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Wondimagegnehu A, Gizaw M, Genene Abebe L, Teka B, Kaufmann AM, Abebe T, McMahon SA, Addissie A, Kantelhardt EJ. Perceived causes of cancer in a rural community of Ethiopia: a qualitative study. Glob Health Action 2024; 17:2401862. [PMID: 39285841 PMCID: PMC11409409 DOI: 10.1080/16549716.2024.2401862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 09/04/2024] [Indexed: 09/20/2024] Open
Abstract
BACKGROUND Although cancer incidence and mortality are rising in Ethiopia, lay and health professional perceptions of the disease remain limited. OBJECTIVE To explore perceptions of cancer, including its causes, signs and symptoms, and transmission within a rural community in Ethiopia. METHODS We conducted a qualitative study in four rural neighbourhoods of Butajira in central Ethiopia. Seven Focus Group Discussions (FGDs) and six In-Depth Interviews (IDIs) were held with community members, women representatives, religious leaders and key informants using two interview guides (divided by method). Behaviour change theories and a community research framework were used to summarize the findings. RESULTS Across respondent categories and data collection methods, respondents described cancer or nekersa, which translates as 'an illness that cannot be cured', as serious and fatal. Cancer was further viewed as becoming more common and as underpinning more deaths particularly among women. Causes of cancer largely focused on individual behaviours namely mitch (referring to exposure to sunlight), poor personal hygiene and urinating on the ground/dirty areas. Almost all participants strongly related cancer to a wound that does not heal and entails a foul-smelling discharge. Bleeding and weight loss were other commonly mentioned complaints of cancer. CONCLUSIONS Although cancer is known among rural communities in this area, misconceptions about cancer aetiology and conflation of the signs and symptoms of cancer versus other diseases merit health messaging. Our study calls for design research to determine how to culturally tailor educational materials and deliver health campaigns regarding cancer causes, signs and symptoms within this context.
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Affiliation(s)
- Abigiya Wondimagegnehu
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Global Health Working Group, Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University, Halle-Wittenberg, Germany
- NCD Working Group, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Muluken Gizaw
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Global Health Working Group, Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University, Halle-Wittenberg, Germany
- NCD Working Group, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Lidya Genene Abebe
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Global Health Working Group, Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University, Halle-Wittenberg, Germany
- NCD Working Group, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Brhanu Teka
- Global Health Working Group, Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University, Halle-Wittenberg, Germany
- Department of Microbiology, Immunology and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Andreas M Kaufmann
- Clinic for Gynecology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institutes of Health, Berlin, Germany
| | - Tamrat Abebe
- Global Health Working Group, Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University, Halle-Wittenberg, Germany
- Department of Microbiology, Immunology and Parasitology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Shannon A McMahon
- Heidelberg Institute of Global Health, Heidelberg University Hospital, Heidelberg, Germany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Adamu Addissie
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Global Health Working Group, Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University, Halle-Wittenberg, Germany
- NCD Working Group, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eva J Kantelhardt
- Global Health Working Group, Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University, Halle-Wittenberg, Germany
- Department of Gynaecology, Martin-Luther-University, Halle-Wittenberg, Germany
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Wondimagegnehu A, Assefa M, Teferra S, Kantelhardt EJ, Zebrack B, Addissie A. A Qualitative Study on Psychosocial Challenges of Patients With Cancer in Ethiopia Using the Social-Ecological Model. QUALITATIVE HEALTH RESEARCH 2024; 34:828-841. [PMID: 38229470 DOI: 10.1177/10497323231219409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Cancer diagnosis and treatment can be physically arduous, disrupting patients' social and work lives. Understanding the extent of these problems is key to addressing patients' needs, but specific psychosocial challenges have not yet been well studied in resource-limited settings. A qualitative study was conducted in the capital and two regions of Ethiopia with the aim of exploring psychosocial challenges among cancer patients. A total of 14 in-depth interviews (IDIs) and 16 focus group discussions (FGDs) were done with cancer patients, health professionals, community representatives, and religious leaders. Four separate interview guides were used to facilitate the interviews and discussions. All transcribed documents, field notes, and reflexive memos were entered into NVivo 12 software, and deductive thematic analysis using the social-ecological model was applied to summarize the main findings. At an individual level, emotional distress, suicidal risk, denial, and refusal of treatment were identified immediately after diagnosis while hopelessness, feeling depressed, and fear of death were commonly reported psychosocial challenges during the course of treatment. Involvement of family members in major treatment decisions was recognized at an interpersonal level. Our result also revealed that cancer patients had strong social support from family members and close friends. In the community, traditional medicine and religious rituals were considered an alternative treatment for cancer. The findings indicate that counselling and psychoeducation are crucial for cancer patients, family members, and close friends. Awareness creation programmes should be delivered through collaboration with religious leaders and traditional healers.
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Affiliation(s)
- Abigiya Wondimagegnehu
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle, Germany
| | - Mathewos Assefa
- Department of Oncology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Teferra
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Eva J Kantelhardt
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle, Germany
- Department of Gynecology, Martin-Luther-University, Halle, Germany
| | - Bradley Zebrack
- School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Adamu Addissie
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle, Germany
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Sebi EP, Tejanaik P, Narendiran V. Healthcare Provider-Related Factors in the Diagnostic Delay of Cervical Cancer: A Cross-Sectional Study. Cureus 2024; 16:e61865. [PMID: 38975480 PMCID: PMC11227626 DOI: 10.7759/cureus.61865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2024] [Indexed: 07/09/2024] Open
Abstract
Background and objective Cervical cancer is the second most common malignancy among Indian women. In 2018, the World Health Organization (WHO) called for global action toward the elimination of cervical cancer through the triple-intervention strategy. One of its pillars is ensuring 70% screening coverage of eligible women with a high-performance test at least twice in their lifetime. Various factors contribute to the delayed diagnosis of cervical cancer, increasing the burden of the disease. In this study, we aimed to determine the healthcare provider (HCP)-related factors in the diagnostic delay of advanced cervical cancer. Methods This prospective cross-sectional study was conducted over two months in the cancer clinic of the Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India. We interviewed 384 women diagnosed with advanced cervical cancer [the International Federation of Gynecology and Obstetrics (FIGO) stage IB3-IVB] by using a questionnaire to capture data inputs regarding the various healthcare services they had received in the past 10 years along with details of HCPs. The collected data were analyzed using the software STATA version 17.0. Results Among 384 participants, 185 (48.1%) had interacted with an HCP in the past 10 years; 157 (40.8%) of them had visited a healthcare facility. Among these 185 women, only 22.16% had been advised to undergo screening, and only 15.18% had been tested despite several having access to primary health centers within 10 km of their residence. The lack of screening guidance by HCPs accounted for 78% of delayed diagnoses of cervical cancer. Conclusions Based on our findings, a deficiency in screening guidance in the asymptomatic period by healthcare providers across various levels of our healthcare system contributed significantly to the delayed diagnosis of cervical cancer.
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Affiliation(s)
- Eljo P Sebi
- Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
| | - Parvathi Tejanaik
- Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
| | - Viswanath Narendiran
- Department of Preventive Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
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Hussein K, Kokwaro G, Wafula F, Kassie GM. Assessing the influence of the health system on access to cervical cancer prevention, screening, and treatment services at public health centers in Addis Ababa, Ethiopia. PLoS One 2024; 19:e0300152. [PMID: 38820249 PMCID: PMC11142424 DOI: 10.1371/journal.pone.0300152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 02/22/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Cervical cancer is the second leading cause of cancer death among Ethiopian women. This study aimed to assess the influence of the health system on access to cervical cancer prevention, screening, and treatment services at public health centers in Addis Ababa, Ethiopia. METHODS This study used a cross-sectional survey design and collected data from 51 randomly selected public health centers in Addis Ababa. Open Data Kit was used to administer a semi-structured questionnaire on Android tablets, and SPSS version 26 was used to analyze the descriptive data. RESULTS In the study conducted at 51 health centers, cervical cancer prevention and control services achieved 61% HPV vaccination for girls, 79% for cervical cancer awareness messages, 80% for precancer lesion treatment, and 71% for cervical screening of women. All health centers were performing cervical screening mostly through visual inspection with acetic acid due to the inconsistent availability of HPV DNA tests and the lack of Pap smear tests. In 94% of health centers, adequate human resources were available. However, only 78% of nurses, 75% of midwives, 35% of health officers, and 49% of health extension workers received cervical cancer training in the 24 months preceding the study. Women had provider choices in only 65% of health centers, and 86% of the centers lacked electronic health records. In 41% of the health centers, the waiting time was 30 minutes or longer. About 88% and 90% of the facilities lacked audio and video cervical cancer messages, respectively. CONCLUSION This study revealed that the annual cervical cancer screening achievement was on track to fulfill the WHO's 90-70-90 targets by 2030. We recommend that decision-makers prioritize increasing HPV vaccination rates, enhancing messaging, reducing wait times, and implementing electronic health records to improve access to cervical cancer services in Addis Ababa.
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Affiliation(s)
- Kemal Hussein
- Institute of Healthcare Management, Strathmore University, Nairobi, Kenya
| | - Gilbert Kokwaro
- Institute of Healthcare Management, Strathmore University, Nairobi, Kenya
| | - Francis Wafula
- Institute of Healthcare Management, Strathmore University, Nairobi, Kenya
| | - Getnet Mitike Kassie
- International Institute for Primary Healthcare – Ethiopia (IPHC-E), Addis Ababa, Ethiopia
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Jibat N, Ali R, Adissu W, Buruh G, Abdissa A, Goba GK, Garland SM, Mulholland N, Mulholland K, Amenu D. Less known but greatly feared: Cervical cancer in Ethiopia community awareness. Heliyon 2024; 10:e28328. [PMID: 38601557 PMCID: PMC11004701 DOI: 10.1016/j.heliyon.2024.e28328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 02/26/2024] [Accepted: 03/15/2024] [Indexed: 04/12/2024] Open
Abstract
To improve a community's awareness and attitude towards cervical cancer, strong evidence is needed to inform contextually appropriate policies. This study aims to explore community awareness about cervical cancer from the perspective of women, men and health extension workers (HEWs). The research was conducted from May to July 2021 in Jimma, Ethiopia. A total of 23 in-depth interviews were conducted. The study included married and unmarried women (15-19 and 25-29 years old), men of similar ages (married and unmarried), and HEWs. Furthermore, eight separate focus group discussions (FGDs) were conducted with both men and women. Thematic analysis was used to draw findings from the interviews and FGDs. Community awareness about cervical cancer was very limited. However, people who knew of it believed that cancer is fatal. A few participants were aware of cervical cancer through its symptoms, but most people did not know it by name and had never heard about HPV as the cause of cervical cancer. There was little understanding of HPV risk, transmission factors, prevention, vaccination, screening, or treatment. Participants considered their participation in this study as their first chance to learn about the disease. HEWs had limited knowledge about HPV and cervical cancer. Study participants demonstrated favorable attitudes towards HPV vaccination, cervical screening, and treatment after they received basic information about cervical cancer from the data collectors. Participants and HEWs strongly suggested awareness creation programs for the wider community members, including active involvement of men and HEWs in cervical cancer interventions. There is a critical information gap regarding cervical cancer, its cause and risk factors, HPV transmission, cervical screening, and treatment programs. Limited community awareness leads to poor uptake of cervical screening in the few settings where it is available. Therefore, community awareness programs about HPV, cervical cancer, and available services should improve the community's awareness of cervical cancer and HPV.
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Affiliation(s)
- Nega Jibat
- Department of Sociology, College of Social Science and Humanities Jimma University, Jimma Ethiopia
| | - Rahma Ali
- Department of Population and Family Health, Faculty of Public Health, Jimma University, Jimma, Ethiopia
| | - Wondimagegn Adissu
- School of Medical Laboratory, Faculty of Health Science, Jimma University, Jimma, Ethiopia
| | - Gerezgiher Buruh
- College of Health Science, Mekelle University, Mekelle, Ethiopia
| | | | - Gelila K. Goba
- Department of Obstetrics and Gynecology, University of Illinois, Chicago, USA
| | - Suzanne M. Garland
- Department of Obstetrics and Gynecology, University of Melbourne, Australia
| | - Nigisti Mulholland
- Family & Reproductive Rights Education Program, Royal Women's Hospital, Melbourne, Australia
| | - Kim Mulholland
- Department of Pediatrics, University of Melbourne, Murdoch Children's Research Institute, Australia
- London School of Tropical Medicine, UK
| | - Demisew Amenu
- Department of Gynecology and Obstetrics, Faculty of Medical Science, Jimma University, Jimma, Ethiopia
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Mwenda V, Mwangi M, Gathecha G, Kibachio J, Too R, Gura Z, Temmerman M. Factors associated with late diagnosis of cervical cancer at two national referral hospitals, Kenya 2017: A case control study. Gynecol Oncol Rep 2024; 52:101355. [PMID: 38500641 PMCID: PMC10945120 DOI: 10.1016/j.gore.2024.101355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/01/2023] [Accepted: 02/27/2024] [Indexed: 03/20/2024] Open
Abstract
Background Cervical cancer is the leading cause of cancer mortality among women in Kenya. Two thirds of cervical cancer cases in Kenya are diagnosed in advanced stages. We aimed to identify factors associated with late diagnosis of cervical cancer, to guide policy interventions. Methods An unmatched case control study (ratio 1:2) was conducted among women aged ≥ 18 years with cervical cancer at Kenyatta National and Moi Teaching and Referral Hospitals. We defined a case as patients with International Federation of Gynecology and Obstetrics (FIGO) stage ≥ 2A and controls as those with stage ≤ 1B. A structured questionnaire was used to document exposure variables. We calculated adjusted odds ratio (aOR) to identify any associations. Results We enrolled 192 participants (64 cases, 128 controls). Mean age 39.2 (±9.3) years, 145 (76 %) were married, 77 (40 %) had primary level education, 168 (88 %) had their first pregnancy ≤ 24 years of age, 85 (44 %) were > para 3 and 150 (78 %) used contraceptives. Late diagnosis of cervical cancer was associated with cost of travel to cancer centres > USD 6.1 (aOR 6.43 95% CI [1.30, 31.72]), age > 50 years (aOR 4.71; 95% CI [1.18, 18.80]), anxiety over cost of cancer care (aOR 5.6; 95% CI [1.05, 32.72]) and ultrasound examination during evaluation of symptoms (aOR 4.89; 95% CI [1.07-22.42]). Previous treatment for gynecological infections (aOR 0.10; 95% CI [0.02, 0.47]) was protective against late diagnosis. Conclusion Cost of seeking care and the quality of the diagnostic process were important factors in this study. Decentralization of care, innovative health financing solutions and clear diagnostic and referral algorithms for women presenting with gynecological symptoms could reduce late-stage diagnosis in Kenya.
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Affiliation(s)
- Valerian Mwenda
- Department of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
| | - Martin Mwangi
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
| | - Gladwell Gathecha
- Department of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
| | - Joseph Kibachio
- Department of Non-Communicable Diseases, Ministry of Health, Nairobi, Kenya
| | - Robert Too
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
- School of Public Health, Moi University, Eldoret, Kenya
| | - Zeinab Gura
- Field Epidemiology and Laboratory Training Program, Ministry of Health, Nairobi, Kenya
| | - Marleen Temmerman
- Department of Obstetrics and Gynaecology, Aga Khan University Hospital, Nairobi, Kenya
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Tjokroprawiro BA, Novitasari K, Saraswati W, Yuliati I, Ulhaq RA, Sulistya HA. The challenging journey of cervical cancer diagnosis and treatment at the second largest hospital in Indonesia. Gynecol Oncol Rep 2024; 51:101325. [PMID: 38314320 PMCID: PMC10837473 DOI: 10.1016/j.gore.2024.101325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/06/2024] [Accepted: 01/10/2024] [Indexed: 02/06/2024] Open
Abstract
Objectives Cervical cancer is a major health concern in developing countries. Access to preventive measures is limited in low- and middle-income countries, and cervical cancer is often identified at an advanced stage of the disease. In this study, we aimed to investigate when patients were first diagnosed and received treatment at a large hospital in Indonesia. Methods Data were collected using a questionnaire from outpatient visits and descriptively analyzed. Totally, 215 cervical cancer patients being treated at the Dr. Soetomo Academic Hospital's gynecological oncology outpatient clinic in Indonesia between August and October 2022 were included. Results Most patients were 51-60 years old (36.3 %), housewives (87 %), and had an elementary school education level (50 %). Most (88.4 %) admitted they were unaware about cervical cancer prevention, and 85.6 % never underwent screening. Most cervical biopsies were performed at primary hospitals (42.3 %). Fear of cancer treatment was the most frequent reason for patients arriving late at tertiary hospitals (50 %). Treatment delays occurred because patients had to visit two healthcare facilities before visiting a tertiary hospital (47.4 %). Most patients were diagnosed with stage III cancer (38.1 %), and chemotherapy was administered as the first-line therapy (96.3 %). Most patients (51.2 %) received their first therapy >12 months after initial symptom onset. Conclusions Most cervical cancer patients were diagnosed at a late stage owing to a lack of information regarding early symptoms and irregular screenings. Treatment was delayed owing to social barriers. Therefore, the government should have more strict policies to implement cervical cancer detection and prevention.
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Affiliation(s)
- Brahmana Askandar Tjokroprawiro
- Departement of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Jl. Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia
| | - Khoirunnisa Novitasari
- Departement of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Jl. Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia
| | - Wita Saraswati
- Departement of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Jl. Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia
| | - Indra Yuliati
- Departement of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Jl. Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia
| | - Renata Alya Ulhaq
- Departement of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Jl. Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia
| | - Hanif Ardiansyah Sulistya
- Departement of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Academic Hospital, Jl. Prof. Dr. Moestopo 6-8, Surabaya 60286, Indonesia
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Lacika JL, Wabinga H, Kagaayi J, Opito R, Orach CG, Mwaka AD. Diagnostic and pre-treatment intervals among patients with cervical cancer attending care at the Uganda Cancer Institute: a cross-sectional study. BMC Womens Health 2023; 23:633. [PMID: 38012615 PMCID: PMC10683271 DOI: 10.1186/s12905-023-02785-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Majority of patients with cervical cancer in the low- and middle-income countries experience long diagnostic and pre-treatment intervals. This study sought to determine the factors associated with the diagnostic and pre-treatment intervals among patients with cervical cancer. METHODS This was a cross-sectional study conducted at the Uganda Cancer Institute (UCI) during October 2019 to January 2020. Patients aged ≥ 18 years with histological diagnosis of cervical cancer were consecutively sampled. Data were collected using a pre-tested semi-structured questionnaire and a data abstraction form. Diagnostic intervals, defined as the time between first visit of a patient to a primary healthcare provider to time of getting confirmed diagnosis, of ≤ 3 months was defined as early & >3 months as late. Pre-treatment intervals, which is the time from histological diagnosis to starting cancer chemo-radiotherapy of ≤ 1 month was defined as early and > 1 month as late. Data were analysed using STATA version 14.0. We used modified Poisson regression models with robust variance to determine socio-demographic and clinical factors associated with the intervals. RESULTS The mean age of the participants was 50.0 ± 11.7 years. The median diagnostic and pre-treatment intervals were 3.1 (IQR: 1.4-8.2) months and 2.4 (IQR: 1.2-4.1) months respectively. Half of the participants, 49.6% (200/403) were diagnosed early; one in 5 patients, 20.1% (81/403) promptly (within one month) initiated cancer chemo-radiotherapy. Participants more likely to be diagnosed early included those referred from district hospitals (level 5) (aPR = 2.29; 95%CI: 1.60-3.26) and with squamous cell carcinomas (aPR = 1.55; 95%CI: 1.07-2.23). Participants more likely to be diagnosed late included those who first discussed their symptoms with relatives, (aPR = 0.77; 95%CI: (0.60-0.98), had > 2 pre-referral visits (aPR = 0.75; 95%CI (0.61-0.92), and had advanced stage (stages 3 or 4) (aPR = 0.68; 95%CI: 0.55-0.85). Participants more likely to initiate cancer chemo-radiotherapy early included older patients (≥ 60 years) (aPR = 2.44; 95%CI: 1.18-5.03). Patients likely to start treatment late were those who had ≥2 pre-referral visits (aPR = 0.63; 95%CI: 0.41-0.98) and those that took 3 - 6 months with symptoms before seeking healthcare (aPR = 0.52;95%CI: 0.29 - 0.95). CONCLUSION Interventions to promote prompt health-seeking and early diagnosis of cervical cancer need to target primary healthcare facilities and aim to enhance capacity of primary healthcare professionals to promptly initiate diagnostic investigations. Patients aged < 60 years require targeted interventions to promote prompt initiation of chemo-radiation therapy.
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Affiliation(s)
- Jackie Lalam Lacika
- Department of Community Health & Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Henry Wabinga
- Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Joseph Kagaayi
- Department of Community Health & Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Ronald Opito
- Department of Public Health, School of Health Sciences, Soroti University, P.O Box 211, Soroti, Uganda
| | - Christopher Garimoi Orach
- Department of Community Health & Behavioural Sciences, School of Public Health, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Amos Deogratius Mwaka
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda.
- Department of Medicine, Faculty of Medicine, Gulu University, P.O Box 166, Gulu, Uganda.
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Parida P, Lewis S, Sharan K, Kamal MV, Kumar NAN, Godkhindi VM, Varambally S, Rangnekar VM, Rao M, Damerla RR. Increased Gene Expression of C1orf74 Is Associated with Poor Prognosis in Cervical Cancer. Cells 2023; 12:2530. [PMID: 37947608 PMCID: PMC10649411 DOI: 10.3390/cells12212530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023] Open
Abstract
C1orf74, also known as URCL4, has been reported to have higher expression and be associated with poor prognosis in lung adenocarcinoma patients, and its role in regulation of the EGFR/AKT/mTORC1 pathway has been recently elucidated. In the current study, we used publicly available data and experimental validation of C1orf74 gene expression and its association with prognosis in cervical cancer patients. qRT-PCR was performed using RNA from cervical cancer cell lines and twenty-five cervical cancer patients. Data from TNMplot revealed that mRNA expression of the C1orf74 gene in primary tumor tissues, as well as metastatic tissues from cervical cancer patients, was significantly higher compared to normal cervical tissues. HPV-positive tumors had higher expression of this gene compared to HPV-negative tumors. qPCR analysis also demonstrated higher expression of C1orf74 in HPV-positive cervical cancer cell lines and most cervical cancer patients. The promoter methylation levels of the C1orf74 gene in cervical cancer tissues were lower compared to normal cervical tissues (p < 0.05). Collectively, our study indicates that higher expression of the C1orf74 gene caused by hypomethylation of its promoter is associated with poor overall survival in cervical cancer patients. Thus, C1orf74 is a novel prognostic marker in cervical cancer.
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Affiliation(s)
- Preetiparna Parida
- Department of Medical Genetics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education (MAHE), Manipal 576104, Karnataka, India;
| | - Shirley Lewis
- Department of Radiotherapy and Oncology, Manipal Comprehensive Cancer Care Centre, Kasturba Medical College, Manipal, Manipal Academy of Higher Education (MAHE), Manipal 576104, Karnataka, India; (S.L.); (K.S.)
| | - Krishna Sharan
- Department of Radiotherapy and Oncology, Manipal Comprehensive Cancer Care Centre, Kasturba Medical College, Manipal, Manipal Academy of Higher Education (MAHE), Manipal 576104, Karnataka, India; (S.L.); (K.S.)
| | - Mehta Vedant Kamal
- Department of Surgical Oncology, Manipal Comprehensive Cancer Care Centre, Kasturba Medical College, Manipal, Manipal Academy of Higher Education (MAHE), Manipal 576104, Karnataka, India; (M.V.K.); (N.A.N.K.)
| | - Naveena A. N. Kumar
- Department of Surgical Oncology, Manipal Comprehensive Cancer Care Centre, Kasturba Medical College, Manipal, Manipal Academy of Higher Education (MAHE), Manipal 576104, Karnataka, India; (M.V.K.); (N.A.N.K.)
| | - Vishwapriya M. Godkhindi
- Department of Pathology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education (MAHE), Manipal 576104, Karnataka, India;
| | - Sooryanarayana Varambally
- Cellular and Molecular Pathology, Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
- O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Vivek M. Rangnekar
- Department of Radiation Medicine, College of Medicine, University of Kentucky, Lexington, KY 40536, USA;
- Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
| | - Mahadev Rao
- Department of Pharmacy Practice, Center for Translational Research, Manipal College of Pharmaceutical Sciences, Manipal, Manipal Academy of Higher Education (MAHE), Manipal 576104, Karnataka, India
| | - Rama Rao Damerla
- Department of Medical Genetics, Kasturba Medical College, Manipal, Manipal Academy of Higher Education (MAHE), Manipal 576104, Karnataka, India;
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Bayable A, Tegenaw A, Tesfaye Z, Lidetu T, Assefa A, Dessie G. Delay in health-seeking behaviour and associated factors among adult patients with cancer in Ethiopia: a multicentre cross-sectional study. BMJ Open 2023; 13:e071406. [PMID: 37643843 PMCID: PMC10465914 DOI: 10.1136/bmjopen-2022-071406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 06/14/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES Delays in obtaining proper cancer treatment can lead to advanced stages at diagnosis. Despite the problems, there is not enough evidence regarding delay in presentation. This study aims to assess delay in health-seeking behaviour and associated factors among adult patients with cancer in Ethiopia. DESIGN Multicentre cross-sectional study design. SETTING Data were collected from selected oncology centres in Ethiopia. PARTICIPANTS A multistage sampling technique was used to select 635 study participants from May 9 to June 9 2022. OUTCOME MEASURES Patients who have a duration of ≥3 months from symptom recognition to the first healthcare visit were considered as delay in health-seeking behaviour. Data were entered using Epi data and exported to SPSS for further analysis. Before analysis, model fitness was carried out using Hosmer and Lemeshow test. Variables with a p value<0.25 in the bivariable analysis were included in multivariable logistic regression. In multivariable logistic regression, a p value<0.05 significant level was considered as the factor for delay in health-seeking behaviour. RESULTS In this study, a total of 628 adult patients with cancer participated. A total of 72.6% of patients had a delay in health-seeking behaviour. Variables such as being female (AOR=2.81; 95% CI=1.29 to 6.14), rural residence (AOR=2.82; 95% CI=1.43 to 5.58), low social support (AOR=4.16; 95% CI=2.04 to 8.49), not having comorbidity (AOR=4.44; 95% CI=2.28 to 8.66), stage III cancer (AOR=3.73; 95% CI=1.37 to 9.98), stage IV cancer (AOR=3.07; 95% CI=1.28 to 6.41), additional symptoms (AOR=3.03; 95% CI=1.55 to 5.94), never heard about cancers (AOR=4.09; 95% CI=2.06 to 8.11) and never heard about cancer screening (AOR=2.16; 95% CI=1.06 to 4.40) were identified as factors for delay in health-seeking behaviour. CONCLUSION This study showed that relatively higher magnitude in which approximately three-fourth of adult patients with cancer were delayed in seeking medical attention. As a result, more effort must be made to tackle delay in health-seeking behaviour and associated factors.
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Affiliation(s)
- Alem Bayable
- Department of Adult Health Nursing, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Abebu Tegenaw
- Department of Adult Health Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Zerihun Tesfaye
- Department of Emergency and Critical Care, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia
| | - Tadios Lidetu
- Department of Adult Health Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Amare Assefa
- Department of Oncology, College of Medicine and Health Science, Jimma University, Jimma, Ethiopia
| | - Getenet Dessie
- Department of Adult Health Nursing, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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11
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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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12
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Patient delay and related influencing factors in Chinese women under 35 years diagnosed with cervical cancer: A cross-sectional study. Asia Pac J Oncol Nurs 2022; 10:100165. [PMID: 36579173 PMCID: PMC9791130 DOI: 10.1016/j.apjon.2022.100165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/01/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022] Open
Abstract
Objective Patient delay was defined as an interval between the discovery of the initial symptoms and diagnosis, which was longer than 90 days. This study aimed to determine the patient delay rate and related factors in women with cervical cancer in Hunan province, South-Central China. Methods A cross-sectional study was conducted among 140 women with cervical cancer aged <35 years from October, 2019 to March, 2021. Assumptions in Andersen Behavioral Model of Health Services Utilization were used to measure the factors influencing patient delay. Logistic regression models were used to identify factors associated with patient delay. A P-value of <5% was considered significant. Results A total of 57 (40.71%) young women with cervical cancer had patient delay, with an average delay time of 178.70 (307.90) days. Predisposing factors, such as religion, unemployment, health beliefs related to cancer screening, and a history of cervical cancer screening within 2 years or more (P < 0.05), were associated with patient delay. Enabling factors, such as distance to the nearest medical facility and type of the nearest medical facility, were associated with a reduced likelihood of patient delay. With the need-for-care factor, young women who experienced vaginal pain after or during intercourse had a higher risk (adjusted odds ratio, 33.48; 95% confidence interval, 3.22-348.68, P = 0.003) of patient delay. Conclusions These findings reinforce the need for programs to enhance knowledge and awareness about cervical cancer screening and the importance of early diagnosis in women to help eliminate cervical cancer in China by 2050.
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13
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Wondimagegnehu A, Negash Bereded F, Assefa M, Teferra S, Zebrack B, Addissie A, Kantelhardt EJ. Burden of Cancer and Utilization of Local Surgical Treatment Services in Rural Hospitals of Ethiopia: A Retrospective Assessment from 2014 to 2019. Oncologist 2022; 27:e889-e898. [PMID: 35791963 PMCID: PMC9632304 DOI: 10.1093/oncolo/oyac127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 05/18/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Global cancer estimations for Ethiopia announced 77 352 new cases in 2020 based on the only population-based registry in Addis Ababa. This study characterizes cancer patients in rural Ethiopia at 8 primary and secondary hospitals between 2014 and 2019. PATIENTS AND METHODS All clinically or pathologically confirmed cancer cases that were diagnosed between 1 May 2014 and 29 April 2019 were included. A structured data extraction tool was used to retrospectively review patients' charts and descriptive analysis was done. RESULTS A total of 1298 cancer cases were identified, of which three-fourths were females with a median age of 42 years. Breast (38%) and cervical (29%) cancers were the most common among females, while prostate (19%) and oesophageal cancers (16%) were the most common among males. Only 39% of tumors were pathologically confirmed. Nearly two-thirds of the cases were diagnosed at an advanced stage. Surgery was the only accessible treatment option for more than half of the cancer patients, and systemic treatment (except endocrine) was rarely available. One in 5 patients did not receive the recommended surgical procedure, half due to patient refusal or lack of the patient returning to the hospital. CONCLUSION The pattern of cancer diagnoses in rural hospitals shows an exceptionally high burden in women in their middle-ages due to breast and cervical cancers. Advanced stage presentation, lack of pathology services, and unavailability of most systemic treatment options were common. The surgery was offered to nearly 60% of the patients, showing the significant efforts of health workers to reduce sufferings.
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Affiliation(s)
- Abigiya Wondimagegnehu
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia,Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University, Halle, Saale, Germany
| | - Fekadu Negash Bereded
- Department of Surgery, St Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mathewos Assefa
- Department of Oncology, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Solomon Teferra
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bradley Zebrack
- University of Michigan, School of Social Work, Ann Arbor, MI, USA
| | - Adamu Addissie
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia,Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University, Halle, Saale, Germany
| | - Eva J Kantelhardt
- Corresponding author: Eva J. Kantelhardt, MD, Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle, Germany.
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14
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McCutchan G, Weiss B, Quinn-Scoggins H, Dao A, Downs T, Deng Y, Ho H, Trung L, Emery J, Brain K. Psychosocial influences on help-seeking behaviour for cancer in low-income and lower middle-income countries: a mixed-methods systematic review. BMJ Glob Health 2021; 6:bmjgh-2020-004213. [PMID: 33531348 PMCID: PMC7868297 DOI: 10.1136/bmjgh-2020-004213] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 12/09/2020] [Accepted: 01/06/2021] [Indexed: 12/14/2022] Open
Abstract
Introduction Starting cancer treatment early can improve outcomes. Psychosocial factors influencing patients’ medical help-seeking decisions may be particularly important in low and lower middle-income countries (LMIC) where cancer outcomes are poor. Comprehensive review evidence is needed to understand the psychosocial influences on medical help-seeking for cancer symptoms, attendance for diagnosis and starting cancer treatment. Methods Mixed-methods systematic review registered on PROSPERO (CRD42018099057). Peer-reviewed databases were searched until April 2020 for studies assessing patient-related barriers and facilitators to medical help-seeking for cancer symptoms, diagnosis and treatment in adults (18+ years) living in LMICs. Quality of included studies was assessed using the Critical Appraisal Skills Programme tool. Data were synthesised using meta-analytic techniques, meta-ethnography or narrative synthesis as appropriate. Results Of 3963 studies identified, 64 were included. In quantitative studies, use of traditional, complementary and alternative medicine (TCAM) was associated with 3.60 higher odds of prolonged medical help-seeking (95% CI 2.06 to 5.14). Qualitative studies suggested that use of TCAM was a key barrier to medical help-seeking in LMICs, and was influenced by causal beliefs, cultural norms and a preference to avoid biomedical treatment. Women face particular barriers, such as needing family permission for help-seeking, and higher stigma for cancer treatment. Additional psychosocial barriers included: shame and stigma associated with cancer such as fear of social rejection (eg, divorce/disownment); limited knowledge of cancer and associated symptoms; and financial and access barriers associated with travel and appointments. Conclusion Due to variable quality of studies, future evaluations would benefit from using validated measures and robust study designs. The use of TCAM and gender influences appear to be important barriers to help-seeking in LMIC. Cancer awareness campaigns developed with LMIC communities need to address cultural influences on medical help-seeking behaviour.
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Affiliation(s)
- Grace McCutchan
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK .,Wales Cancer Research Centre, Cardiff University, Cardiff, UK
| | - Bahr Weiss
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Harriet Quinn-Scoggins
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK.,PRIME Centre Wales, Cardiff University, Cardiff, UK
| | - Anh Dao
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Tom Downs
- Department of Acute Medicine, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor, Gwynedd, UK
| | - Yunfeng Deng
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Ha Ho
- Center for Research, Information and Services in Psychology, Vietnam National University, Hanoi, Vietnam
| | - Lam Trung
- Danang Psychiatric Hospital, Da Nang, Vietnam
| | - Jon Emery
- Department of General Practice and Centre for Cancer Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Kate Brain
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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15
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Dereje N, Addissie A, Worku A, Gebremariam A, Kantelhardt EJ, Assefa M, Jemal A. Association between waiting time for radiotherapy initiation and disease progression among women with cervical cancer in Addis Ababa, Ethiopia. Int J Cancer 2021; 149:1284-1289. [PMID: 33997978 DOI: 10.1002/ijc.33689] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 04/19/2021] [Accepted: 04/29/2021] [Indexed: 12/24/2022]
Abstract
There is shortage of radiotherapy machines in low-income countries, including Ethiopia. Data on adverse effects of this on cancer outcomes are limited, however. Herein, we examined the extent of waiting time for radiotherapy and its association with disease progression based on a prospective cohort study of women diagnosed with stage IA-IVA cervical cancer in Addis Ababa and who were scheduled to receive radiotherapy at Tikur Anbessa Specialized Hospital, the only hospital that provides radiotherapy services in the country. Association was examined using Multivariable mixed effects logistic regression model. Among the 178 women with cervical cancer scheduled for receipt of radiotherapy and with vital status information, 16 deceased (9.0%) while waiting for radiotherapy. For the remaining 162 women who initiated radiotherapy, the median treatment waiting period was 137 days (IQR = 60-234 days), with 74.1% of women waiting for >60 days. Tumor progressed to higher stage for 44.4% of these women. Compared to those women who initiated radiotherapy ≤60 days after diagnostic confirmation, the odds of tumor progression to higher stage was three times higher in those women who initiated radiotherapy between 120-179 days (aOR =3.30, 95%CI: 1.18-9.27) and ≥180 days (aOR =3.06, 95%CI: 1.24-7.52). Waiting period for receipt of radiotherapy among women with cervical cancer is exceedingly long in Addis Ababa, and it is associated with disease progression to higher stages. These findings reinforce the need to expand radiotherapy infrastructure in order to mitigate the undue high burden of the disease in Ethiopia and other parts of Africa.
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Affiliation(s)
- Nebiyu Dereje
- Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia.,Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adamu Addissie
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alem Gebremariam
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia.,Department of Public Health, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
| | - Eva Johanna Kantelhardt
- Department of Gynecology, Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle, Halle, Germany
| | - Mathewos Assefa
- Department of Oncology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ahmedin Jemal
- Surveillance & Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
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16
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Wassie M, Fentie B. Prevalence of late-stage presentation and associated factors of cervical cancer patients in Tikur Anbesa Specialized Hospital, Ethiopia: institutional based cross-sectional study. Infect Agent Cancer 2021; 16:30. [PMID: 33975620 PMCID: PMC8111725 DOI: 10.1186/s13027-021-00371-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/29/2021] [Indexed: 11/22/2022] Open
Abstract
Background Cancer of the uterine cervix remains a main public health problem in Sub-Saharan Africa. About two-thirds of patients with cervical cancer were diagnosed at late stage with contributing factors of out-of-pocket medical bill, looking for care out of conventional health settings and multiple visits to healthcare facilities before diagnostic confirmations in Addis Ababa. Therefore, the aim of this study was to identify prevalence of late-stage presentation and associated factors among cervical cancer patients in Tikur Anbesa Specialized Hospital (TASH). Methods Institutional based cross-sectional study was conducted from March to April 2019 in TASH oncology center. Data were extracted from patient’s chart using structured checklist prepared in English and analyzed using STATA14.2. Binary logistic regression model was used to identify variables that affect the outcome variable. Results A total of 1057 cervical cancer patients were included in this five-years retrospective study. The prevalence of late-stage presentation among cervical cancer patients was 56.8%. It was affected by being anemic [AOR = 1.55,95%CI (1.17–2.10)], came from Oromia region (AOR = 0.65,95%CI (0.46–0.91) and Addis Ababa city [AOR:0.5;95%CI (0.34–0.73)], rural residency [AOR:1.88;95% (1.38–2.56)] and age ≥ 60 years [AOR:1.89;95%CI (1.12–3.20)]. Conclusion The study revealed that the prevalence of late-stage presentation among cervical cancer patients is high. Being anemic, regions where patients came from, rural residency and age group ≥ 60 years were statically significant. It is better to expand cervical cancer education for rural dwellers, expand cancer treatment centers and prioritize to patients with anemia and advanced age.
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Affiliation(s)
- Mulugeta Wassie
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Beletech Fentie
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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17
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Griesel M, Seraphin TP, Mezger NCS, Hämmerl L, Feuchtner J, Joko-Fru WY, Sengayi-Muchengeti M, Liu B, Vuma S, Korir A, Chesumbai GC, Nambooze S, Lorenzoni CF, Akele-Akpo MT, Ayemou A, Traoré CB, Wondemagegnehu T, Wienke A, Thomssen C, Parkin DM, Jemal A, Kantelhardt EJ. Cervical Cancer in Sub-Saharan Africa: A Multinational Population-Based Cohort Study of Care and Guideline Adherence. Oncologist 2021; 26:e807-e816. [PMID: 33565668 PMCID: PMC8100544 DOI: 10.1002/onco.13718] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 01/15/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Cervical cancer (CC) is the most common female cancer in many countries of sub-Saharan Africa (SSA). We assessed treatment guideline adherence and its association with overall survival (OS). METHODS Our observational study covered nine population-based cancer registries in eight countries: Benin, Ethiopia, Ivory Coast, Kenya, Mali, Mozambique, Uganda, and Zimbabwe. Random samples of 44-125 patients diagnosed from 2010 to 2016 were selected in each. Cancer-directed therapy (CDT) was evaluated for degree of adherence to National Comprehensive Cancer Network (U.S.) Guidelines. RESULTS Of 632 patients, 15.8% received CDT with curative potential: 5.2% guideline-adherent, 2.4% with minor deviations, and 8.2% with major deviations. CDT was not documented or was without curative potential in 22%; 15.7% were diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage IV disease. Adherence was not assessed in 46.9% (no stage or follow-up documented, 11.9%, or records not traced, 35.1%). The largest share of guideline-adherent CDT was observed in Nairobi (49%) and the smallest in Maputo (4%). In patients with FIGO stage I-III disease (n = 190), minor and major guideline deviations were associated with impaired OS (hazard rate ratio [HRR], 1.73; 95% confidence interval [CI], 0.36-8.37; HRR, 1.97; CI, 0.59-6.56, respectively). CDT without curative potential (HRR, 3.88; CI, 1.19-12.71) and no CDT (HRR, 9.43; CI, 3.03-29.33) showed substantially worse survival. CONCLUSION We found that only one in six patients with cervical cancer in SSA received CDT with curative potential. At least one-fifth and possibly up to two-thirds of women never accessed CDT, despite curable disease, resulting in impaired OS. Investments into more radiotherapy, chemotherapy, and surgical training could change the fatal outcomes of many patients. IMPLICATIONS FOR PRACTICE Despite evidence-based interventions including guideline-adherent treatment for cervical cancer (CC), there is huge disparity in survival across the globe. This comprehensive multinational population-based registry study aimed to assess the status quo of presentation, treatment guideline adherence, and survival in eight countries. Patients across sub-Saharan Africa present in late stages, and treatment guideline adherence is remarkably low. Both factors were associated with unfavorable survival. This report warns about the inability of most women with cervical cancer in sub-Saharan Africa to access timely and high-quality diagnostic and treatment services, serving as guidance to institutions and policy makers. With regard to clinical practice, there might be cancer-directed treatment options that, although not fully guideline adherent, have relevant survival benefit. Others should perhaps not be chosen even under resource-constrained circumstances.
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Affiliation(s)
- Mirko Griesel
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University, Halle-Wittenberg, Germany
| | - Tobias P Seraphin
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University, Halle-Wittenberg, Germany
| | - Nikolaus C S Mezger
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University, Halle-Wittenberg, Germany
| | - Lucia Hämmerl
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University, Halle-Wittenberg, Germany
| | - Jana Feuchtner
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University, Halle-Wittenberg, Germany
| | - Walburga Yvonne Joko-Fru
- Clinical Trials Service Unit & Epidemiological Studies Unit, Department of Medicine, University of Oxford, Oxford, United Kingdom.,African Cancer Registry Network, Oxford, United Kingdom
| | | | - Biying Liu
- African Cancer Registry Network, Oxford, United Kingdom
| | - Samukeliso Vuma
- Department of Radiotherapy, Mpilo Hospital, Bulawayo, Zimbabwe
| | - Anne Korir
- National Cancer Registry, Kenya Medical Research Institute, Nairobi, Kenya
| | - Gladys C Chesumbai
- Eldoret Cancer Registry, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Sarah Nambooze
- Kampala Cancer Registry, Department of Pathology, Makerere University, Kampala, Uganda
| | - Cesaltina F Lorenzoni
- Departamento de Patologia, Faculdade de Medicina Universidade Eduardo Mondlane, Maputo, Mozambique
| | | | - Amalado Ayemou
- Oncologie-Radiothérapie, Programme National de Lutte contre le Cancer, Abidjan, Côte d'Ivoire
| | - Cheick B Traoré
- Service du Laboratoire d'Anatomie et Cytologie Pathologiques, Centre Hospitalier Universitaire du Point G, Bamako, Mali
| | | | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University, Halle-Wittenberg, Germany
| | - Christoph Thomssen
- Department of Gynaecology, Martin-Luther-University, Halle-Wittenberg, Germany
| | - Donald M Parkin
- Clinical Trials Service Unit & Epidemiological Studies Unit, Department of Medicine, University of Oxford, Oxford, United Kingdom.,African Cancer Registry Network, Oxford, United Kingdom
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia, USA
| | - Eva J Kantelhardt
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University, Halle-Wittenberg, Germany.,Department of Gynaecology, Martin-Luther-University, Halle-Wittenberg, Germany
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18
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Dereje N, Gebremariam A, Addissie A, Worku A, Assefa M, Abraha A, Tigeneh W, Kantelhardt EJ, Jemal A. Factors associated with advanced stage at diagnosis of cervical cancer in Addis Ababa, Ethiopia: a population-based study. BMJ Open 2020; 10:e040645. [PMID: 33051237 PMCID: PMC7554500 DOI: 10.1136/bmjopen-2020-040645] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To describe the patterns and factors associated with advanced stage at diagnosis of cervical cancer among Addis Ababa residents, Ethiopia. DESIGN A population-based cross-sectional study. SETTING Seven major hospitals or diagnostic facilities in Addis Ababa, Ethiopia. PARTICIPANTS All histopathology-confirmed patients with incident cervical cancer diagnosed from 1 January 2017 to 30 June 2018 among Addis Ababa residents. OUTCOME MEASURES The proportion of patients with cervical cancer diagnosed at early stage (stage I/II) and advanced stage (stage III/IV) of the disease according to International Federation of Gynaecology and Obstetrics staging criteria, and adjusted prevalence ratio (APR) for factors associated with advanced-stage diagnosis using a Poisson regression with robust variance model. RESULTS The mean age of the study participants was 52.9 (±13.3) years. Nearly two-thirds (60.4%, 95% CI: 53.8% to 66.5%) of patients with cervical cancer were diagnosed at an advanced stage. Advanced stage at diagnosis was significantly associated with paying medical bill out of pocket (APR=1.44, 95% CI: 1.08 to 1.91), diagnostic interval >90 days (APR=1.31, 95% CI: 1.04 to 1.71), practicing religion as a remedy or not taking immediate action following symptom recognition (APR=1.25, 95% CI: 1.08 to 1.91) and visiting more than three different health facilities prior to diagnostic confirmation (APR=1.24, 95% CI: 1.07 to 1.51). CONCLUSIONS Our findings of the high proportion of advanced-stage diagnosis of cervical cancer in Addis Ababa and its strong associations with out-of-pocket medical bill, seeking care out of conventional medicine settings and multiple visits to healthcare facilities before diagnostic confirmations underscore the need for public policies to improve the affordability of cancer care and enhance community awareness about the severity of the disease and referral system, in addition to expanding cervical cancer screening.
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Affiliation(s)
- Nebiyu Dereje
- Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
- Public Health, College of Medicine and Health Sciences, Wachemo University, Hosanna, Ethiopia
| | - Alem Gebremariam
- Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
- Public Health, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia
| | - Adamu Addissie
- Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mathewos Assefa
- Oncology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Aynalem Abraha
- Oncology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Eva Johanna Kantelhardt
- Department of Gynaecology, Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-Universitat Halle-Wittenberg, Halle, Saxony-Anhalt, Germany
| | - Ahmedin Jemal
- Surveillance & Health Services Research, American Cancer Society, Atlanta, Georgia, USA
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Yang H, He K, Dong W, Fang J, Zhong S, Tang L, Long L. PIM-1 may function as an oncogene in cervical cancer via activating the EGFR signaling. Int J Biol Markers 2020; 35:67-73. [PMID: 32914663 DOI: 10.1177/1724600820936295] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND This work was designed to explore the roles of PIM-1 in the development of cervical cancer. METHODS There were 90 paired cervical tumor samples and the non-tumor adjacent tissue. The levels of PIM-1 in different samples were examined using quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) methods. The potential diagnostic value of PIM-1 was analyzed by the receiver operating characteristic (ROC) curve; furthermore, the expression of EGFR in tumor samples was detected, and Pearson's correlation analysis was performed to analyze the relationship between the expression of PIM-1 and EGFR. Finally, cervical cancer cell line Hela cells were cultured and treated by PIM-1 siRNA, and MTT assay and Pi/Annexin V assay were performed to explore the effects of PIM-1 siRNA on the growth and apoptosis ability of the Hela cells. RESULTS PIM-1 was significantly up-regulated in cervical cancer tissue compared to adjacent tissue, and the expression of PIM-1 in patients with cervical cancer is positively associated with the size and metastasis of the tumor. ROC analysis showed PIM-1 is a sensitive biomarker for the diagnosis of cervical cancer. Furthermore, EGFR was over-expressed in cervical cancer tumor tissues, and the levels of PIM-1 and EGFR in cervical cancer tissue were positively correlated. Finally, PIM-1 siRNA dramatically inhibited the viability and promoted the apoptosis of the Hela cells. CONCLUSION Our findings prove that PIM-1 may function as an oncogene in cervical cancer and can regulate the EGFR signaling in cervical cancer.
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Affiliation(s)
- Hongwen Yang
- Women & Children Health Institute Futian Shenzhen, Shenzhen, China
| | - Kui He
- The Second People's Hospital of Futian District, Shenzhen, China
| | - Weile Dong
- The First Affiliated Hospital of University of South China, Hengyang, China
| | - Jinchuan Fang
- Women & Children Health Institute Futian Shenzhen, Shenzhen, China
| | - Suyun Zhong
- Women & Children Health Institute Futian Shenzhen, Shenzhen, China
| | - Lixia Tang
- Women & Children Health Institute Futian Shenzhen, Shenzhen, China
| | - Lihua Long
- Women & Children Health Institute Futian Shenzhen, Shenzhen, China
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Abstract
Women’s cancers remain a major challenge for many health systems. Between 1991 and 2017, the death rate for all major cancers fell continuously in the United States, excluding uterine cervix and uterine corpus cancers. Together with HPV (Human Papillomavirus) testing and cytology, colposcopy has played a central role in cervical cancer screening. This medical procedure allows physicians to view the cervix at a magnification of up to 10%. This paper presents an automated colposcopy image analysis framework for the classification of precancerous and cancerous lesions of the uterine cervix. This framework is based on an ensemble of MobileNetV2 networks. Our experimental results show that this method achieves accuracies of 83.33% and 91.66% on the four-class and binary classification tasks, respectively. These results are promising for the future use of automatic classification methods based on deep learning as tools to support medical doctors.
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