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Salako O, Enyi A, Miesfeldt S, Kabukye JK, Ngoma M, Namisango E, LeBaron V, Sisimayi C, Ebenso B, Lorenz KA, Wang Y, Ryan Wolf J, van den Hurk C, Allsop M. Remote Symptom Monitoring to Enhance the Delivery of Palliative Cancer Care in Low-Resource Settings: Emerging Approaches from Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7190. [PMID: 38131741 PMCID: PMC10743024 DOI: 10.3390/ijerph20247190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/10/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
This paper brings together researchers, clinicians, technology developers and digital innovators to outline current applications of remote symptom monitoring being developed for palliative cancer care delivery in Africa. We outline three remote symptom monitoring approaches from three countries, highlighting their models of delivery and intended outcomes, and draw on their experiences of implementation to guide further developments and evaluations of this approach for palliative cancer care in the region. Through highlighting these experiences and priority areas for future research, we hope to steer efforts to develop and optimise remote symptom monitoring for palliative cancer care in Africa.
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Affiliation(s)
- Omolola Salako
- Radiation Biology, Radiotherapy and Radiodiagnosis (RBRR) Digital Health Hub, College of Medicine, Lagos University Teaching Hospital, Lagos 102215, Nigeria;
| | | | - Susan Miesfeldt
- Medical Oncology, Maine Medical Center, MaineHealth Cancer Care Center, Scarborough, ME 04106, USA;
| | - Johnblack K. Kabukye
- Uganda Cancer Institute, Upper Mulago Hill Road, Kampala P.O. Box 3935, Uganda;
- Swedish Program for ICT in Developing Regions (SPIDER), Department of Computer and Systems Sciences (DSV), Stockholm University, 164 55 Stockholm, Sweden
| | - Mamsau Ngoma
- Ocean Road Cancer Institute, Dar es Salaam P.O. Box 3592, Tanzania;
| | - Eve Namisango
- African Palliative Care Association, Kampala P.O. Box 72518, Uganda;
| | - Virginia LeBaron
- School of Nursing, University of Virginia, Charlottesville, VA 22903, USA;
| | - Chenjerai Sisimayi
- Department of Mathematics and Applied Mathematics, University of Johannesburg, Johannesburg 2006, South Africa;
| | - Bassey Ebenso
- School of Medicine, University of Leeds, Leeds LS2 9LU, UK;
| | - Karl A. Lorenz
- Ci2i, United States Department of Veterans Affairs, Menlo Park, CA 94025, USA;
- Primary Care and Population Health, Stanford School of Medicine, Stanford, CA 94305, USA
| | - Yan Wang
- School of Nursing, University of Pittsburgh, Pittsburgh, PA 15213, USA;
| | - Julie Ryan Wolf
- Departments of Dermatology and Radiation Oncology, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY 14642, USA;
| | - Corina van den Hurk
- R&D Department, Netherlands Comprehensive Cancer Organisation, 3501 DB Utrecht, The Netherlands;
| | - Matthew Allsop
- School of Medicine, University of Leeds, Leeds LS2 9LU, UK;
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Yorke J, Brenu SG, Awoonor-Williams R, Tabiri S, Seidu AS, Yamoah FA, Akpaloo J, Der EM, Adjei E, Okyere I, Ihekanandu KK, Bonsu EBO, Kyei I, Mensah S, Adinku MO, Yorke DA, Agyapong AO, Aitpillah FSK, Agyei MK, Oppong-Nkrumah NA, Annan KD, Ellis TAF, Danso P, Buckman TA, Acheampong E. A gist on an obscure neoplasm in Ghana: gastrointestinal stromal tumours. BMC Res Notes 2023; 16:318. [PMID: 37932827 PMCID: PMC10629135 DOI: 10.1186/s13104-023-06593-8] [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: 05/10/2023] [Accepted: 10/24/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Gastrointestinal Stromal Tumour is a rare but potentially curable tumour of the gastrointestinal tract accounting for up to 1% of all gastrointestinal tumours. The discovery of Imatinib mesylate, a novel tyrosine kinase inhibitor has improved the chances even for unresectable, recurrent, or metastatic diseases. METHODS This study sought to document the clinical and pathological characteristics of GISTs from two tertiary hospitals in Ghana that have undergone immunohistochemistry confirmation between 2014 and 2021. RESULTS The median age of the subjects was 50 years with most of them (28.0%) being above 61 years. There were more females than males (64.0% vs. 36.0%). Abdominal mass and abdominal pain made up the majority of the clinical presentations. The majority of the subjects had partial gastrectomy (32.0%) which was followed by wedge resection (28.0%). Appendectomy and sleeve gastrectomy were the least performed procedures (8% each). Four of the 25 patients (16.0%) had resections of involved contiguous organs done with splenectomy being the most common procedure. The majority of GISTs were found in the stomach (68.0%) followed by the appendix (12.0%) and small bowel (12.0%). Gastrointestinal bleeding (55.8%) and abdominal pain (38.5%) were the most reported symptoms. Free resection margins were observed in 84.0% of the subjects and only 3/25 (12.0%) experienced tumour recurrence. CONCLUSION GIST is a potentially curable tumour that once was obscure but currently gaining popularity. Surgical resection offers the hope of a cure for localized disease while targeted therapies is a viable option for recurrent, metastatic, or unresectable tumours.
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Affiliation(s)
- Joseph Yorke
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | - Stephen Tabiri
- Department of Surgery, School of Medical Sciences, University of Development Studies, Tamale, Ghana
| | | | | | - Joseph Akpaloo
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Ernest Adjei
- Directorate of Pathology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Isaac Okyere
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | - Ishmael Kyei
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Samuel Mensah
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Michael Ofoe Adinku
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | - Francis Somiah-Kwaw Aitpillah
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Martin Kofi Agyei
- Directorate of Internal Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | | | | | - Patrick Danso
- Directorate of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Tonnies Abeku Buckman
- Department of Medical Laboratory Science, KAAF University College, Fetteh-Kakraba, Gomoa East District, Gomoa-East, Ghana.
| | - Emmanuel Acheampong
- Department of Molecular Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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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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Hewage SA, Samaraweera S, Joseph N, Kularatna S, Gunawardena N. Presentation, Diagnosis and Treatment Delays in Breast Cancer Care and Their Associations in Sri Lanka, a Low-resourced Country. Clin Oncol (R Coll Radiol) 2022; 34:598-607. [PMID: 35672184 DOI: 10.1016/j.clon.2022.05.007] [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: 12/07/2021] [Revised: 04/08/2022] [Accepted: 05/11/2022] [Indexed: 11/03/2022]
Abstract
AIMS Delays in breast cancer care, one important attributable factor for breast cancer being diagnosed at advanced stages, are not systematically studied in many countries. This study assessed the magnitude and factors associated with delays in breast cancer care in Sri Lanka, from symptom detection to treatment initiation. MATERIALS AND METHODS We interviewed 800 consecutively sampled female breast cancer patients, diagnosed within the last 12 months, using context-specific questionnaires and medical records. We defined the cut-off times for delays using international guidelines and features of the national health system and care-seeking patterns in the country. Delays were estimated as proportions with 95% confidence intervals and presented for: (i) presentation delay; (ii) diagnosis delay and (iii) treatment delay. We looked at how sociodemographic and healthcare availability and accessibility at the individual level were associated with delays using multivariate logistic regression, with a P value of 0.05 to define statistical significance. RESULTS Nearly two-thirds of patients reported a presentation delay (63.3%, 95% confidence interval 59.9-66.6%). A diagnosis delay (36.7%, 95% confidence interval 33.4-40.0%) was also seen among one-third, whereas treatment delays (13.2%, 95% confidence interval 10.8-15.5%) were less common. Low family monthly income (odds ratio 6.3; 95% confidence interval 4.2-9.3) and poor knowledge on breast cancer (odds ratio 2.7; 95% confidence interval 1.8-3.8) were associated with presentation delay. Poor health literacy (odds ratio 1.7; 95% confidence interval 1.1-2.7) and the need to make more than two visits to the first contact health provider prior to diagnosis (odds ratio 7.2; 95% confidence interval 4.6-11.1) were associated with diagnosis delays, whereas directly contacting an appropriate specialised health provider once the lump was detected reduced diagnosis delay (odds ratio 0.3; 95% confidence interval 0.2-0.4). Having undergone a core biopsy (odds ratio 0.5; 95% confidence interval 0.3-0.8) and having a mammogram (odds ratio 0.6; 95% confidence interval 4.7-32.7) reduced the likelihood of treatment delays. CONCLUSIONS Our study findings show that delays in breast cancer care in Sri Lanka are much lower than those in other lower-middle income countries. However, there is significant room for improvement, especially in relation to the excellence in quality of care, such as improving access to mammography services. Periodical estimation of breast cancer delays enabling temporal comparisons will probably provide useful information to policy makers in improving care delivery for breast cancer patients and, hence, is recommended. Such future assessments designed for comparisons between different treatment modalities would provide more information to assist policy decisions in care improvement.
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Affiliation(s)
- S A Hewage
- National Cancer Control Programme, Elvitigala Mawatha, Colombo, Sri Lanka.
| | - S Samaraweera
- National Cancer Control Programme, Elvitigala Mawatha, Colombo, Sri Lanka
| | - N Joseph
- Sri Lanka Cancer Research Group, Maharagama, Sri Lanka
| | - S Kularatna
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - N Gunawardena
- WHO Country Office for Sri Lanka, Colombo, Sri Lanka
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Nnaji CA, Ezenwankwo EF, Kuodi P, Walter FM, Moodley J. Timeliness of diagnosis of breast and cervical cancers and associated factors in low-income and middle-income countries: a scoping review. BMJ Open 2022; 12:e057685. [PMID: 35121607 PMCID: PMC8819798 DOI: 10.1136/bmjopen-2021-057685] [Citation(s) in RCA: 1] [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 Addressing the barriers to early breast and cervical cancer diagnosis in low and middle-income countries (LMICs) requires a sound understanding and accurate assessment of diagnostic timeliness. This review aimed to map the current evidence on the time to breast and cervical cancer diagnosis and associated factors in LMICs. DESIGN Scoping review. SOURCES MEDLINE (via PubMed), Cochrane Library, Scopus and CINAHL. ELIGIBILITY CRITERIA Studies describing the time to diagnosis and associated factors in the context of breast and cervical cancer in LMICs published from 1 January 2010 to 20 May 2021. STUDY SELECTION AND DATA SYNTHESIS Two reviewers independently screened all abstracts and full texts using predefined inclusion criteria. The review was reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. Evidence was narratively synthesised using predefined themes. RESULTS Twenty-six studies conducted across 24 LMICs were included in the review, most (24/26) of which focused on breast cancer. Studies varied considerably in their conceptualisation and assessment of diagnostic time, events, intervals and delays, with a minority of the studies reporting the use of validated methods and tools. Patient-related intervals and delays were more frequently evaluated and reported than provider-related and health system-related intervals and delays. Across studies, there were variations in the estimated lengths of the appraisal, help-seeking, patient and diagnostic intervals for both cancers and the factors associated with them. CONCLUSIONS Despite the significant burden of breast and cervical cancer in LMICs, there is limited information on the timeliness of diagnosis of these cancers. Major limitations included variations in conceptualisation and assessment of diagnostic events and intervals. These underscore the need for the use of validated and standardised tools, to improve accuracy and translation of findings to better inform interventions for addressing diagnostic delays in LMICs.
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Affiliation(s)
- Chukwudi A Nnaji
- Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa
- Cancer Research Initiative, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa
| | - Elochukwu F Ezenwankwo
- Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa
- Cancer Research Initiative, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa
| | - Paul Kuodi
- Department of Public Health, Faculty of Health Sciences, Lira University, Lira, Uganda
| | - Fiona M Walter
- Wolfson Institute of Population Health, Queen Mary University of London Barts and The London School of Medicine and Dentistry, London, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jennifer Moodley
- Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa
- Cancer Research Initiative, University of Cape Town Faculty of Health Sciences, Cape Town, Western Cape, South Africa
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Omisore AD, Odedeyi AA, Famurewa OC, Olasehinde O, Olugbade OT, Esan OT, Aderibigbe AS, Akinola RA. Practice, Perceptions, and Prospects of Mammography Screening in Nigeria: Insights from a National Survey of Female Health Workers. Clin Breast Cancer 2022; 22:462-472. [DOI: 10.1016/j.clbc.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/03/2022] [Accepted: 02/14/2022] [Indexed: 11/17/2022]
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Akpoghor O, Eghonghon A, Osime O. Pattern of emergency presentation of patients with breast cancer at the University of Benin Teaching Hospital. JOURNAL OF WEST AFRICAN COLLEGE OF SURGEONS 2022; 12:70-74. [PMID: 36213813 PMCID: PMC9536413 DOI: 10.4103/jwas.jwas_124_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 06/16/2022] [Indexed: 11/04/2022]
Abstract
Background: Materials and Methods: Results: Conclusion:
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Vanderpuye V, Dadzie MA, Huo D, Olopade OI. Assessment of Breast Cancer Management in Sub-Saharan Africa. JCO Glob Oncol 2021; 7:1593-1601. [PMID: 34843373 PMCID: PMC8624034 DOI: 10.1200/go.21.00282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To document progress and bottlenecks in breast cancer management in sub-Saharan Africa, subsequent to a 2013 pilot survey conducted through the African Organization for Research and Treatment in Cancer (AORTIC) network. METHODS An anonymous survey of breast cancer management was conducted in 2018 among AORTIC members. Results concerning respondent specialty, access to tumor boards, treatment accessibility, diagnostic services, and factors influencing treatment outcomes were compared with the 2013 findings. RESULTS Thirty-seven respondents from 30 facilities in 21 sub-Saharan Africa countries responded. The majority (92%) were clinical oncologists. Radiotherapy facilities were available in 70% of facilities. Seventy-eight percent of these had linear accelerators, and 42% had cobalt60 machines. Eighty percent of facilities had multidisciplinary tumor boards. Immunohistochemistry was routinely performed in 74% of facilities, computed tomography scan in 90%, bone scan in 16%, and positron emission tomography scans in 5%. Anthracyclines, taxanes, tamoxifen, letrozole, anastrozole, and zoledronic acid were available in the majority; trastuzumab, fertility, and genetic counseling were available in 66%, 58%, and 16%, respectively. There were a 50% increase in oncologist respondents over 2013 and a > 50% increase in radiotherapy facilities, particularly linear accelerators. Availability of trastuzumab, aromatase inhibitors, and taxanes increased. Immunohistochemistry capacity remained the same, whereas facilities harvesting at least 10 axillary lymph nodes increased. Bone scan facilities decreased. Responses suggested improved diagnostic services, systemic therapies, and radiotherapy. Sociocultural and economic barriers, system delays, and advanced stage at presentation remain. CONCLUSION Clinicians in sub-Saharan Africa have basic tools to improve breast cancer outcomes, recording positive strides in domains such as radiotherapy and systemic therapy. Socioeconomic and cultural barriers and system delays persist. Workforce expansion must be prioritized to improve quality of care to improve outcomes. This study highlights the current state of breast cancer management in Sub Saharan Africa, documenting key advancements , challenges and bottlenecks encountered in the sub region. Aside the major aspects of management, pertinent areas such as multidisciplinary tumour board engagements, fertility , genetic counselling and factors affecting outcome were explored. Majority of institutions manage breast cancer patients within a multidisciplinary setting using standard treatment guidelines. The high out of pocket cost of cancer treatment and advanced stage at presentation transcends in many sub Saharan countries negatively impacting outcomes. These results should serve as a benchmark to stakeholders , to guide urgent interventions required to further improve outcomes.
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Affiliation(s)
- Verna Vanderpuye
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Mary-Ann Dadzie
- National Centre for Radiotherapy, Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Dezheng Huo
- Department of Public Health Sciences, University of Chicago, Chicago, IL
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Agodirin O, Olatoke S, Rahman G, Kolawole O, Oguntola S, Olasehinde O, Ayandipo O, Olaogun J, Katung A, Etonyeaku A, Habeeb O, Adeyeye A, Agboola J, Akande H, Akanbi O, Fatudimu O, Ajiboye A. Determinants of late detection and advanced-stage diagnosis of breast cancer in Nigeria. PLoS One 2021; 16:e0256847. [PMID: 34731161 PMCID: PMC8565753 DOI: 10.1371/journal.pone.0256847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 08/17/2021] [Indexed: 11/20/2022] Open
Abstract
Late detection of Breast cancer(BC) and progressing with advanced-stage diagnosis after early detection contribute differently to the challenges of managing BC in Africa. Understanding the difference may improve cancer education programs and their effectiveness.
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Affiliation(s)
- Olayide Agodirin
- Department of Surgery, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Nigeria
- Department of Surgery, General Hospital, Ilorin, Nigeria
- * E-mail:
| | - Samuel Olatoke
- Department of Surgery, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Ganiyu Rahman
- Department of Surgery, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Nigeria
- Department of Surgery, Cape Coast University and Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Oladapo Kolawole
- Department of Surgery, LAUTECH Teaching Hospital, Osogbo, Nigeria
| | - Saliu Oguntola
- Department of Surgery, LAUTECH Teaching Hospital, Ogbomoso, Nigeria
| | - Olalekan Olasehinde
- Department of Surgery, Obafemi Awolowo University and Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | | | - Julius Olaogun
- Department of Surgery, Ekiti State University and Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Aba Katung
- Department of Surgery, Federal Medical Center, Owo, Nigeria
| | - Amarachukwu Etonyeaku
- Department of Surgery, Obafemi Awolowo University Ile-Ife and Obafemi Awolowo Teaching Hospital Complex, Ilesha, Nigeria
| | - Olufemi Habeeb
- Department of Surgery, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Ademola Adeyeye
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - John Agboola
- Department of Surgery, General Hospital, Ilorin, Nigeria
| | - Halimat Akande
- Department of Radiology, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Olusola Akanbi
- Department of Surgery, LAUTECH Teaching Hospital, Ogbomoso, Nigeria
| | - Oluwafemi Fatudimu
- Department of Surgery, Federal Teaching Hospital, Ido-Ekiti and Afe Babalola University, Ado-Ekiti, Nigeria
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11
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Nguyen SM, Nguyen QT, Nguyen LM, Pham AT, Luu HN, Tran HTT, Tran TV, Shu X. Delay in the diagnosis and treatment of breast cancer in Vietnam. Cancer Med 2021; 10:7683-7691. [PMID: 34664428 PMCID: PMC8559509 DOI: 10.1002/cam4.4244] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Delays in diagnosis and treatment from first noticeable breast cancer symptoms are associated with poor outcomes. Understanding the reasons and barriers for patients' delay in seeking medical care is critical to mitigating the problem. METHODS In-person surveys were conducted among 462 women, aged 18-79, with incident breast cancer cases, recruited from two cancer hospitals in North Vietnam. Delay, defined as the time interval between symptom recognition to the diagnosis and initiation of treatment equal to or exceeding 3 months, was categorized as follows: no delay (<3 months), moderate delay (3-8 months), and serious delay (≥9 months). Multivariable multinomial logistic regression was applied in data analyses. RESULTS Over one-quarter patients (31.5%) experienced moderate delays, and close to one-fifth (17.5%) experienced serious delays. Adjusted odds ratios and 95% confidence intervals for moderate and serious delays were 5.60 (3.00-10.47) and 4.25 (2.05-8.85) for financial and physical barriers, respectively. Moderate delay was positively associated with psychological barriers (5.55 [1.75-17.57]) and lack of proper knowledge (3.15 [1.47-6.74]). The associations of barriers with delays in diagnosis and treatment appeared stronger among women living in rural areas. A lack of proper knowledge was significantly associated with delay among young women (<45 years old) and those with high incomes, while psychological barriers were significantly associated with delay among older women (≥45 years old). CONCLUSION Delays in diagnosis and treatment are common among Vietnamese breast cancer patients and are affected by several noted barriers. Proper policy needs to be developed to address this public health issue.
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Affiliation(s)
- Sang M. Nguyen
- Division of EpidemiologyDepartment of MedicineVanderbilt Epidemiology CenterVanderbilt‐Ingram Cancer CenterVanderbilt University School of MedicineNashvilleTennesseeUSA
| | - Quang T. Nguyen
- National Cancer HospitalVietnam National Cancer InstituteHanoiVietnam
- Hanoi Medical UniversityHanoiVietnam
| | | | - Anh T. Pham
- National Cancer HospitalVietnam National Cancer InstituteHanoiVietnam
- Hanoi Medical UniversityHanoiVietnam
| | - Hung N. Luu
- UPMC Hillman Cancer CenterUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
- Department of EpidemiologyGraduate School of Public HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Huong T. T. Tran
- National Cancer HospitalVietnam National Cancer InstituteHanoiVietnam
- Hanoi Medical UniversityHanoiVietnam
| | - Thuan V. Tran
- National Cancer HospitalVietnam National Cancer InstituteHanoiVietnam
- Hanoi Medical UniversityHanoiVietnam
- Ministry of HealthHanoiVietnam
| | - Xiao‐Ou Shu
- Division of EpidemiologyDepartment of MedicineVanderbilt Epidemiology CenterVanderbilt‐Ingram Cancer CenterVanderbilt University School of MedicineNashvilleTennesseeUSA
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12
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Rick TJ, Aagard M, Erwin E, Leintz C, Danik E, Serventi F, Henke O, Yeates K. Barriers to Cancer Care in Northern Tanzania: Patient and Health-System Predictors for Delayed Presentation. JCO Glob Oncol 2021; 7:1500-1508. [PMID: 34665667 PMCID: PMC8791818 DOI: 10.1200/go.21.00253] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Cancer is a growing problem in Africa, and delays in receiving timely cancer care often results in poorer outcomes. The purpose of this study was to identify the patient and health-system factors associated with delayed cancer care in adults living in the Northern Zone of Tanzania. PATIENTS AND METHODS Between July 2018 and July 2019, we surveyed adult patients presenting to an oncology clinic in Northern Tanzania. Delayed presentation was defined as 12 weeks or longer from initial symptoms to presentation for cancer care. Multivariate logistic regression and adjusted relative risk (aRR) were used to identify factors predicting delayed presentation. RESULTS Among 244 adult patients with cancer who completed the survey, 78% (n = 191) had delayed presentation. Patient-related factors associated with delayed presentation included lower educational attainment (P = .03), increased travel time (P = .05), lack of cancer knowledge (P < .05), and fear of cancer and cancer treatments (P < .05) on multivariate analysis. On analysis of aRR, patients without private car and those with health insurance had higher risk of delayed presentation (aRR: 1.27; 95% CI, 1.02 to 1.32 and aRR: 1.15; 95% CI, 1.01 to 1.32). There was a strong association with increased number of visits before presentation at the cancer center and delayed presentation (P = .0009). CONCLUSION Cancer awareness and prevention efforts targeting patients and community-level health care workers are key to reduce delays in cancer care in Northern Tanzania. Patient and health system barriers contribute to delayed presentation of patients with cancer in Northern Tanzania.![]()
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Affiliation(s)
- Tara J Rick
- Department of Physician Assistant Studies, Saint Catherine's University, St Paul, MN.,Department of Radiotherapy, Erasmus MC, Rotterdam, the Netherlands
| | | | | | - Caara Leintz
- Department of Physician Assistant Studies, Saint Catherine's University, St Paul, MN
| | - Elizabeth Danik
- Kilimanjaro Christian Medical Center, Cancer Care Center, Moshi, Tanzania
| | - Furaha Serventi
- Kilimanjaro Christian Medical Center, Cancer Care Center, Moshi, Tanzania
| | - Oliver Henke
- Kilimanjaro Christian Medical Center, Cancer Care Center, Moshi, Tanzania.,Section Global Health, University Hospital Bonn, Bonn, Germany
| | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
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13
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Miraj S, Saeed H, Jabeen S, Rasool F, Islam M, Zeeshan Danish, Imran I, Hashmi FK, Majeed A, Yasmeen S. Association of breast cancer reporting delays and care intervals with tumor size in patients with advanced disease. Women Health 2021; 61:832-844. [PMID: 34538224 DOI: 10.1080/03630242.2021.1976357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In Pakistan, breast cancer (BC) is frequently diagnosed with advanced disease. We aimed to examine the association of breast tumor size with reasons of reporting delays, care intervals in patients with advanced disease. This cross-sectional study enrolled 392 BC patients from tertiary care hospitals. Data were collected from August 2018-March 2019. Chi-square for significance and logistic regression for association were used. Patients between 31 and 45 years of age (51%), rural residents (39%), lower-class (88.4%), no family history (17.1%), at stage-IV (36%) and patient interval >90 days (70%, p = .034) presented with large tumor size (>5 cm). Tumor size was significantly associated with area of residence (p = .043), social-class (p = .027), family history (p = .004), smoking (p = .021), nipple discharge (p = .004), recurrence (p = .024), and metastasis (p = .007). Patient-interval was associated with poor knowledge (OR;4.3,p = .0001), influence of traditional healers (OR;2.3,p = .05), religion (OR;3.9,p = .0001), finances (OR;2.4,p = .045), and competing life priorities (OR;2.9,p = .026). In-adjusted linear regression model, area of residences, education, social-class, family-history, recurrence, cancer type, and patient interval (β;0.110,p = .030) were found to be independent predictors of tumor size. In conclusion, education, family history, area of residence, social class, recurrence, cancer stage and patient interval, co-influenced by religion, finances, life priorities, traditional healers, and poor knowledge, were independent predictors of tumor size in BC patients.
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Affiliation(s)
- Shumaila Miraj
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Hamid Saeed
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Sumaira Jabeen
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Fawad Rasool
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Muhammad Islam
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Zeeshan Danish
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Imran Imran
- Department of Pharmacology, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | | | - Abdul Majeed
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Sadia Yasmeen
- University College of Pharmacy, University of the Punjab, Lahore, Pakistan
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14
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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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15
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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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