females between 24 and 95 years (n = 420). Most respondents visited FHP within 60 days of detecting symptoms (230 (60, 95% CI 53–63). Most had long primary-care (237 of 377 (64 95% CI 59–68) and detection-to-specialist (293 (73% (95% CI 68–77)) intervals. The primary care interval (median 106 days, IQR 13–337) was longer than the help-seeking interval (median 42 days, IQR 7–150) Wilcoxon signed-rank test p = 0.001. There was a strong correlation between the length of primary care interval and the detection-to-specialist interval (r = 0.9, 95% CI 0.88–0.92). Patronizing the hospital, receiving the correct advice, and having a big tumor (> 5 cm) were associated with short intervals. Tumors were detected early, but most became advanced before arriving at the specialist clinic. The difference in tumor size between detection and arriving at a specialist clinic was 5.0 ± 4.9 cm (95% CI 4.0–5.0). The hazard of progressing from early to locally advanced disease was least in the first 30 days (3%). The hazard was 31% in 90 days. Conclusion Most respondents presented early to the first healthcare provider, but most arrived late at a specialist clinic. The primary care interval was longer than the help-seeking interval. Most tumors were early at detection but locally advanced before arriving in a specialist clinic. Interventions aiming to shorten the primary care interval will have the most impact on time to breast cancer presentation for specialist oncology care in Nigeria.
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Affiliation(s)
- Olayide Agodirin
- Department of Surgery, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Kwara state, Nigeria.
| | - Samuel Olatoke
- Department of Surgery, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Kwara state, Nigeria
| | - Ganiyu Rahman
- Department of Surgery, University of Cape Coast and Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Julius Olaogun
- Department of Surgery, Ekiti State Teaching Hospital, Ado-Ekiti, Ekiti state, Nigeria
| | - Olalekan Olasehinde
- Department of Surgery, Obafemi Awolowo Teaching Hospital, Ile-Ife, Osun state, Nigeria
| | - Aba Katung
- Department of Surgery, Federal Medical Center, Owo, Ondo State, Nigeria
| | - Oladapo Kolawole
- Department of Surgery, LAUTECH Teaching Hospital, Osogbo, Osun state, Nigeria
| | - Omobolaji Ayandipo
- Department of Surgery, University College Hospital, Ibadan, Oyo state, Nigeria
| | - Amarachukwu Etonyeaku
- Department of Surgery, Obafemi Awolowo Teaching Hospital, Ilesha, Osun state, Nigeria
| | - Olufemi Habeeb
- Department of Surgery, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Kwara state, Nigeria
| | - Ademola Adeyeye
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Kwara state, Nigeria
| | - John Agboola
- Department of Surgery, General Hospital Ilorin, Ilorin, Kwara state, Nigeria
| | - Halimat Akande
- Department of Radiology, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Kwara state, Nigeria
| | - Soliu Oguntola
- Department of Surgery, LAUTECH Teaching Hospital, Ogbomoso, Oyo State, Nigeria
| | - Olusola Akanbi
- Department of Surgery, LAUTECH Teaching Hospital, Ogbomoso, Oyo State, Nigeria
| | - Oluwafemi Fatudimu
- Department of Surgery, Federal Teaching Hospital, Ido-Ekiti, Ekiti state, Nigeria
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Agodirin OS, Aremu I, Rahman GA, Olatoke SA, Akande HJ, Oguntola AS, Olasehinde O, Ojulari S, Etonyeaku A, Olaogun J, Romanoff A. Prevalence of Themes Linked to Delayed Presentation of Breast Cancer in Africa: A Meta-Analysis of Patient-Reported Studies. JCO Glob Oncol 2020; 6:731-742. [PMID: 32437263 PMCID: PMC7268898 DOI: 10.1200/jgo.19.00402] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The prevalence of themes linked to delay in presentation of breast cancer (BC) and their underlying factors vary considerably throughout Africa. Regional differences and trends are largely unreported. The purpose of this research was to provide summary estimates of the prevalence and distribution of the themes and underlying factors linked to delay in the presentation of BC, regional variation, and trends in an effort to identify targets for intervention. DESIGN We screened articles found through PubMed/Medline, African Journal OnLine, Science Direct, Google/Google Scholar, and ResearchGate. We included patient-reported surveys on the reasons linked to delayed presentation under 6 previously identified themes: symptom misinterpretation, fear, preference for alternative care, social influence, hospital-related factors, and access factors. The meta-analytical procedure in MetaXL used the quality-effect model. RESULTS Twelve of the 236 identified articles were eligible for this review. The overall summary estimate of late presentation (> 90 days) was 54% (95% CI, 23 to 85) and was worst in the eastern and central regions. Symptom misinterpretation was the most common theme (50%; 95% CI, 21 to 56), followed by fear (17%; 95% CI, 3 to 27), hospital-related theme (11%; 95% CI, 1 to 21), preference for alternative care (10%; 95% CI, 0 to 21), social influence (7%; 95% CI, 0 to 14), and access-related theme (6%; 95% CI, 0 to 13). The most common factor underlying symptom misinterpretation was mischaracterizing the breast lesion as benign (60%; 95% CI, 4 to 100) which surpassed lack of awareness in the last decade. Misdiagnosis and failure to refer were the dominant hospital-related factors. CONCLUSION Modifiable factors such as mischaracterizing malignant masses as benign, fear, misdiagnosis, and failure to refer were the prevalent factors contributing to delays throughout Africa. These factors are promising targets for intervention.
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Affiliation(s)
- Olayide S Agodirin
- Department of Surgery, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - Isiaka Aremu
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - Ganiyu A Rahman
- Department of Surgery, University of Cape Coast and Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Samuel A Olatoke
- Department of Surgery, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - Halimat J Akande
- Department of Radiology, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - Adetunji S Oguntola
- Department of Surgery, Lautech Teaching Hospital, Ogbomoso, Oyo State, Nigeria
| | - Olalekan Olasehinde
- Department of Surgery, Obafemi Awolowo Teaching Hospital, Ile-Ife, Osun State, Nigeria
| | - Sheriff Ojulari
- Department of Physiology, University of Ilorin, Ilorin, Kwara State, Nigeria
| | - Amarachukwu Etonyeaku
- Department of Surgery, Obafemi Awolowo Teaching Hospital, Ile-Ife, Osun State, Nigeria
| | - Julius Olaogun
- Department of Surgery, Ekiti State Teaching Hospital, Ado-Ekiti, Ekiti State, Nigeria
| | - Anya Romanoff
- Breast Surgery, Dubin Breast Center, Icahn School of Medicine, The Mount Sinai Hospital, New York, NY.,Department of Health System Design and Global Health, Icahn School of Medicine, The Mount Sinai Hospital, New York, NY
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