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Mathoma A, Sartorius B, Mahomed S. Evaluation of cancer screening services provided for people living with HIV in Botswana, 2022-2023. Health Promot Int 2024; 39:daae042. [PMID: 38742893 DOI: 10.1093/heapro/daae042] [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] [Indexed: 05/16/2024] Open
Abstract
People living with human immunodeficiency virus (PLHIV) have an increased risk of cancers. Currently, Botswana has no screening guidelines for common cancers in PLHIV except cervical cancer. Also, the proportion of PLHIV who are screened for cancer is unknown. This study aimed to evaluate cancer screening services for PLHIV receiving care in the human immunodeficiency virus (HIV) clinics. Resources for cancer screening were assessed and medical records of adults initiating antiretroviral therapy (ART) from 2020 to 2021 in 20 high-volume HIV clinics in Gaborone and Francistown were reviewed. Questionnaires assessing knowledge and practices of cancer screening were administered to health workers. The majority of clinics had the required resources for cancer screening (specifically cervical cancer). Of the 62 health workers working at the HIV clinics, 57 (91.9%) completed the questionnaire: 35 (62.5%) nurses and 22 (37.5%) doctors. Only 26.3% of the health workers were trained in cervical cancer screening. Doctors were more likely to report practicing routine screening of other cancers (e.g. breast) (p = 0.003) while more nurses reported assessing patients for cancer history during follow-up visits (p = 0.036). Most health workers did not perform physical examinations to detect cancer at initial or follow-up visits. Of the 1000 records of PLHIV reviewed, 57.3% were females, and only 38% of these were screened for cervical cancer. Besides cervical cancer, almost all (97.8%) were not screened for any cancer at ART initiation and during follow-up. These findings highlight the need to improve cancer screening services of PLHIV in Botswana through the training of health workers, and the development and enhanced use of screening guidelines.
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Affiliation(s)
- Anikie Mathoma
- Division of Research and Innovation, University of Botswana, Corner of Notwane and Mabuto Road, Plot 4775, Gaborone, Botswana
- Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, 236 George Campbell Building, King George V Avenue, Durban 4001, South Africa
| | - Benn Sartorius
- Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, 236 George Campbell Building, King George V Avenue, Durban 4001, South Africa
- Faculty of Medicine, UQ Centre for Clinical Research (UQCCR), University of Queensland, Brisbane, St Lucia QLD 4072, Australia
- Centre for Tropical Medicine and Global Health, University of Oxford, New Richards Building, Roosevelt Dr, Headington, Oxford OX3 7LG, UK
- Department of Health Metric Sciences, University of Washington, 3980 15th Ave NE, Seattle, WA 98195, USA
| | - Saajida Mahomed
- Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, 236 George Campbell Building, King George V Avenue, Durban 4001, South Africa
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2
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Friebel-Klingner TM, Bazzett-Matabele L, Ramogola-Masire D, Monare B, Ralefala TB, Seiphetlheng A, Ramontshonyana G, Vuylsteke P, Mitra N, Wiebe DJ, Rebbeck TR, McCarthy AM, Grover S. Distance to Multidisciplinary Team Clinic in Gaborone, Botswana, and Stage at Cervical Cancer Presentation for Women Living With and Without HIV. JCO Glob Oncol 2022; 8:e2200183. [PMID: 36395437 PMCID: PMC10166426 DOI: 10.1200/go.22.00183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/20/2022] [Accepted: 09/16/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Cervical cancer is the leading cause of cancer death for women in Botswana. Barriers in access to cancer care can lead to later stages at diagnosis and increased mortality. This study evaluated access, defined as travel time from a patient's residential village to a multidisciplinary team clinic in Gaborone, with stage of cervical cancer at presentation. In addition, because of the high HIV prevalence in Botswana, we explored the association between travel time and HIV status. METHODS Eligible patients with cervical cancer presenting to the multidisciplinary team between 2015 and 2020 were included. Data were abstracted from questionnaires and hospital records. Google Maps was used to calculate travel time. Multinomial regression was used to examine travel time and cancer stage, and multivariable logistic regression was used to investigate travel time and HIV status. RESULTS We identified 959 patients with cervical cancer of which 70.1% were women living with HIV. The median travel time was approximately 2 hours. Using a reference group of stage I disease and a travel time of < 1 hour, the odds of presenting with stage II increased for patients traveling 3-5 hours (adjusted odds ratio [OR], 2.00; 95% CI, 1.14 to 3.52) and > 5 hours (OR, 2.19; 95% CI, 1.15 to 4.19). There were no significant associations for stage III. For stage IV disease, the odds were increased for patients traveling 3-5 hours (OR, 2.93; 95% CI, 1.26 to 6.79) and > 5 hours (adjusted OR, 4.05; 95% CI, 1.62 to 10.10). In addition, the odds of patients presenting living with HIV increased with increasing travel time (trend test = 0.004). CONCLUSION This study identified two potential factors, travel time and HIV status, that influence access to comprehensive cervical cancer care in Botswana.
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Affiliation(s)
- Tara M. Friebel-Klingner
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | - Lisa Bazzett-Matabele
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT
| | - Doreen Ramogola-Masire
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Barati Monare
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | | | | | | | | | - Nandita Mitra
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Douglas J. Wiebe
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | - Timothy R. Rebbeck
- Dana-Farber Cancer Institute and Harvard TH Chan School of Public Health, Boston, MA
| | - Anne Marie McCarthy
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Surbhi Grover
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
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3
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McMahon DE, Chemtai L, Grant M, Singh R, Semeere A, Byakwaga H, Laker-Oketta M, Maurer T, Busakhala N, Martin J, Bassett IV, Butler L, Freeman EE. Understanding Diagnostic Delays for Kaposi Sarcoma in Kenya: A Qualitative Study. J Acquir Immune Defic Syndr 2022; 90:494-503. [PMID: 35499523 PMCID: PMC9283252 DOI: 10.1097/qai.0000000000003011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Although HIV-associated Kaposi sarcoma (KS) is frequently diagnosed at an advanced stage in sub-Saharan Africa, reasons for diagnostic delays have not been well described. METHODS We enrolled patients >18 years with newly diagnosed KS between 2016 and 2019 into the parent study, based in western Kenya. We then purposively selected 30 participants with diversity of disease severity and geographic locations to participate in semistructured interviews. We used 2 behavioral models in developing the codebook for this analysis: situated Information, Motivation, and Behavior framework and Andersen model of total patient delay. We then analyzed the interviews using framework analysis. RESULTS The most common patient factors that delayed diagnosis were lack of KS awareness, seeking traditional treatments, lack of personal efficacy, lack of social support, and fear of cancer, skin biopsy, amputation, and HIV diagnosis. Health system factors that delayed diagnosis included previous negative health care interactions, incorrect diagnoses, lack of physical examination, delayed referral, and lack of tissue biopsy availability. Financial constraints were prominent barriers for patients to access and receive care. Facilitators for diagnosis included being part of an HIV care network, living near health facilities, trust in the health care system, desire to treat painful or disfiguring lesions, and social support. CONCLUSIONS Lack of KS awareness among patients and providers, stigma surrounding diagnoses, and health system referral delays were barriers in reaching KS diagnosis. Improved public health campaigns, increased availability of biopsy and pathology facilities, and health provider training about KS are needed to improve early diagnosis of KS.
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Affiliation(s)
- Devon E McMahon
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | | | - Rhea Singh
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Virginia Commonwealth University School of Medicine, Richmond, VA
| | | | | | | | - Toby Maurer
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN
| | | | | | - Ingrid V Bassett
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Esther E Freeman
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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4
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Friebel-Klingner TM, Iyer HS, Ramogola-Masire D, Bazzett-Matabele L, Monare B, Seiphetlheng A, Ralefala TB, Mitra N, Wiebe DJ, Rebbeck TR, Grover S, McCarthy AM. Evaluating the geographic distribution of cervical cancer patients presenting to a multidisciplinary gynecologic oncology clinic in Gaborone, Botswana. PLoS One 2022; 17:e0271679. [PMID: 35925976 PMCID: PMC9352107 DOI: 10.1371/journal.pone.0271679] [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: 07/29/2021] [Accepted: 07/05/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE In Botswana, cervical cancer is the leading cause of cancer death for females. With limited resources, Botswana is challenged to ensure equitable access to advanced cancer care. Botswana's capital city, Gaborone, houses the only gynecologic oncology multi-disciplinary team (MDT) and the one chemoradiation facility in the country. We aimed to identify areas where fewer women were presenting to the MDT clinic for care. METHODS This cross-sectional study examined cervical cancer patients presenting to the MDT clinic between January 2015 and March 2020. Patients were geocoded to residential sub-districts to estimate age-standardized presentation rates. Global Moran's I and Anselin Local Moran's I tested the null hypothesis that presentation rates occurred randomly in Botswana. Community- and individual-level factors of patients living in sub-districts identified with higher (HH) and lower (LL) clusters of presentation rates were examined using ordinary least squares with a spatial weights matrix and multivariable logistic regression, respectively, with α level 0.05. RESULTS We studied 990 patients aged 22-95 (mean: 50.6). Presentation rates were found to be geographically clustered across the country (p = 0.01). Five sub-districts were identified as clusters, two high (HH) sub-district clusters and three low (LL) sub-district clusters (mean presentation rate: 35.5 and 11.3, respectively). Presentation rates decreased with increased travel distance (p = 0.033). Patients residing in LL sub-districts more often reported abnormal vaginal bleeding (aOR: 5.62, 95% CI: 1.31-24.15) compared to patients not residing in LL sub-districts. Patients in HH sub-districts were less likely to be living with HIV (aOR: 0.59; 95% CI: 0.38-0.90) and more likely to present with late-stage cancer (aOR: 1.78; 95%CI: 1.20-2.63) compared to patients not in HH sub-districts. CONCLUSIONS This study identified geographic clustering of cervical cancer patients presenting for care in Botswana and highlighted sub-districts with disproportionately lower presentation rates. Identified community- and individual level-factors associated with low presentation rates can inform strategies aimed at improving equitable access to cervical cancer care.
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Affiliation(s)
- Tara M. Friebel-Klingner
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | - Hari S. Iyer
- Dana-Farber Cancer Institute and Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Doreen Ramogola-Masire
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Department of Obstetrics and Gynecology, Yale University, New Haven, Connecticut, United States of America
| | - Lisa Bazzett-Matabele
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Department of Obstetrics and Gynecology, Yale University, New Haven, Connecticut, United States of America
| | - Barati Monare
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | | | | | - Nandita Mitra
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Douglas J. Wiebe
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | - Timothy R. Rebbeck
- Dana-Farber Cancer Institute and Harvard TH Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Surbhi Grover
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Anne Marie McCarthy
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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5
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Molebatsi K, Iyer HS, Kohler RE, Gabegwe K, Nkele I, Rabasha B, Botebele K, Barak T, Balosang S, Tapela NM, Dryden-Peterson SL. Improving identification of symptomatic cancer at primary care clinics: A predictive modeling analysis in Botswana. Int J Cancer 2022; 151:1663-1673. [PMID: 35716138 PMCID: PMC10286759 DOI: 10.1002/ijc.34178] [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: 11/16/2021] [Revised: 02/26/2022] [Accepted: 03/08/2022] [Indexed: 12/24/2022]
Abstract
In resource-limited settings, augmenting primary care provider (PCP)-based referrals with data-derived algorithms could direct scarce resources towards those patients most likely to have a cancer diagnosis and benefit from early treatment. Using data from Botswana, we compared accuracy of predictions of probable cancer using different approaches for identifying symptomatic cancer at primary clinics. We followed cancer suspects until they entered specialized care for cancer treatment (following pathologically confirmed diagnosis), exited from the study following noncancer diagnosis, or died. Routine symptom and demographic data included baseline cancer probability assessed by the primary care provider (low, intermediate, high), age, sex, performance status, baseline cancer probability by study physician, predominant symptom (lump, bleeding, pain or other) and HIV status. Logistic regression with 10-fold cross-validation was used to evaluate classification by different sets of predictors: (1) PCPs, (2) Algorithm-only, (3) External specialist physician review and (4) Primary clinician augmented by algorithm. Classification accuracy was assessed using c-statistics, sensitivity and specificity. Six hundred and twenty-three adult cancer suspects with complete data were retained, of whom 166 (27%) were diagnosed with cancer. Models using PCP augmented by algorithm (c-statistic: 77.2%, 95% CI: 73.4%, 81.0%) and external study physician assessment (77.6%, 95% CI: 73.6%, 81.7%) performed better than algorithm-only (74.9%, 95% CI: 71.0%, 78.9%) and PCP initial assessment (62.8%, 95% CI: 57.9%, 67.7%) in correctly classifying suspected cancer patients. Sensitivity and specificity statistics from models combining PCP classifications and routine data were comparable to physicians, suggesting that incorporating data-driven algorithms into referral systems could improve efficiency.
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Affiliation(s)
- Kesaobaka Molebatsi
- Department of Statistics, University of Botswana, Gaborone, Botswana.,Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Hari S Iyer
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Racquel E Kohler
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA.,Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Kemiso Gabegwe
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Isaac Nkele
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Bokang Rabasha
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | - Tomer Barak
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | | | - Neo M Tapela
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.,Nuffield Department of Population Health, Oxford University, Oxford, UK
| | - Scott L Dryden-Peterson
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Department of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Dare AJ, Knapp GC, Romanoff A, Olasehinde O, Famurewa OC, Komolafe AO, Olatoke S, Katung A, Alatise OI, Kingham TP. High-burden Cancers in Middle-income Countries: A Review of Prevention and Early Detection Strategies Targeting At-risk Populations. Cancer Prev Res (Phila) 2021; 14:1061-1074. [PMID: 34507972 DOI: 10.1158/1940-6207.capr-20-0571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/06/2021] [Accepted: 08/23/2021] [Indexed: 12/09/2022]
Abstract
Cancer incidence is rising in low- and especially middle-income countries (MIC), driven primarily by four high-burden cancers (breast, cervix, lung, colorectal). By 2030, more than two-thirds of all cancer deaths will occur in MICs. Prevention and early detection are required alongside efforts to improve access to cancer treatment. Successful strategies for decreasing cancer mortality in high-income countries are not always effective, feasible or affordable in other countries. In this review, we evaluate strategies for prevention and early detection of breast, cervix, lung, and colorectal cancers, focusing on modifiable risk factors and high-risk subpopulations. Tobacco taxation, human papilloma virus vaccination, cervical cancer screen-and-treat strategies, and efforts to reduce patient and health system-related delays in the early detection of breast and colorectal cancer represent the highest yield strategies for advancing cancer control in many MICs. An initial focus on high-risk populations is appropriate, with increasing population coverage as resources allow. These strategies can deliver significant cancer mortality gains, and serve as a foundation from which countries can develop comprehensive cancer control programs. Investment in national cancer surveillance infrastructure is needed; the absence of national cancer data to identify at-risk groups remains a barrier to the development of context-specific cancer control strategies.
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Affiliation(s)
- Anna J Dare
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York.,Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Gregory C Knapp
- Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Surgery, Division of General Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anya Romanoff
- Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York.,Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Akinwumi O Komolafe
- Department of Morbid Anatomy and Forensic Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Samuel Olatoke
- Department of Surgery, University of Ilorin, Ilorin, Nigeria
| | - Aba Katung
- Department of Surgery, Federal Medical College - Owo, Owo, Nigeria
| | | | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York. .,Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, New York
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McGinnis GJ, Ning MS, Bvochora-Nsingo M, Chiyapo S, Balang D, Ralefala T, Lin A, Zetola NM, Grover S. Management of Head and Neck Cancers With or Without Comorbid HIV Infection in Botswana. Laryngoscope 2021; 131:E1558-E1566. [PMID: 33098322 PMCID: PMC8046722 DOI: 10.1002/lary.29206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/24/2020] [Accepted: 10/13/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVES/HYPOTHESIS Head and neck cancer (HNC) is the fifth most common malignancy in sub-Saharan Africa, a region with hyperendemic human immunodeficiency virus (HIV)-infection. HIV patients have higher rates of HNC, yet the effect of HIV-infection on oncologic outcomes and treatment toxicity is poorly characterized. STUDY DESIGN Prospective observational cohort study. METHODS HNC patients attending a government-funded oncology clinic in Botswana were prospectively enrolled in an observational cohort registry from 2015 to 2019. Clinical characteristics were analyzed via Cox proportional hazards and logistic regression followed by secondary analysis by HIV-status. Overall survival (OS) was evaluated via Kaplan-Meier. RESULTS The study enrolled 149 patients with a median follow-up of 23 months. Patients presented with advanced disease (60% with T4-primaries), received limited treatment (19% chemotherapy, 8% surgery, 29% definitive radiation [RT]), and had delayed care (median time from diagnosis to RT of 2.5 months). Median OS was 36.2 months. Anemia was associated with worse survival (HR 2.74, P = .001). Grade ≥ 3 toxicity rate with RT was 30% and associated with mucosal subsite (OR 4.04, P = .03) and BMI < 20 kg/m2 (OR 6.04, P = .012). Forty percent of patients (n = 59) were HIV-infected; most (85%) were on antiretroviral therapy, had suppressed viral loads (90% with ≤400 copies/mL), and had immunocompetent CD4 counts (median 400 cells/mm3 ). HIV-status was not associated with decreased receipt or delays of definitive RT, worse survival, or increased toxicity. CONCLUSIONS Despite access to government-funded care, HNC patients in Botswana present late and have delays in care, which likely contributes to suboptimal survival outcomes. While a disproportionate number has comorbid HIV infection, HIV-status does not adversely affect outcomes. LEVEL OF EVIDENCE 2c Laryngoscope, 131:E1558-E1566, 2021.
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Affiliation(s)
- Gwendolyn J McGinnis
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Matthew S Ning
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, U.S.A
| | | | - Sebathu Chiyapo
- Department of Oncology, Gaborone Private Hospital, Gaborone, Botswana
| | - Dawn Balang
- Department of Oncology, Gaborone Private Hospital, Gaborone, Botswana
| | - Tlotlo Ralefala
- School of Medicine, University of Botswana, Gaborone, Botswana
- Princess Marina Hospital, Gaborone, Botswana
| | - Alexander Lin
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Nicola M Zetola
- School of Medicine, University of Botswana, Gaborone, Botswana
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Surbhi Grover
- School of Medicine, University of Botswana, Gaborone, Botswana
- Princess Marina Hospital, Gaborone, Botswana
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Botswana University of Pennsylvania Partnership, Gaborone, Botswana
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8
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Dykstra M, Malone B, Lekuntwane O, Efstathiou J, Letsatsi V, Elmore S, Castro C, Tapela N, Dryden-Peterson S. Impact of Community-Based Clinical Breast Examinations in Botswana. JCO Glob Oncol 2021; 7:17-26. [PMID: 33405960 PMCID: PMC8081526 DOI: 10.1200/go.20.00231] [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: 12/15/2022] Open
Abstract
PURPOSE We evaluated a clinical breast examination (CBE) screening program to determine the prevalence of breast abnormalities, number examined per cancer diagnosis, and clinical resources required for these diagnoses in a middle-income African setting. METHODS We performed a retrospective review of a CBE screening program (2015-2018) by Journey of Hope Botswana, a Botswana-based nongovernmental organization (NGO). Symptomatic and asymptomatic women were invited to attend. Screening events were held in communities throughout rural and periurban Botswana, with CBEs performed by volunteer nurses. Individuals who screened positive were referred to a private tertiary facility and were followed by the NGO. Data were obtained from NGO records. RESULTS Of 6,120 screened women (50 men excluded), 452 (7.4%) presented with a symptom and 357 (5.83%) were referred for further evaluation; 257 ultrasounds, 100 fine-needle aspirations (FNAs), 58 mammograms, and 31 biopsies were performed. In total, 6,031 were exonerated from cancer, 78 were lost to follow-up (67 for ≤ 50 years and 11 for > 50 years), and 11 were diagnosed with cancer (five for 41-50 years and six for > 50 years, 10 presented with symptoms). Overall breast cancer prevalence was calculated to be 18/10,000 (95% CI, 8 to 29/10,000). The number of women examined per breast cancer diagnosis was 237 (95% CI, 126 to 1910) for women of age 41-50 years and 196 (95% CI, 109 to 977) for women of age > 50 years. Median time to diagnosis for all women was 17.5 [1 to 32.5] days. CBE-detected tumors were not different than tumors presenting through standard care. CONCLUSION In a previously unscreened population, yield from community-based CBE screening was high, particularly among symptomatic women, and required modest diagnostic resources. This strategy has potential to reduce breast cancer mortality.
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Affiliation(s)
- Michael Dykstra
- Beth Israel Deaconess Medical Center, Boston, MA.,Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Brighid Malone
- Bokamoso Private Hospital, Gaborone, Botswana.,Journey of Hope Botswana, Gaborone, Botswana
| | | | | | | | - Shekinah Elmore
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | | | - Neo Tapela
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.,University of Oxford, Oxford, UK
| | - Scott Dryden-Peterson
- Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana.,Brigham and Women's Hospital, Boston, MA.,Harvard School of Public Health, Boston, MA
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9
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McGee-Avila JK, Doose M, Nova J, Kumar R, Stroup AM, Tsui J. Patterns of HIV testing among women diagnosed with invasive cervical cancer in the New Jersey Medicaid Program. Cancer Causes Control 2020; 31:931-941. [PMID: 32803402 DOI: 10.1007/s10552-020-01333-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/04/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Practice-based guidelines recommend HIV testing during initial invasive cervical cancer (ICC) workup. Determinants of HIV testing during diagnosis of AIDS-defining cancers in vulnerable populations, where risk for HIV infection is higher, are under-explored. METHODS We examine factors associated with patterns of HIV testing among Medicaid enrollees diagnosed with ICC. Using linked data from the New Jersey State Cancer Registry and New Jersey Medicaid claims and enrollment files, we evaluated HIV testing among 242 ICC cases diagnosed from 2012 to 2014 in ages 21-64 at (a) any point during Medicaid enrollment (2011-2014) and (b) during cancer workup 6 months pre ICC diagnosis to 6 months post ICC diagnosis. Logistic regression models identified factors associated with HIV testing. RESULTS Overall, 13% of women had a claim for HIV testing during ICC workup. Two-thirds (68%) of women did not have a claim for HIV testing (non-receipt of HIV testing) while enrolled in Medicaid. Hispanic/NH-API/Other women had lower odds of non-receipt of HIV testing compared with NH-Whites (OR: 0.40; 95% CI: 0.17-0.94). Higher odds of non-receipt of HIV testing were observed among cases with no STI testing (OR: 4.92; 95% CI 2.27-10.67) and < 1 year of Medicaid enrollment (OR: 3.07; 95% CI 1.14- 8.26) after adjusting for other factors. CONCLUSIONS Few women had HIV testing claims during ICC workup. Opportunities for optimal ICC care are informed by knowledge of HIV status. Further research should explore if lack of HIV testing claims during ICC workup is an accurate indicator of ICC care, and if so, to assess testing barriers during workup.
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Affiliation(s)
- Jennifer K McGee-Avila
- School of Nursing, Rutgers, The State University of New Jersey, Newark, NJ, USA
- François-Xavier Bagnoud Center, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Michelle Doose
- School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
- Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Jose Nova
- Center for State Health Policy, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Rizie Kumar
- Department of Sociology, University of Maryland, College Park, College Park, MD, USA
| | - Antoinette M Stroup
- School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
- Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
- New Jersey State Cancer Registry, New Jersey Department of Health, Trenton, NJ, USA
| | - Jennifer Tsui
- School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ, USA.
- Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA.
- Center for State Health Policy, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA.
- Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA.
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10
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Min J, Chin LK, Oh J, Landeros C, Vinegoni C, Lee J, Lee SJ, Park JY, Liu AQ, Castro CM, Lee H, Im H, Weissleder R. CytoPAN-Portable cellular analyses for rapid point-of-care cancer diagnosis. Sci Transl Med 2020; 12:eaaz9746. [PMID: 32759277 PMCID: PMC8217912 DOI: 10.1126/scitranslmed.aaz9746] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/06/2020] [Accepted: 06/19/2020] [Indexed: 12/18/2022]
Abstract
Rapid, automated, point-of-care cellular diagnosis of cancer remains difficult in remote settings due to lack of specialists and medical infrastructure. To address the need for same-day diagnosis, we developed an automated image cytometry system (CytoPAN) that allows rapid breast cancer diagnosis of scant cellular specimens obtained by fine needle aspiration (FNA) of palpable mass lesions. The system is devoid of moving parts for stable operations, harnesses optimized antibody kits for multiplexed analysis, and offers a user-friendly interface with automated analysis for rapid diagnoses. Through extensive optimization and validation using cell lines and mouse models, we established breast cancer diagnosis and receptor subtyping in 1 hour using as few as 50 harvested cells. In a prospective patient cohort study (n = 68), we showed that the diagnostic accuracy was 100% for cancer detection and the receptor subtyping accuracy was 96% for human epidermal growth factor receptor 2 and 93% for hormonal receptors (ER/PR), two key biomarkers associated with breast cancer. A combination of FNA and CytoPAN offers faster, less invasive cancer diagnoses than the current standard (core biopsy and histopathology). This approach should enable the ability to more rapidly diagnose breast cancer in global and remote settings.
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Affiliation(s)
- Jouha Min
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Lip Ket Chin
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114, USA
- School of Electrical and Electronic Engineering, Nanyang Technological University, Singapore 639798, Singapore
| | - Juhyun Oh
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Christian Landeros
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard-MIT Program in Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Claudio Vinegoni
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Jeeyeon Lee
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
| | - Soo Jung Lee
- Department of Oncology/Hematology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
| | - Jee Young Park
- Department of Pathology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
| | - Ai-Qun Liu
- School of Electrical and Electronic Engineering, Nanyang Technological University, Singapore 639798, Singapore
| | - Cesar M Castro
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114, USA
- Cancer Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Hakho Lee
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114, USA.
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Hyungsoon Im
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114, USA.
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Ralph Weissleder
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114, USA.
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Systems Biology, Harvard Medical School, Boston, MA 02115, USA
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11
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Lin LL, Lakomy DS, Chiao EY, Strother RM, Wirth M, Cesarman E, Borok M, Busakhala N, Chibwesha CJ, Chinula L, Ndlovu N, Orem J, Phipps W, Sewram V, Vogt SL, Sparano JA, Mitsuyasu RT, Krown SE, Gopal S. Clinical Trials for Treatment and Prevention of HIV-Associated Malignancies in Sub-Saharan Africa: Building Capacity and Overcoming Barriers. JCO Glob Oncol 2020; 6:1134-1146. [PMID: 32697667 PMCID: PMC7392698 DOI: 10.1200/go.20.00153] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The aim of this study was to review the current status of clinical trials for HIV-associated malignancies in people living with HIV in sub-Saharan Africa (SSA) and efforts made by the AIDS Malignancy Consortium (AMC) to build capacity in SSA for HIV malignancy research. METHODS All malignancy-related clinical trials in 49 SSA countries on ClinicalTrials.gov were reviewed and evaluated for inclusion and exclusion criteria pertaining to HIV status. Additional studies by AMC in SSA were compiled from Web-based resources, and narrative summaries were prepared to highlight AMC capacity building and training initiatives. RESULTS Of 96 cancer trials identified in SSA, only 11 focused specifically on people living with HIV, including studies in Kaposi sarcoma, cervical dysplasia and cancer, non-Hodgkin lymphoma, and ocular surface squamous neoplasia. Recognizing the increasing cancer burden in the region, AMC expanded its clinical trial activities to SSA in 2010, with 4 trials completed to date and 6 others in progress or development, and has made ongoing investments in developing research infrastructure in the region. CONCLUSION As the HIV-associated malignancy burden in SSA evolves, research into this domain has been limited. AMC, the only global HIV malignancy-focused research consortium, not only conducts vital HIV-associated malignancies research in SSA, but also develops pathology, personnel, and community-based infrastructure to meet these challenges in SSA. Nonetheless, there is an ongoing need to build on these efforts to improve HIV-associated malignancies outcomes in SSA.
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Affiliation(s)
- Lilie L. Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David S. Lakomy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Dartmouth Geisel School of Medicine, Hanover, NH
| | - Elizabeth Y. Chiao
- Department of General Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Ethel Cesarman
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY
| | - Margaret Borok
- Department of Medicine, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Naftali Busakhala
- Department of Pharmacology and Toxicology, Moi University School of Medicine, Eldoret, Kenya
| | - Carla J. Chibwesha
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC
- Clinical HIV Research Unit, Department of Medicine, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
- Division of Global Women’s Health, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Lameck Chinula
- Division of Global Women’s Health, Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC
- UNC Project-Malawi, Lilongwe, Malawi
| | - Ntokozo Ndlovu
- Department of Radiology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | | | - Warren Phipps
- Uganda Cancer Institute, Kampala, Uganda
- Department of Medicine, University of Washington, Seattle, WA
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Vikash Sewram
- African Cancer Institute, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Samantha L. Vogt
- Department of Medical Oncology, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Joseph A. Sparano
- Montefiore-Einstein Cancer Center, Montefiore Medical Center, Bronx, NY
| | - Ronald T. Mitsuyasu
- Center for Clinical AIDS Research and Education, University of California, Los Angeles, Los Angeles, CA
| | | | - Satish Gopal
- Center for Global Health, National Cancer Institute, Rockville, MD
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12
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Freeman EE, Busakhala N, Regan S, Asirwa FC, Wenger M, Seth D, Moon KC, Semeere A, Maurer T, Wools-Kaloustian K, Bassett I, Martin J. Real-world use of chemotherapy for Kaposi's sarcoma in a large community-based HIV primary care system in Kenya. BMC Cancer 2020; 20:71. [PMID: 31996161 PMCID: PMC6990575 DOI: 10.1186/s12885-019-6506-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 12/30/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Kaposi's sarcoma (KS) is one of the most common HIV-associated malignancies in sub-Saharan Africa. Worldwide, the availability of antiretroviral therapy (ART) has improved KS survival. In resource-rich settings, survival has also benefited from chemotherapy, which is widely available. Little is known, however, about the epidemiology of chemotherapy use for HIV-associated KS in resource-limited regions such as sub-Saharan Africa. METHODS We identified all patients newly diagnosed with HIV-related KS from 2009 to 2012 in the 26-clinic AMPATH network, a large community-based care network in Kenya. We ascertained disease severity at diagnosis, frequency of initiation of chemotherapy, and distribution of chemotherapeutic regimens used. Indications for chemotherapy included AIDS Clinical Trial Group T1 stage and/or "severe" disease defined by WHO KS treatment guidelines. RESULTS Of 674 patients diagnosed with KS, charts were available for 588; 61% were men, median age was 35 years, and median CD4 at KS diagnosis was 185 cells/μl. At time of diagnosis, 58% had at least one chemotherapy indication, and 22% had more than one indication. For patients with a chemotherapy indication, cumulative incidence of chemotherapy initiation (with death as a competing event) was 37% by 1 month and 56% by 1 year. Median time from diagnosis to chemotherapy initiation was 25 days (IQR 1-50 days). In multivariable regression, patients with > 3 chemotherapy indications at time of diagnosis had a 2.30 (95% CI 1.46-3.60) increased risk of rapid chemotherapy initiation (within 30 days of diagnosis) compared to those with only one chemotherapy indication (p < 0.001). Initial regimens were bleomycin-vincristine (78%), adriamycin-bleomycin-vincristine (11%), etoposide (7%), and gemcitabine (4%). CONCLUSIONS A substantial fraction of patients with KS in East Africa are diagnosed at advanced disease stage. For patients with chemotherapy indications, nearly half did not receive chemotherapy by one year. Liposomal anthracyclines, often used in resource-rich settings, were not first line. These findings emphasize challenges in East Africa cancer care, and highlight the need for further advocacy for improved access to higher quality chemotherapy in this setting.
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Affiliation(s)
- Esther E Freeman
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Bartlett Hall 6R, 55 Fruit Street, Boston MA, MA, 02114, USA.
| | | | - Susan Regan
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Bartlett Hall 6R, 55 Fruit Street, Boston MA, MA, 02114, USA
| | - Fredrick Chite Asirwa
- AMPATH, Moi University, Eldoret, Kenya
- Indiana University, Indianapolis, Indiana, USA
| | | | - Divya Seth
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Bartlett Hall 6R, 55 Fruit Street, Boston MA, MA, 02114, USA
| | - Khatiya Chelidze Moon
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Bartlett Hall 6R, 55 Fruit Street, Boston MA, MA, 02114, USA
| | - Aggrey Semeere
- University of California, San Francisco, USA
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Toby Maurer
- University of California, San Francisco, USA
| | | | - Ingrid Bassett
- Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Bartlett Hall 6R, 55 Fruit Street, Boston MA, MA, 02114, USA
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13
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Bhatia RK, Narasimhamurthy M, Martei YM, Prabhakar P, Hutson J, Chiyapo S, Makozhombwe I, Feldman M, Kayembe MKA, Cooper K, Grover S. Report of clinico-pathological features of breast cancer in HIV-infected and uninfected women in Botswana. Infect Agent Cancer 2019; 14:28. [PMID: 31649747 PMCID: PMC6805363 DOI: 10.1186/s13027-019-0245-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 09/12/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND To characterize the clinico-pathological features including estrogen receptor (ER), progesterone receptor (PR) and Her-2/neu (HER2) expression in breast cancers in Botswana, and to compare them by HIV status. METHODS This was a retrospective study using data from the National Health Laboratory and Diagnofirm Medical Laboratory in Gaborone from January 1, 2011 to December 31, 2015. Clinico-pathological details of patients were abstracted from electronic medical records. RESULTS A total of 384 unique breast cancer reports met our inclusion criteria. Of the patients with known HIV status, 42.7% (50/117) were HIV-infected. Median age at the time of breast cancer diagnosis was 54 years (IQR 44-66 years). HIV-infected individuals were more likely to be diagnosed before age 50 years compared to HIV-uninfected individuals (68.2% vs 23.8%, p < 0.001). The majority of patients (68.6%, 35/51) presented with stage III at diagnosis. Stage IV disease was not presented because of the lack of data in pathology records surveyed, and additionally these patients may not present to clinic if the disease is advanced. Overall, 68.9% (151/219) of tumors were ER+ or PR+ and 16.0% (35/219) were HER2+. ER+ or PR+ or both, and HER2- was the most prevalent profile (62.6%, 132/211), followed by triple negative (ER-/PR-/HER2-, 21.3%, 45/211), ER+ or PR+ or both, and HER2+, (9.0%, 19/211) and ER-/PR-/HER2+ (7.1%, 15/211). There was no significant difference in receptor status noted between HIV-infected and HIV-uninfected individuals. CONCLUSIONS Majority of breast cancer patients in Botswana present with advanced disease (stage III) at diagnosis and hormone receptor positive disease. HIV-infected breast cancer patients tended to present at a younger age compared to HIV-uninfected patients. HIV status does not appear to be associated with the distribution of receptor status in breast cancers in Botswana.
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Affiliation(s)
- Rohini K. Bhatia
- University of Rochester School of Medicine and Dentistry, Rochester, NY USA
| | - Mohan Narasimhamurthy
- Department of Pathology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Yehoda M. Martei
- Division of Hematology – Oncology, University of Pennsylvania, Philadelphia, PA USA
| | - Pooja Prabhakar
- University of Texas Southwestern Medical Center, TX, Dallas, USA
| | - Jeré Hutson
- University of Pennsylvania, Philadelphia, PA USA
| | | | | | - Michael Feldman
- Department of Pathology, University of Pennsylvania, Philadelphia, PA USA
| | | | - Kum Cooper
- Department of Pathology, University of Pennsylvania, Philadelphia, PA USA
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104 USA
- Princess Marina Hospital, Gaborone, Botswana
- Botswana University of Pennsylvania Partnership, Gaborone, Botswana
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14
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Deliana M, Suza DE, Tarigan R. Advanced Stage Cancer Patients Experience in Seeking Treatment in Medan, Indonesia. Open Access Maced J Med Sci 2019; 7:2194-2203. [PMID: 31456851 PMCID: PMC6698112 DOI: 10.3889/oamjms.2019.590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Proper treatment of cancer can make it easier for the healing process. Delay in patients seeking treatment is a problem that often occurs today. Handling of complementary and alternative therapies, which is not appropriate is one of the causes of delay in seeking treatment, which worsens the patient's condition. Patients usually come to health services already diagnosed with advanced cancer. AIM The purpose of this study is to explore the experience of advanced cancer patients in seeking treatment. METHODS This study is qualitative research with descriptive phenomenology approach. Participants in this study were 15 advanced cancer patients who were treated in the chemotherapy room at Adam Malik General Hospital Medan and Murni Teguh Hospital using purposive sampling technique. Data collection was done with in-depth interviews. All interviews were first recorded and then transcribed. This study was analysed using the Colaizzi approach method. RESULTS The six main themes indicated that advanced-stage cancer patients for seeking treatment. Themes such as 1) choose the complementary and alternative treatment rather than medical treatment, 2) seek medical treatment as a final decision, 3) integrating complementary treatment as supportive therapy in addition to medical treatment, 4) external sources influence patient decisions, 5) reduce negative feelings by surrendering to God, and 6) lack of involvement of basic health services. CONCLUSION Advanced cancer patients have experience using complementary and alternative therapies, which are not appropriate before using a medical treatment on the grounds of distrust of medical treatment and advice from the environment around patients. The importance of nurses in providing appropriate education related to complementary and alternative treatment to cancer patients according to the stage of the disease.
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Affiliation(s)
- Muthia Deliana
- Master Student of Medical-Surgical Nursing, Universitas Sumatra Utara, Medan, Indonesia
| | - Dewi Elizadiani Suza
- Faculty of Nursing, Universitas Sumatera Utara, Jl. Prof. T. Ma’as No 3, Kampus USU, Medan, Indonesia
| | - Rosina Tarigan
- Faculty of Nursing, Universitas Sumatera Utara, Jl. Prof. T. Ma’as No 3, Kampus USU, Medan, Indonesia
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15
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Iyer HS, Kohler RE, Ramogola-Masire D, Brown C, Molebatsi K, Grover S, Kablay I, Bvochora-Nsingo M, Efstathiou JA, Lockman S, Tapela N, Dryden-Peterson SL. Explaining disparities in oncology health systems delays and stage at diagnosis between men and women in Botswana: A cohort study. PLoS One 2019; 14:e0218094. [PMID: 31170274 PMCID: PMC6553768 DOI: 10.1371/journal.pone.0218094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 05/24/2019] [Indexed: 01/04/2023] Open
Abstract
Purpose Men in Botswana present with more advanced cancer than women, leading to poorer outcomes. We sought to explain sex-specific differences in time to and stage at treatment initiation. Methods Cancer patients who initiated oncology treatment between October 2010 and June 2017 were recruited at four oncology centers in Botswana. Primary outcomes were time from first visit with cancer symptom to treatment initiation, and advanced cancer (stage III/IV). Sociodemographic and clinical covariates were obtained retrospectively through interviews and medical record review. We used accelerated failure time and logistic models to estimate standardized sex differences in treatment initiation time and risk differences for presentation with advanced stage. Results were stratified by cancer type (breast, cervix, non-Hodgkin’s lymphoma, anogenital, head and neck, esophageal, other). Results 1886 participants (70% female) were included. After covariate adjustment, men experienced longer excess time from first presentation to treatment initiation (8.4 months) than women (7.0 months) for all cancers combined (1.4 months, 95% CI: 0.30, 2.5). In analysis stratified by cancer type, we only found evidence of a sex disparity (Men: 8.2; Women: 6.8 months) among patients with other, non-common cancers (1.4 months, 95% CI: 0.01, 2.8). Men experienced an increased risk of advanced stage (Men: 67%; Women: 60%; aRD: 6.7%, 95% CI: -1.7%, 15.1%) for all cancers combined, but this disparity was only statistically significant among patients with anogenital cancers (Men: 72%; Women: 50%; aRD: 22.0%, 95% CI: 0.5%, 43.5%). Conclusions Accounting for the types of cancers experienced by men and women strongly attenuated disparities in time to treatment initiation and stage. Higher incidence of rarer cancers among men could explain these disparities.
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Affiliation(s)
- Hari S. Iyer
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Racquel E. Kohler
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Dana-Farber Cancer Institute, Boston, Massachusetts, United States of America
| | - Doreen Ramogola-Masire
- Botswana University of Pennsylvania Partnership, Gaborone, Botswana
- School of Medicine, University of Botswana, Gaborone, Botswana
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Carolyn Brown
- Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA, United States of America
| | | | - Surbhi Grover
- Botswana University of Pennsylvania Partnership, Gaborone, Botswana
- School of Medicine, University of Botswana, Gaborone, Botswana
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Princess Marina Hospital, Gaborone, Botswana
| | | | | | - Jason A. Efstathiou
- Dana-Farber Cancer Institute, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Shahin Lockman
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Botswana Ministry of Health and Wellness, Gaborone, Botswana
| | - Neo Tapela
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Botswana Ministry of Health and Wellness, Gaborone, Botswana
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Scott L. Dryden-Peterson
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
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16
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Anakwenze C, Bhatia R, Rate W, Bakwenabatsile L, Ngoni K, Rayne S, Dhillon P, Narasimhamurthy M, Ho-Foster A, Ramogola-Masire D, Grover S. Factors Related to Advanced Stage of Cancer Presentation in Botswana. J Glob Oncol 2019; 4:1-9. [PMID: 30532993 PMCID: PMC6818282 DOI: 10.1200/jgo.18.00129] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Botswana, a country with a high prevalence of HIV, has an increasing
incidence of cancer-related mortality in the post–antiretroviral
therapy era. Despite universal access to free health care, the majority of
Botswana patients with cancer present at advanced stages. This study was
designed to explore the factors related to advanced-stage cancer
presentation in Botswana. Methods Patients attending an oncology clinic between December 2015 and January 2017
at Princess Marina Hospital in Gaborone, Botswana, completed a questionnaire
on sociodemographic and clinical factors as well as cancer-related fears,
attitudes, beliefs, and stigma. Odds ratios (ORs) were calculated to
identify factors significantly associated with advanced stage (stage III and
IV) at diagnosis. Results Of 214 patients, 18.7% were men and 81.3% were women. The median age at
diagnosis was 46 years, with 71.9% of patients older than 40 years. The most
commonly represented cancers included cervical (42.3%), breast (16%), and
head and neck (15.5%). Cancer stages represented in the study group included
8.4% at stage I, 19.2% at stage II, 24.1% at stage III, 11.9% at stage IV,
and 36.4% at an unknown stage. Patients who presented at advanced stages
were significantly more likely to not be afraid of having cancer (OR, 3.48;
P < .05), believe that their family would not care
for them if they needed treatment (OR, 6.35; P = .05), and
believe that they could not afford to develop cancer (OR, 2.73;
P < .05). The perception that symptoms were less
serious was also significantly related to advanced stage (P
< .05). Patients with non–female-specific cancers were more likely
to present in advanced stages (OR, 5.67; P < .05). Conclusion Future cancer mortality reduction efforts should emphasize cancer symptom
awareness and early detection through routine cancer screening, as well as
increasing the acceptability of care-seeking, especially among male
patients.
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Affiliation(s)
- Chidinma Anakwenze
- Chidinma Anakwenze, MD Anderson Cancer Center, Houston, TX; Rohini Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile, Ari Ho-Foster, and Surbhi Grover, Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Philadelphia, PA; Kebatshabile Ngoni, Mohan Narasimhamurthy, and Doreen Ramogola-Masire, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; Preet Dhillon, Public Health Foundation of India, Gurgaon, Haryana, India; and Ari Ho-Foster, Doreen Ramogola-Masire and Surbhi Grover, University of Pennsylvania, Philadelphia, PA
| | - Rohini Bhatia
- Chidinma Anakwenze, MD Anderson Cancer Center, Houston, TX; Rohini Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile, Ari Ho-Foster, and Surbhi Grover, Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Philadelphia, PA; Kebatshabile Ngoni, Mohan Narasimhamurthy, and Doreen Ramogola-Masire, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; Preet Dhillon, Public Health Foundation of India, Gurgaon, Haryana, India; and Ari Ho-Foster, Doreen Ramogola-Masire and Surbhi Grover, University of Pennsylvania, Philadelphia, PA
| | - William Rate
- Chidinma Anakwenze, MD Anderson Cancer Center, Houston, TX; Rohini Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile, Ari Ho-Foster, and Surbhi Grover, Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Philadelphia, PA; Kebatshabile Ngoni, Mohan Narasimhamurthy, and Doreen Ramogola-Masire, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; Preet Dhillon, Public Health Foundation of India, Gurgaon, Haryana, India; and Ari Ho-Foster, Doreen Ramogola-Masire and Surbhi Grover, University of Pennsylvania, Philadelphia, PA
| | - Lame Bakwenabatsile
- Chidinma Anakwenze, MD Anderson Cancer Center, Houston, TX; Rohini Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile, Ari Ho-Foster, and Surbhi Grover, Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Philadelphia, PA; Kebatshabile Ngoni, Mohan Narasimhamurthy, and Doreen Ramogola-Masire, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; Preet Dhillon, Public Health Foundation of India, Gurgaon, Haryana, India; and Ari Ho-Foster, Doreen Ramogola-Masire and Surbhi Grover, University of Pennsylvania, Philadelphia, PA
| | - Kebatshabile Ngoni
- Chidinma Anakwenze, MD Anderson Cancer Center, Houston, TX; Rohini Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile, Ari Ho-Foster, and Surbhi Grover, Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Philadelphia, PA; Kebatshabile Ngoni, Mohan Narasimhamurthy, and Doreen Ramogola-Masire, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; Preet Dhillon, Public Health Foundation of India, Gurgaon, Haryana, India; and Ari Ho-Foster, Doreen Ramogola-Masire and Surbhi Grover, University of Pennsylvania, Philadelphia, PA
| | - Sarah Rayne
- Chidinma Anakwenze, MD Anderson Cancer Center, Houston, TX; Rohini Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile, Ari Ho-Foster, and Surbhi Grover, Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Philadelphia, PA; Kebatshabile Ngoni, Mohan Narasimhamurthy, and Doreen Ramogola-Masire, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; Preet Dhillon, Public Health Foundation of India, Gurgaon, Haryana, India; and Ari Ho-Foster, Doreen Ramogola-Masire and Surbhi Grover, University of Pennsylvania, Philadelphia, PA
| | - Preet Dhillon
- Chidinma Anakwenze, MD Anderson Cancer Center, Houston, TX; Rohini Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile, Ari Ho-Foster, and Surbhi Grover, Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Philadelphia, PA; Kebatshabile Ngoni, Mohan Narasimhamurthy, and Doreen Ramogola-Masire, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; Preet Dhillon, Public Health Foundation of India, Gurgaon, Haryana, India; and Ari Ho-Foster, Doreen Ramogola-Masire and Surbhi Grover, University of Pennsylvania, Philadelphia, PA
| | - Mohan Narasimhamurthy
- Chidinma Anakwenze, MD Anderson Cancer Center, Houston, TX; Rohini Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile, Ari Ho-Foster, and Surbhi Grover, Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Philadelphia, PA; Kebatshabile Ngoni, Mohan Narasimhamurthy, and Doreen Ramogola-Masire, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; Preet Dhillon, Public Health Foundation of India, Gurgaon, Haryana, India; and Ari Ho-Foster, Doreen Ramogola-Masire and Surbhi Grover, University of Pennsylvania, Philadelphia, PA
| | - Ari Ho-Foster
- Chidinma Anakwenze, MD Anderson Cancer Center, Houston, TX; Rohini Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile, Ari Ho-Foster, and Surbhi Grover, Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Philadelphia, PA; Kebatshabile Ngoni, Mohan Narasimhamurthy, and Doreen Ramogola-Masire, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; Preet Dhillon, Public Health Foundation of India, Gurgaon, Haryana, India; and Ari Ho-Foster, Doreen Ramogola-Masire and Surbhi Grover, University of Pennsylvania, Philadelphia, PA
| | - Doreen Ramogola-Masire
- Chidinma Anakwenze, MD Anderson Cancer Center, Houston, TX; Rohini Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile, Ari Ho-Foster, and Surbhi Grover, Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Philadelphia, PA; Kebatshabile Ngoni, Mohan Narasimhamurthy, and Doreen Ramogola-Masire, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; Preet Dhillon, Public Health Foundation of India, Gurgaon, Haryana, India; and Ari Ho-Foster, Doreen Ramogola-Masire and Surbhi Grover, University of Pennsylvania, Philadelphia, PA
| | - Surbhi Grover
- Chidinma Anakwenze, MD Anderson Cancer Center, Houston, TX; Rohini Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile, Ari Ho-Foster, and Surbhi Grover, Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Philadelphia, PA; Kebatshabile Ngoni, Mohan Narasimhamurthy, and Doreen Ramogola-Masire, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; Preet Dhillon, Public Health Foundation of India, Gurgaon, Haryana, India; and Ari Ho-Foster, Doreen Ramogola-Masire and Surbhi Grover, University of Pennsylvania, Philadelphia, PA
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17
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Low DH, Phipps W, Orem J, Casper C, Bender Ignacio RA. Engagement in HIV Care and Access to Cancer Treatment Among Patients With HIV-Associated Malignancies in Uganda. J Glob Oncol 2019; 5:1-8. [PMID: 30763144 PMCID: PMC6426497 DOI: 10.1200/jgo.18.00187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Health system constraints limit access to HIV and cancer treatment programs in sub-Saharan Africa. Limited access and continuity of care affect morbidity and mortality of patients with cancer and HIV. We assessed barriers in the care cascade of comorbid HIV and cancer. PATIENTS AND METHODS Structured interviews were conducted with 100 adult patients with HIV infection and new diagnoses of cancer at the Uganda Cancer Institute. Participants completed follow-up questionnaires after 1 year to assess ongoing engagement with and barriers to care. RESULTS The median time from new-onset cancer symptoms to initiation of cancer care at the Uganda Cancer Institute was 209 days (interquartile range, 113 to 384 days). Persons previously established in HIV care waited less overall to initiate cancer care ( P = .04). Patients established in HIV care experienced shorter times from initial symptoms to seeking of cancer care ( P = .02) and from seeking of care to cancer diagnosis ( P = .048). Barriers to receiving care for HIV and cancer included difficulty traveling to multiple clinics/hospitals (46%), conflicts between HIV and cancer appointments (23%), prohibitive costs (21%), and difficulty adhering to medications (15%). Reporting of any barriers to care was associated with premature discontinuation of cancer treatment ( P = .003). CONCLUSION Patients with HIV-associated malignancies reported multiple barriers to receiving care for both conditions, although knowledge of HIV status and engagement in HIV care before presentation with malignancy reduced subsequent time to the start of cancer treatment. This study provides evidence to support creation and evaluation of integrated HIV and cancer care models.
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Affiliation(s)
- Daniel H. Low
- Swedish Family Medicine Residency at Cherry Hill, Seattle, WA
- University of Washington School of Medicine, Seattle, WA
| | - Warren Phipps
- University of Washington School of Medicine, Seattle, WA
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Jackson Orem
- Fred Hutchinson Cancer Research Center, Seattle, WA
- Uganda Cancer Institute, Kampala, Uganda
| | - Corey Casper
- Fred Hutchinson Cancer Research Center, Seattle, WA
- Infectious Diseases Research Institute, Seattle, WA
| | - Rachel A Bender Ignacio
- University of Washington School of Medicine, Seattle, WA
- Fred Hutchinson Cancer Research Center, Seattle, WA
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18
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Im H, Pathania D, McFarland PJ, Sohani AR, Degani I, Allen M, Coble B, Kilcoyne A, Hong S, Rohrer L, Abramson JS, Dryden-Peterson S, Fexon L, Pivovarov M, Chabner B, Lee H, Castro CM, Weissleder R. Design and clinical validation of a point-of-care device for the diagnosis of lymphoma via contrast-enhanced microholography and machine learning. Nat Biomed Eng 2018; 2:666-674. [PMID: 30555750 PMCID: PMC6291220 DOI: 10.1038/s41551-018-0265-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 06/15/2018] [Indexed: 11/21/2022]
Abstract
The identification of patients with aggressive cancer who require immediate therapy is a health challenge in low-income and middle-income countries. Limited pathology resources, high healthcare costs and large-case loads call for the development of advanced standalone diagnostics. Here, we report and validate an automated, low-cost point-of-care device for the molecular diagnosis of aggressive lymphomas. The device uses contrast-enhanced microholography and a deep-learning algorithm to directly analyse percutaneously obtained fine-needle aspirates. We show the feasibility and high accuracy of the device in cells, as well as the prospective validation of the results in 40 patients clinically referred for image-guided aspiration of nodal mass lesions suspicious for lymphoma. Automated analysis of human samples with the portable device should allow for the accurate classification of patients with benign and malignant adenopathy.
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Affiliation(s)
- Hyungsoon Im
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Divya Pathania
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Philip J McFarland
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Ismail Degani
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Matthew Allen
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Benjamin Coble
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA
- Department of Engineering and Management, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Aoife Kilcoyne
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Seonki Hong
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Lucas Rohrer
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA
- Department of Health Sciences, Northeastern University, Boston, MA, USA
| | | | - Scott Dryden-Peterson
- Botswana Harvard AIDS Institute, Gaborone, Botswana
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Lioubov Fexon
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Misha Pivovarov
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Bruce Chabner
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Hakho Lee
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Cesar M Castro
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA.
- Massachusetts General Hospital Cancer Center, Boston, MA, USA.
| | - Ralph Weissleder
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA, USA.
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
- Department of Systems Biology, Harvard Medical School, Boston, MA, USA.
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19
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Brown CA, Kohler RE, John O, Motswetla G, Mmalane M, Tapela N, Grover S, Dryden-Peterson S, Lockman S, Dryden-Peterson SL. Multilevel Factors Affecting Time to Cancer Diagnosis and Care Quality in Botswana. Oncologist 2018; 23:1453-1460. [PMID: 30082488 DOI: 10.1634/theoncologist.2017-0643] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 04/20/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Cancer incidence is increasing in Africa, and the majority of patients are diagnosed with advanced disease, limiting treatment options and survival. We sought to understand care patterns and factors contributing to delayed diagnosis and treatment initiation among patients with cancer in Botswana. PATIENTS AND METHODS We recruited 20 patients who were enrolled in a prospective cancer cohort in Botswana to a qualitative substudy that explored cancer care pathways and factors affecting cancer care access and quality. We conducted an in-depth interview with each participant between October 2014 and January 2015, using a a structured interview guide with questions about initial cancer symptoms, previous consultations, diagnosis, and care pathways. Medical records were used to confirm dates or treatment details when needed. RESULTS Individual and interpersonal factors such as cancer awareness and social support facilitated care-seeking behaviors. However, patients experienced multiple delays in diagnosis and treatment because of provider and health system barriers. Health system factors, such as misdiagnosis, understaffed facilities, poor referral communication and scheduling, and inadequate laboratory reporting systems, affected access to and quality of cancer care. CONCLUSION These findings highlight the need for interventions at the patient, provider, and health system levels to improve cancer care quality and outcomes in Botswana. Results also suggest that widespread cancer education has potential to promote early diagnosis through family and community networks. Identified barriers and facilitators suggest that interventions to improve community education and access to diagnostic technologies could help improve cancer outcomes in this setting. IMPLICATIONS FOR PRACTICE The majority (54%) of patients with cancer in Botswana present with advanced-stage cancer despite universal access to free health care, limiting the options for treatment and decreasing the likelihood of positive treatment outcomes. To reduce time from symptom onset to cancer treatment initiation, causes of delay in cancer care trajectories must be identified. The narratives of the patients interviewed for this study give insight into psychosocial factors, outlooks on disease, lower-level provider delays, and health system barriers that contribute to substantial delays for patients with cancer in Botswana. Identification of problems and barriers is essential for development of effective interventions to mitigate these factors, in order to improve cancer outcomes in this population.
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Affiliation(s)
- Carolyn A Brown
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Emory Rollins School of Public Health, Atlanta, Georgia, USA
| | - Racquel E Kohler
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Oaitse John
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | | | - Mompati Mmalane
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Neo Tapela
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Ministry of Health Botswana, Gaborone, Botswana
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Surbhi Grover
- Department of Radiation Oncology, Botswana-UPENN Partnership, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Oncology, Princess Marina Hospital, Gaborone, Botswana
| | | | - Shahin Lockman
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Scott L Dryden-Peterson
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
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20
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Bhatia RK, Rayne S, Rate W, Bakwenabatsile L, Monare B, Anakwenze C, Dhillon P, Narasimhamurthy M, Dryden-Peterson S, Grover S. Patient Factors Associated With Delays in Obtaining Cancer Care in Botswana. J Glob Oncol 2018; 4:1-13. [PMID: 30199305 PMCID: PMC6223504 DOI: 10.1200/jgo.18.00088] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Purpose Delays in diagnosis and treatment of cancers can lead to poor survival. These delays represent a multifaceted problem attributable to patient, provider, and systemic factors. We aim to quantify intervals from symptom onset to treatment start among patients with cancer in Botswana and to understand potential risk factors for delay. Patients and Methods From December 2015 to January 2017, we surveyed patients seen in an oncology clinic in Botswana. We calculated proportions of patients who experienced delays in appraisal (between detecting symptoms and perceiving a reason to discuss them with provider, defined as > 1 month), help seeking (between discussing symptoms and first consultation with provider, defined as > 1 month), diagnosis (between first consultation and receiving a diagnosis, defined as > 3 months), and treatment (between diagnosis and starting treatment, defined as > 3 months). Results Among 214 patients with cancer who completed the survey, median age at diagnosis was 46 years, and the most common cancer was cancer of the cervix (42.2%). Eighty-one percent of patients were women, 60.7% were HIV infected, and 56.6% presented with advanced cancer (stage III or IV). Twenty-six percent of patients experienced delays in appraisal, 35.5% experienced delays help seeking, 63.1% experienced delays in diagnosis, and 50.4% experienced delays in treatment. Patient income, education, and age were not associated with delays. In univariable analysis, patients living with larger families were less likely to experience a help-seeking delay (odds ratio [OR], 0.31; P = .03), women and patients with perceived very serious symptoms were less likely to experience an appraisal delay (OR, 0.45; P = .032 and OR, 0.14; P = .02, respectively). Conclusion Nearly all patients surveyed experienced a delay in obtaining cancer care. In a setting where care is provided without charge, cancer type and male sex were more important predictors of delays than socioeconomic factors.
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Affiliation(s)
- Rohini K. Bhatia
- Rohini K. Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile and Barati Monare, Botswana-University of Pennsylvania Partnership; Mohan Narasimhamurthy, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Chidinma Anakwenze, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX; Preet Dhillon, Public Health Foundation of India, Gurgaon, India; Scott Dryden-Peterson, Brigham and Women’s Hospital and Botswana Harvard AIDS Institute, Harvard TH Chan School of Public Health, Boston, MA
| | - Sarah Rayne
- Rohini K. Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile and Barati Monare, Botswana-University of Pennsylvania Partnership; Mohan Narasimhamurthy, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Chidinma Anakwenze, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX; Preet Dhillon, Public Health Foundation of India, Gurgaon, India; Scott Dryden-Peterson, Brigham and Women’s Hospital and Botswana Harvard AIDS Institute, Harvard TH Chan School of Public Health, Boston, MA
| | - William Rate
- Rohini K. Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile and Barati Monare, Botswana-University of Pennsylvania Partnership; Mohan Narasimhamurthy, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Chidinma Anakwenze, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX; Preet Dhillon, Public Health Foundation of India, Gurgaon, India; Scott Dryden-Peterson, Brigham and Women’s Hospital and Botswana Harvard AIDS Institute, Harvard TH Chan School of Public Health, Boston, MA
| | - Lame Bakwenabatsile
- Rohini K. Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile and Barati Monare, Botswana-University of Pennsylvania Partnership; Mohan Narasimhamurthy, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Chidinma Anakwenze, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX; Preet Dhillon, Public Health Foundation of India, Gurgaon, India; Scott Dryden-Peterson, Brigham and Women’s Hospital and Botswana Harvard AIDS Institute, Harvard TH Chan School of Public Health, Boston, MA
| | - Barati Monare
- Rohini K. Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile and Barati Monare, Botswana-University of Pennsylvania Partnership; Mohan Narasimhamurthy, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Chidinma Anakwenze, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX; Preet Dhillon, Public Health Foundation of India, Gurgaon, India; Scott Dryden-Peterson, Brigham and Women’s Hospital and Botswana Harvard AIDS Institute, Harvard TH Chan School of Public Health, Boston, MA
| | - Chidinma Anakwenze
- Rohini K. Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile and Barati Monare, Botswana-University of Pennsylvania Partnership; Mohan Narasimhamurthy, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Chidinma Anakwenze, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX; Preet Dhillon, Public Health Foundation of India, Gurgaon, India; Scott Dryden-Peterson, Brigham and Women’s Hospital and Botswana Harvard AIDS Institute, Harvard TH Chan School of Public Health, Boston, MA
| | - Preet Dhillon
- Rohini K. Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile and Barati Monare, Botswana-University of Pennsylvania Partnership; Mohan Narasimhamurthy, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Chidinma Anakwenze, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX; Preet Dhillon, Public Health Foundation of India, Gurgaon, India; Scott Dryden-Peterson, Brigham and Women’s Hospital and Botswana Harvard AIDS Institute, Harvard TH Chan School of Public Health, Boston, MA
| | - Mohan Narasimhamurthy
- Rohini K. Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile and Barati Monare, Botswana-University of Pennsylvania Partnership; Mohan Narasimhamurthy, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Chidinma Anakwenze, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX; Preet Dhillon, Public Health Foundation of India, Gurgaon, India; Scott Dryden-Peterson, Brigham and Women’s Hospital and Botswana Harvard AIDS Institute, Harvard TH Chan School of Public Health, Boston, MA
| | - Scott Dryden-Peterson
- Rohini K. Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile and Barati Monare, Botswana-University of Pennsylvania Partnership; Mohan Narasimhamurthy, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Chidinma Anakwenze, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX; Preet Dhillon, Public Health Foundation of India, Gurgaon, India; Scott Dryden-Peterson, Brigham and Women’s Hospital and Botswana Harvard AIDS Institute, Harvard TH Chan School of Public Health, Boston, MA
| | - Surbhi Grover
- Rohini K. Bhatia, University of Rochester School of Medicine and Dentistry, Rochester, NY; Sarah Rayne, University of the Witwatersrand, Johannesburg, South Africa; William Rate, Georgetown University School of Medicine, Washington, DC; Lame Bakwenabatsile and Barati Monare, Botswana-University of Pennsylvania Partnership; Mohan Narasimhamurthy, University of Botswana; Surbhi Grover, Princess Marina Hospital, Gaborone, Botswana; Surbhi Grover, University of Pennsylvania, Philadelphia, PA; Chidinma Anakwenze, University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX; Preet Dhillon, Public Health Foundation of India, Gurgaon, India; Scott Dryden-Peterson, Brigham and Women’s Hospital and Botswana Harvard AIDS Institute, Harvard TH Chan School of Public Health, Boston, MA
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21
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Tapela NM, Peluso MJ, Kohler RE, Setlhako II, Botebele K, Gabegwe K, Nkele I, Narasimhamurthy M, Mmalane M, Grover S, Barak T, Shulman LN, Lockman S, Dryden-Peterson S. A Step Toward Timely Referral and Early Diagnosis of Cancer: Implementation and Impact on Knowledge of a Primary Care-Based Training Program in Botswana. Front Oncol 2018; 8:187. [PMID: 29896450 PMCID: PMC5986942 DOI: 10.3389/fonc.2018.00187] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 05/11/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction Health system delays in diagnosis of cancer contribute to the glaring disparities in cancer mortality between high-income countries and low- and middle-income countries. In Botswana, approximately 70% of cancers are diagnosed at late stage and median time from first health facility visit for cancer-related symptoms to specialty cancer care was 160 days (IQR 59-653). We describe the implementation and early outcomes of training targeting primary care providers, which is a part of a multi-component implementation study in Kweneng-East district aiming to enhance timely diagnosis of cancers. Methods Health-care providers from all public facilities within the district were invited to participate in an 8-h intensive short-course program developed by a multidisciplinary team and adapted to the Botswana health system context. Participants' performance was assessed using a 25-multiple choice question tool, with pre- and post-assessments paired by anonymous identifier. Statistical analysis with Wilcoxon signed-rank test to compare performance at the two time points across eight sub-domains (pathophysiology, epidemiology, social context, symptoms, evaluation, treatment, documentation, follow-up). Linear regression and negative binomial modeling were used to determine change in performance. Participants' satisfaction with the program was measured on a separate survey using a 5-point Likert scale. Results 176 participants attended the training over 5 days in April 2016. Pooled linear regression controlling for test version showed an overall performance increase of 16.8% after participation (95% CI 15.2-18.4). Statistically significant improvement was observed for seven out of eight subdomains on test A and all eight subdomains on test B. Overall, 71 (40.3%) trainees achieved a score greater than 70% on the pretest, and 161 (91.5%) did so on the posttest. Participants reported a high degree of satisfaction with the training program's content and its relevance to their daily work. Conclusion We describe a successfully implemented primary health care provider-focused training component of an innovative intervention aiming to reduce health systems delays in cancer diagnosis in sub-Saharan Africa. The training achieved district-wide participation, and improvement in the knowledge of primary health-care providers in this setting. Clinical Trial Registration www.ClinicalTrials.gov, identifier NCT02752061.
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Affiliation(s)
- Neo M Tapela
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States
| | - Michael J Peluso
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, United States.,Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Racquel E Kohler
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Irene I Setlhako
- Princess Marina Hospital, Ministry of Health and Wellness, Gaborone, Botswana
| | | | - Kemiso Gabegwe
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Isaac Nkele
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Mohan Narasimhamurthy
- Department of Pathology, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Mompati Mmalane
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
| | - Surbhi Grover
- University of Pennsylvania, Philadelphia, PA, United States.,Botswana Upenn Partnership, Gaborone, Botswana
| | - Tomer Barak
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Lawrence N Shulman
- Center for Global Cancer Medicine, Abramson Cancer Center, University of Pennsylvania, Philadelphia, PA, United States
| | - Shahin Lockman
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Harvard TH Chan School of Public Health, Boston, MA, United States.,Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, United States
| | - Scott Dryden-Peterson
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Harvard TH Chan School of Public Health, Boston, MA, United States.,Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA, United States
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22
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Hainsworth EG, Shahmanesh M, Stevenson F. Exploring the views and experiences of HIV positive patients treated for cancer: a systematic review of the literature. AIDS Care 2017; 30:535-543. [PMID: 28975801 DOI: 10.1080/09540121.2017.1381332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A systematic review of the literature was conducted to find out what is known about patients' experiences of a dual diagnosis of HIV and cancer. We systematically searched the following databases; MEDLINE (Ovid Version); CINAHL Plus; PsycINFO and EMBASE from inception to June 2016 for studies that included patients with a dual diagnosis of cancer and HIV and focused on patient experiences. Studies with a focus on one illness rather than a dual diagnosis, those that focused on treatment strategies and medical management, epidemiology and pathology studies and comparison studies were all excluded. The full text of the included studies were reviewed. Information on location, sample size, study design and a narrative summary of findings were extracted using a standardised format. Studies were combined thematically. 1777 records were screened by title and abstract using the selection criteria described in the methods. Eight records were reviewed in depth in full text and seven selected as eligible. The selected studies suggest that a dual diagnosis of HIV and cancer has a powerful impact on individuals' behaviour. The experience of stigma was a consistent factor in all patient accounts and the strategy of selective disclosure to access support reveals how patient agency can interplay with stigma. This is an area largely unexplored in the published literature; further research into patients' experiences of a dual diagnosis of HIV and cancer will provide relevant knowledge in order to tailor and improve services.
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Affiliation(s)
- Emma G Hainsworth
- a Department of Primary Care and Population Sciences , University College London , London , UK
| | - Maryam Shahmanesh
- b Department of Infection and Population Health , Institute of Global Health, University College London , London , UK
| | - Fiona Stevenson
- c Department of Primary Care and Population Sciences , University College London , London , UK
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23
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Chinula L, Moses A, Gopal S. HIV-associated malignancies in sub-Saharan Africa: progress, challenges, and opportunities. Curr Opin HIV AIDS 2017; 12:89-95. [PMID: 27607593 PMCID: PMC5241291 DOI: 10.1097/coh.0000000000000329] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW To summarize recent developments for HIV-associated malignancies (HIVAM) in low-income and middle-income countries (LMIC) with particular focus on sub-Saharan Africa (SSA). RECENT FINDINGS Antiretroviral therapy (ART) scale-up is leading to epidemiologic transitions in LMIC similar to high-income countries, with aging and growth of HIV-infected populations, declining infectious deaths, increasing cancer deaths, and transitions from AIDS-defining cancers to non-AIDS defining cancers. Despite ART scale-up, the HIVAM burden remains high including an enormous AIDS-defining cancers burden in SSA. For Kaposi sarcoma, patients treated with ART and chemotherapy can experience good outcomes even in rural SSA, but Kaposi sarcoma heterogeneity remains insufficiently understood including virologic, immunologic, and inflammatory features that may be unique to LMIC. For cervical cancer, scale-up of prevention efforts including vaccination and screening is underway, with benefits already apparent despite continuing high disease burden. For non-Hodgkin lymphoma, curative treatment is possible in the ART era even in SSA, and multifaceted approaches can improve outcomes further. For many other prevalent HIVAM, care and research efforts are being established to guide treatment and prevention specifically in LMIC. SUMMARY Sustained investment for HIVAM in LMIC can help catalyze a cancer care and research agenda that benefits HIV-positive and HIV-negative patients worldwide.
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Affiliation(s)
- Lameck Chinula
- UNC Project-Malawi
- University of North Carolina at Chapel Hill
- University of Malawi College of Medicine
| | - Agnes Moses
- UNC Project-Malawi
- University of North Carolina at Chapel Hill
- University of Malawi College of Medicine
| | - Satish Gopal
- UNC Project-Malawi
- University of North Carolina at Chapel Hill
- University of Malawi College of Medicine
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24
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Suneja G, Brown D, Chang A, Erickson B, Fidarova E, Grover S, Mahantshetty U, Nag S, Narayan K, Bvochora-Nsingo M, Viegas C, Viswanathan AN, Lin MY, Gaffney D. American Brachytherapy Society: Brachytherapy treatment recommendations for locally advanced cervix cancer for low-income and middle-income countries. Brachytherapy 2016; 16:85-94. [PMID: 27919654 DOI: 10.1016/j.brachy.2016.10.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 09/06/2016] [Accepted: 10/21/2016] [Indexed: 01/17/2023]
Abstract
PURPOSE Most cervix cancer cases occur in low-income and middle-income countries (LMIC), and outcomes are suboptimal, even for early stage disease. Brachytherapy plays a central role in the treatment paradigm, improving both local control and overall survival. The American Brachytherapy Society (ABS) aims to provide guidelines for brachytherapy delivery in resource-limited settings. METHODS AND MATERIALS A panel of clinicians and physicists with expertise in brachytherapy administration in LMIC was convened. A survey was developed to identify practice patterns at the authors' institutions and was also extended to participants of the Cervix Cancer Research Network. The scientific literature was reviewed to identify consensus papers or review articles with a focus on treatment of locally advanced, unresected cervical cancer in LMIC. RESULTS Of the 40 participants invited to respond to the survey, 32 responded (response rate 80%). Participants were practicing in 14 different countries including both high-income (China, Singapore, Taiwan, United Kingdom, and United States) and low-income or middle-income countries (Bangladesh, Botswana, Brazil, India, Malaysia, Pakistan, Philippines, Thailand, and Vietnam). Recommendations for modifications to existing ABS guidelines were reviewed by the panel members and are highlighted in this article. CONCLUSIONS Recommendations for treatment of locally advanced, unresectable cervical cancer in LMIC are presented. The guidelines comment on staging, external beam radiotherapy, use of concurrent chemotherapy, overall treatment duration, use of anesthesia, applicator choice and placement verification, brachytherapy treatment planning including dose and prescription point, recommended reporting and documentation, physics support, and follow-up.
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Affiliation(s)
| | - Derek Brown
- University of California San Diego, San Diego, CA
| | - Amy Chang
- Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | | | | | - Surbhi Grover
- University of Pennsylvania, Philadelphia, PA; Princess Marina Hospital, Gaborone, Botswana
| | | | | | | | | | - Celia Viegas
- Instituto Nacional de Cancer- INCA, Rio de Janeiro, Brazil
| | | | - Ming Yin Lin
- Peter MacCallum Cancer Centre, Melbourne, Australia
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25
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Randall TC, Ghebre R. Challenges in Prevention and Care Delivery for Women with Cervical Cancer in Sub-Saharan Africa. Front Oncol 2016; 6:160. [PMID: 27446806 PMCID: PMC4923066 DOI: 10.3389/fonc.2016.00160] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 06/14/2016] [Indexed: 12/21/2022] Open
Abstract
Virtually all cases of invasive cervical cancer are associated with infection by high-risk strains of human papilloma virus. Effective primary and secondary prevention programs, as well as effective treatment for early-stage invasive cancer have dramatically reduced the burden of cervical cancer in high-income countries; 85% of the mortality from cervical cancer now occurs in low- and middle-income countries. This article provides an overview of challenges to cervical cancer care in sub-Saharan Africa (SSA) and identifies areas for programmatic development to meet the global development goal to reduce cancer-related mortality. Advanced stage at presentation and gaps in prevention, screening, diagnostic, and treatment capacities contribute to reduced cervical cancer survival. Cost-effective cervical cancer screening strategies implemented in low resource settings can reduce cervical cancer mortality. Patient- and system-based barriers need to be addressed as part of any cervical cancer control program. Limited human capacity and infrastructure in SSA are major barriers to comprehensive cervical cancer care. Management of early-stage, locally advanced or metastatic cervical cancer involves multispecialty care, including gynecology oncology, medical oncology, radiology, pathology, radiation oncology, and palliative care. Investment in cervical cancer care programs in low- and middle-income countries will need to include effective recruitment programs to engage women in the community to access cancer screening and diagnosis services. Though cervical cancer is a preventable and treatable cancer, the challenges to cervical control in SSA are great and will require a broadly integrated and sustained effort by multiple stakeholders before meaningful progress can be achieved.
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Affiliation(s)
- Thomas C Randall
- Department of Obstetrics and Gynecology, Harvard Medical School, Boston, MA, USA; Global Oncology Initiative, Harvard Cancer Center, Boston, MA, USA
| | - Rahel Ghebre
- Division of Gynecologic Oncology, University of Minnesota Medical School, Duluth, MN, USA; Human Resources for Health Program Rwanda, Yale School of Medicine, New Haven, CT, USA
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