Pregnancy-associated breast cancer in rural Rwanda: the experience of the Butaro Cancer Center of Excellence

Psychometric Properties of the Beck Depression Inventory (BDI-II) in Cancer Patients: Cancer Patients from Butaro Ambulatory Cancer Center, Rwanda

Background

The prevalence of depressive disorders remains high in patients with cancer and their diagnosis and treatment remain an epidemiologic concern. Without proper screening and diagnosis, the necessary care and follow-up would not be possible for these patients who need potential support to increase their quality of mental health. Hence, the screening tools for depression are prominent in diagnosing this mental health disorder; however, there are few studies conducted for assessing psychometric properties of Beck Depression Inventory (BDI-II) amongst the cancer patients from developing countries. We, therefore, determined psychometric properties of the BDI-II among cancer patients from Butaro Ambulatory Cancer Center (BACC).

Methods

Cross-sectional study design was conducted among 425 cancer patients from the BACC, Rwanda. Confirmatory and exploratory factor (CFA) analyses were performed to compare the fit indices of three-factor and two-factor models of the BDI-II. The eligible participants were administered the BDI-II instrument.

Results

Average scores of depression was 16.3 (SD=9.8). Results showed an adequate consistency (Cronbach’s α=0.904) and high correlations with the subscales of this instrument. Our findings showed that the area under the curve of the receiver operating characteristics analysis of BDI-II was 0.805. Our CFA results revealed that three-factor model (χ²=1699.921, p<0.001) represented a better model fit than the two-factor model of BDI-II (χ²=2115.397, p<0.001). In addition, the goodness of fit indices were tested and showed that the Beck’s three-factor model had a better performance than the two-factor model. Kaiser–Meyer–Olin (KMO) measure of 0.916 demonstrated that the factor structure or sampling was adequate for analysis and the Bartlett’s test of sphericity was highly significant (χ²=3780, p<0.001) and this revealed that the items of BDI-II were significantly correlated and sufficiently large.

Conclusion

BDI-II presented a good reliability and validity that represent adequate psychometric properties. Its sensitivity and specificity were suitable. This psychometric measure is important in diagnosing and treating depression in cancer patients.

Experiences and challenges in the management of pregnancy-associated breast cancer at the Korle Bu Teaching Hospital: a review of four cases

Breast cancer is the commonest female cancer worldwide and the most common malignancy during pregnancy. The current management of breast cancer is based on patient and tumour characteristics, preferences and disease stage. In pregnancy-associated breast cancer, the gestational age influences treatment options. Sequencing of therapies is guided by safe imaging options, timing of delivery and prognosis. Systemic therapy options in the neoadjuvant, adjuvant and palliative settings are limited due to safety concerns of the unborn foetus. In resource-constrained regions, the application of safe options may be challenging. This paper reports four of such cases managed in Ghana using a multidisciplinary approach and local resource-appropriate evidence-based practices. Maternal and foetal outcomes were acceptable with none resulting in termination of pregnancy.

Cluster Randomized Trial to Facilitate Breast Cancer Early Diagnosis in a Rural District of Rwanda

PURPOSE

Feasible and effective strategies are needed to facilitate earlier diagnosis of breast cancer in low-income countries. The goal of this study was to examine the impact of health worker breast health training on health care utilization, patient diagnoses, and cancer stage in a rural Rwandan district.

METHODS

We conducted a cluster randomized trial of a training intervention at 12 of the 19 health centers (HCs) in Burera District, Rwanda, in 2 phases. We evaluated the trainings’ impact on the volume of patient visits for breast concerns using difference-in-difference models. We used generalized estimating equations to evaluate incidence of HC and hospital visits for breast concerns, biopsies, benign breast diagnoses, breast cancer, and early-stage disease in catchment areas served by intervention versus control HCs.

RESULTS

From April 2015 to April 2017, 1,484 patients visited intervention HCs, and 308 visited control HCs for breast concerns. The intervention led to an increase of 4.7 visits/month for phase 1 HCs (P = .001) and 7.9 visits/month for phase 2 HCs (P = .007) compared with control HCs. The population served by intervention HCs had more hospital visits (115.1 v 20.5/100,000 person-years, P < .001) and biopsies (36.6 v 8.9/100,000 person-years, P < .001) and higher breast cancer incidence (6.9 v 3.3/100,000 person-years; P = .28). The incidence of early-stage breast cancer was 3.3 per 100,000 in intervention areas and 0.7 per 100,000 in control areas (P = .048).

CONCLUSION

In this cluster randomized trial in rural Rwanda, the training of health workers and establishment of regular breast clinics were associated with increased numbers of patients who presented with breast concerns at health facilities, more breast biopsies, and a higher incidence of benign breast diagnoses and early-stage breast cancers.

Barriers to timely surgery for breast cancer in Rwanda

BACKGROUND

Ensuring timely and high-quality surgery must be a key element of breast cancer control efforts in sub-Saharan Africa. We investigated delays in preoperative care and the impact of on-site versus off-site operation on time to operative treatment of patients with breast cancer at Butaro Cancer Center of Excellence in Rwanda.

METHODS

We used a standardized data abstraction form to collect demographic data, clinical characteristics, treatments received, and disease status as of November 2017 for all patients diagnosed with breast cancer at Butaro Cancer Center of Excellence in 2014 to 2015.

RESULTS

From 2014 to 2015, 89 patients were diagnosed with stage I to III breast cancer and treated with curative intent. Of those, 68 (76%) underwent curative breast operations, 12 (14%) were lost to follow-up, 7 (8%) progressed, and 2 declined the recommended operation. Only 32% of patients who underwent operative treatment had the operation within 60 days from diagnosis or last neoadjuvant chemotherapy. Median time to operation was 122 days from biopsy if no neoadjuvant treatments were given and 51 days from last cycle of neoadjuvant chemotherapy. Patients who received no neoadjuvant chemotherapy experienced greater median times to operation at Butaro Cancer Center of Excellence (180 days) than at a referral hospital in Kigali (93 days, P = .04). Most patients (60%) experienced a disruption in preoperative care, frequently at the point of surgical referral. Documented reasons for disruptions and delays included patient factors, clinically indicated treatment modifications, and system factors.

CONCLUSION

We observed frequent delays to operative treatment, disruptions in preoperative care, and loss to follow-up, particularly at the point of surgical referral. There are opportunities to improve breast cancer survival in Rwanda and other low- and middle-income countries through interventions that facilitate more timely surgical care.