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Kimambo AH, Vuhahula EA, Philipo GS, Mushi BP, Mmbaga EJ, Van Loon K, Ng DL. Rapid Onsite Evaluation for Specimen Adequacy and Triage of Breast Masses in a Low-Resource Setting. Arch Pathol Lab Med 2024; 148:e9-e17. [PMID: 37327201 PMCID: PMC10728347 DOI: 10.5858/arpa.2022-0398-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 06/18/2023]
Abstract
CONTEXT.— Rapid onsite evaluation (ROSE) is critical in determining sample adequacy and triaging cytology samples. Although fine-needle aspiration biopsy (FNAB) is the primary method of initial tissue sampling in Tanzania, ROSE is not practiced. OBJECTIVE.— To investigate the performance of ROSE in determining cellular adequacy and providing preliminary diagnoses in breast FNAB in a low-resource setting. DESIGN.— Patients with breast masses were recruited prospectively from the FNAB clinic at Muhimbili National Hospital. Each FNAB was evaluated by ROSE for overall specimen adequacy, cellularity, and preliminary diagnosis. The preliminary interpretation was compared to the final cytologic diagnosis and histologic diagnosis, when available. RESULTS.— Fifty FNAB cases were evaluated, and all were adequate for diagnosis on ROSE and final interpretation. Overall percentage of agreement (OPA) between preliminary and final cytologic diagnosis was 84%, positive percentage of agreement (PPA) was 33%, and negative percentage of agreement (NPA) was 100% (κ = 0.4, P < .001). Twenty-one cases had correlating surgical resections. OPA between preliminary cytologic and histologic diagnoses was 67%, PPA was 22%, and NPA was 100% (κ = 0.2, P = .09). OPA between final cytologic and histologic diagnoses was 95%, PPA was 89%, and NPA was 100% (κ = 0.9, P = <.001). CONCLUSIONS.— False-positive rates of ROSE diagnoses for breast FNAB are low. While preliminary cytologic diagnoses had a high false-negative rate, final cytologic diagnoses had overall high concordance with histologic diagnoses. Therefore, the role of ROSE for preliminary diagnosis should be considered carefully in low-resource settings, and it may need to be paired with additional interventions to improve pathologic diagnosis.
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Affiliation(s)
- Asteria H Kimambo
- From the Departments of Pathology (Kimambo, Vuhahula) and Epidemiology and Biostatistics (Philipo, Mushi, Mmbaga), Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Edda A Vuhahula
- From the Departments of Pathology (Kimambo, Vuhahula) and Epidemiology and Biostatistics (Philipo, Mushi, Mmbaga), Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Godfrey S Philipo
- From the Departments of Pathology (Kimambo, Vuhahula) and Epidemiology and Biostatistics (Philipo, Mushi, Mmbaga), Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Beatrice P Mushi
- From the Departments of Pathology (Kimambo, Vuhahula) and Epidemiology and Biostatistics (Philipo, Mushi, Mmbaga), Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Elia J Mmbaga
- From the Departments of Pathology (Kimambo, Vuhahula) and Epidemiology and Biostatistics (Philipo, Mushi, Mmbaga), Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- the Department of Community Medicine and Global Health, University of Oslo, Oslo, Norway (Mmbaga)
| | - Katherine Van Loon
- the Division of Hematology and Oncology in the Department of Medicine (Van Loon), the Helen Diller Family Comprehensive Cancer Center (Van Loon, Ng)
| | - Dianna L Ng
- the Division of Hematology and Oncology in the Department of Medicine (Van Loon), the Helen Diller Family Comprehensive Cancer Center (Van Loon, Ng)
- the Department of Pathology (Ng), University of California, San Francisco
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2
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Selekwa M, Maina I, Yeh T, Nkya A, Ncogoza I, Nuss RC, Mushi BP, Haddadi S, Van Loon K, Mbaga E, Massawe W, Roberson DW, Dharsee N, Musimu B, Xu MJ. Tracheostomy care quality improvement in low- and middle-income countries: A scoping review. PLOS Glob Public Health 2023; 3:e0002294. [PMID: 37943736 PMCID: PMC10635432 DOI: 10.1371/journal.pgph.0002294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/09/2023] [Indexed: 11/12/2023]
Abstract
Tracheostomy is a lifesaving, essential procedure performed for airway obstruction in the case of head and neck cancers, prolonged ventilator use, and for long-term pulmonary care. While successful quality improvement interventions in high-income countries such as through the Global Tracheostomy Collaborative significantly reduced length of hospital stay and decreased levels of anxiety among patients, limited literature exists regarding tracheostomy care and practices in low and middle-income countries (LMIC), where most of the world resides. Given limited literature, this scoping review aims to summarize published tracheostomy studies in LMICs and highlight areas in need of quality improvement and clinical research efforts. Based on the PRISMA guidelines, a scoping review of the literature was performed through MEDLINE/PubMed and Embase using terms related to tracheostomy, educational and quality improvement interventions, and LMICs. Publications from 2000-2022 in English were included. Eighteen publications representing 10 countries were included in the final analysis. Seven studies described baseline needs assessments, 3 development of training programs for caregivers, 6 trialed home-based or hospital-based interventions, and finally 2 articles discussed development of standardized protocols. Overall, studies highlighted the unique challenges to tracheostomy care in LMICs including language, literacy barriers, resource availability (running water and electricity in patient homes), and health system access (financial costs of travel and follow-up). There is currently limited published literature on tracheostomy quality improvement and care in LMICs. Opportunities to improve quality of care include increased efforts to measure complications and outcomes, implementing evidence-based interventions tailored to LMIC settings, and using an implementation science framework to study tracheostomy care in LMICs.
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Affiliation(s)
- Msiba Selekwa
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ivy Maina
- Department of Otolaryngology-Head and Neck Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Tiffany Yeh
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Aslam Nkya
- Department of Otolaryngology-Head & Neck Surgery, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Isaie Ncogoza
- Department of Surgery, College of Medicine & Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Roger C. Nuss
- Department of Otolaryngology and Communication Enhancement, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Beatrice P. Mushi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Sumaiya Haddadi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Katherine Van Loon
- Department of Medicine, Division of Hematology/Oncology, University of California San Francisco, San Francisco, California, United States of America
| | - Elia Mbaga
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Willybroad Massawe
- Department of Otolaryngology-Head & Neck Surgery, Muhimbili National Hospital, Dar es Salaam, Tanzania
- Department of Otolaryngology-Head and Neck Surgery, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
| | - David W. Roberson
- Bayhealth Medical Group, Dover, Delaware, United States of America
- Global Tracheostomy Collaborative, Raleigh, North Carolina, United States of America
| | - Nazima Dharsee
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Baraka Musimu
- Department of Otolaryngology-Head and Neck Surgery, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
| | - Mary Jue Xu
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, United States of America
- National Clinician Scholars Program, University of California San Francisco, San Francisco, California, United States of America
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3
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Van Loon K, Mmbaga EJ, Mushi BP, Selekwa M, Mwanga A, Akoko LO, Mwaiselage J, Mosha I, Ng DL, Wu W, Silverstein J, Mulima G, Kaimila B, Gopal S, Snell JM, Benz SC, Vaske C, Sanborn Z, Sedgewick AJ, Radenbaugh A, Newton Y, Collisson EA. A Genomic Analysis of Esophageal Squamous Cell Carcinoma in Eastern Africa. Cancer Epidemiol Biomarkers Prev 2023; 32:1411-1420. [PMID: 37505926 DOI: 10.1158/1055-9965.epi-22-0775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 04/19/2023] [Accepted: 07/26/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Esophageal squamous cell carcinoma (ESCC) comprises 90% of all esophageal cancer cases globally and is the most common histology in low-resource settings. Eastern Africa has a disproportionately high incidence of ESCC. METHODS We describe the genomic profiles of 61 ESCC cases from Tanzania and compare them to profiles from an existing cohort of ESCC cases from Malawi. We also provide a comparison to ESCC tumors in The Cancer Genome Atlas (TCGA). RESULTS We observed substantial transcriptional overlap with other squamous histologies via comparison with TCGA PanCan dataset. DNA analysis revealed known mutational patterns, both genome-wide as well as in genes known to be commonly mutated in ESCC. TP53 mutations were the most common somatic mutation in tumors from both Tanzania and Malawi but were detected at lower frequencies than previously reported in ESCC cases from other settings. In a combined analysis, two unique transcriptional clusters were identified: a proliferative/epithelial cluster and an invasive/migrative/mesenchymal cluster. Mutational signature analysis of the Tanzanian cohort revealed common signatures associated with aging and cytidine deaminase activity (APOBEC) and an absence of signature 29, which was previously reported in the Malawi cohort. CONCLUSIONS This study defines the molecular characteristics of ESCC in Tanzania, and enriches the Eastern African dataset, with findings of overall similarities but also some heterogeneity across two unique sites. IMPACT Despite a high burden of ESCC in Eastern Africa, investigations into the genomics in this region are nascent. This represents the largest comprehensive genomic analysis ESCC from sub-Saharan Africa to date.
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Affiliation(s)
- Katherine Van Loon
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Elia J Mmbaga
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Beatrice P Mushi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Msiba Selekwa
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Ally Mwanga
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Larry O Akoko
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | | | - Dianna L Ng
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Wei Wu
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Jordyn Silverstein
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | | | | | - Satish Gopal
- UNC Project-Malawi, Lilongwe, Malawi
- University of North Carolina, Chapel Hill, North Carolina
| | - Jeff M Snell
- University of North Carolina, Chapel Hill, North Carolina
| | | | | | - Zack Sanborn
- NantOmics/NantHealth, Inc., El Segundo, California
| | | | | | - Yulia Newton
- NantOmics/NantHealth, Inc., El Segundo, California
| | - Eric A Collisson
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, California
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4
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Nomburg J, Bullman S, Nasrollahzadeh D, Collisson EA, Abedi-Ardekani B, Akoko LO, Atkins JR, Buckle GC, Gopal S, Hu N, Kaimila B, Khoshnia M, Malekzadeh R, Menya D, Mmbaga BT, Moody S, Mulima G, Mushi BP, Mwaiselage J, Mwanga A, Newton Y, Ng DL, Radenbaugh A, Rwakatema DS, Selekwa M, Schüz J, Taylor PR, Vaske C, Goldstein A, Stratton MR, McCormack V, Brennan P, DeCaprio JA, Meyerson M, Mmbaga EJ, Van Loon K. An international report on bacterial communities in esophageal squamous cell carcinoma. Int J Cancer 2022; 151:1947-1959. [PMID: 35837755 PMCID: PMC11100422 DOI: 10.1002/ijc.34212] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/23/2022] [Accepted: 04/11/2022] [Indexed: 11/09/2022]
Abstract
The incidence of esophageal squamous cell carcinoma (ESCC) is disproportionately high in the eastern corridor of Africa and parts of Asia. Emerging research has identified a potential association between poor oral health and ESCC. One possible link between poor oral health and ESCC involves the alteration of the microbiome. We performed an integrated analysis of four independent sequencing efforts of ESCC tumors from patients from high- and low-incidence regions of the world. Using whole genome sequencing (WGS) and RNA sequencing (RNAseq) of ESCC tumors from 61 patients in Tanzania, we identified a community of bacteria, including members of the genera Fusobacterium, Selenomonas, Prevotella, Streptococcus, Porphyromonas, Veillonella and Campylobacter, present at high abundance in ESCC tumors. We then characterized the microbiome of 238 ESCC tumor specimens collected in two additional independent sequencing efforts consisting of patients from other high-ESCC incidence regions (Tanzania, Malawi, Kenya, Iran, China). This analysis revealed similar ESCC-associated bacterial communities in these cancers. Because these genera are traditionally considered members of the oral microbiota, we next explored whether there was a relationship between the synchronous saliva and tumor microbiomes of ESCC patients in Tanzania. Comparative analyses revealed that paired saliva and tumor microbiomes were significantly similar with a specific enrichment of Fusobacterium and Prevotella in the tumor microbiome. Together, these data indicate that cancer-associated oral bacteria are associated with ESCC tumors at the time of diagnosis and support a model in which oral bacteria are present in high abundance in both saliva and tumors of some ESCC patients.
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Affiliation(s)
- Jason Nomburg
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Broad Institute of MIT and Harvard, Cambridge, MA
- Harvard Program in Virology, Harvard Medical School, Boston, MA
| | - Susan Bullman
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Dariush Nasrollahzadeh
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Shariati Hospital. Tehran Iran
- International Agency for Research on Cancer (IARC/WHO), Genomic Epidemiology Branch, Lyon, France
| | - Eric A. Collisson
- University of California, San Francisco (UCSF) Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
- Division of Hematology/Oncology, Department of Medicine, UCSF, San Francisco, California, USA
| | - Behnoush Abedi-Ardekani
- International Agency for Research on Cancer (IARC/WHO), Genomic Epidemiology Branch, Lyon, France
| | - Larry O. Akoko
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Joshua R. Atkins
- International Agency for Research on Cancer (IARC/WHO), Genomic Epidemiology Branch, Lyon, France
| | - Geoffrey C. Buckle
- University of California, San Francisco (UCSF) Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
- Division of Hematology/Oncology, Department of Medicine, UCSF, San Francisco, California, USA
| | - Satish Gopal
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Nan Hu
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | | | - Masoud Khoshnia
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Shariati Hospital. Tehran Iran
| | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Shariati Hospital. Tehran Iran
| | - Diana Menya
- School of Public Health, Moi University, Eldoret, Kenya
| | - Blandina T. Mmbaga
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Sarah Moody
- Cancer, Ageing and Somatic Mutation, Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridgeshire, UK
| | | | - Beatrice P. Mushi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Ally Mwanga
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Yulia Newton
- NantOmics/NantHealth, Inc., El Segundo, California, USA
| | - Dianna L. Ng
- University of California, San Francisco (UCSF) Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
- Department of Pathology, UCSF, San Francisco, CA, USA
| | | | - Deogratias S. Rwakatema
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Msiba Selekwa
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Joachim Schüz
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, Lyon, France
| | - Philip R. Taylor
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Charles Vaske
- NantOmics/NantHealth, Inc., El Segundo, California, USA
| | - Alisa Goldstein
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Michael R. Stratton
- Cancer, Ageing and Somatic Mutation, Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridgeshire, UK
| | - Valerie McCormack
- International Agency for Research on Cancer (IARC/WHO), Environment and Lifestyle Epidemiology Branch, Lyon, France
| | - Paul Brennan
- International Agency for Research on Cancer (IARC/WHO), Genomic Epidemiology Branch, Lyon, France
| | - James A. DeCaprio
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Harvard Program in Virology, Harvard Medical School, Boston, MA
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Matthew Meyerson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
- Broad Institute of MIT and Harvard, Cambridge, MA
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
- Department of Genetics, Harvard Medical School, Boston, MA
| | - Elia J. Mmbaga
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Community Medicine and Global Health, University of Oslo, Norway
| | - Katherine Van Loon
- University of California, San Francisco (UCSF) Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
- Division of Hematology/Oncology, Department of Medicine, UCSF, San Francisco, California, USA
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5
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Ho YX, Morse RS, Lambden K, Mushi BP, Ngoma M, Mahuna H, Ngoma T, Miesfeldt S. How a Digital Case Management Platform Affects Community-Based Palliative Care of Sub-Saharan African Cancer Patients: Clinician-Users' Perspectives. Appl Clin Inform 2022; 13:1092-1099. [PMID: 36384234 PMCID: PMC9668489 DOI: 10.1055/s-0042-1758223] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background
Symptom control among cancer patients is a Tanzanian public health priority impacted by limited access to palliative care (PC) specialists and resources. Mobile Palliative Care Link (mPCL), a mobile/web application, aims to extend specialist access via shared care with local health workers (LHWs) with the African
P
alliative care
O
utcome
S
cale (POS) adapted for regular, automated symptom assessment as a core feature.
Objective
The aim of the study is to assess clinicians' attitudes, beliefs, and perceptions regarding mPCL usability and utility with their patients within a government-supported, urban Tanzanian cancer hospital setting.
Methods
We used a mixed methods approach including surveys, qualitative interviews, and system usage data to assess clinicians' experience with mPCL in a field study where discharged, untreatable cancer patients were randomized to mPCL or phone-contact POS collection.
Results
All six specialists and 10 LHWs expressed overall satisfaction with mPCL among 49 intervention arm patients. They perceived mPCL as a way to stay connected with patients and support remote symptom control. Timely access to POS responses and medical records were identified as key benefits. Some differences in perceptions of mPCL use and utility were seen between clinician groups; however, both expressed strong interest in continuing app use, recommending it to colleagues, and extending use throughout Tanzania. Primary use was for clinical status communication and care coordination. Pain and other symptom progression were the most frequently reported reasons for provider–patient interactions accounting for 34% (
n
= 44) and 12% (
n
= 15) of reasons, respectively. Usage barriers included time required to create a new clinical record, perceived need for response to non-urgent reminders or alerts, and training. necessary for competent use. System-level implementation barriers included variable patient access to smartphones and SIM cards and unreliable Internet access.
Conclusion
This work demonstrates broad clinician desire for digital health tools to support remote community-based PC among cancer patients, particularly pain management.
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Affiliation(s)
- Yun Xian Ho
- Dimagi, Inc., Cambridge, Massachusetts, United States,Address for correspondence Yun Xian Ho, PhD Dimagi, Inc.Cambridge, MA 02139United States
| | - Robert S. Morse
- DaVinci Usability, Inc., Lexington, Massachusetts, United States
| | - Kaley Lambden
- Dimagi, Inc., Cambridge, Massachusetts, United States
| | - Beatrice P. Mushi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mamsau Ngoma
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Habiba Mahuna
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Twalib Ngoma
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania,Ocean Road Cancer Institute, Dar es Salaam, Tanzania
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6
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Sakafu LL, Philipo GS, Malichewe CV, Fundikira LS, Lwakatare FA, Van Loon K, Mushi BP, DeBoer RJ, Bialous SA, Lee AY. Delayed diagnostic evaluation of symptomatic breast cancer in sub-Saharan Africa: A qualitative study of Tanzanian women. PLoS One 2022; 17:e0275639. [PMID: 36201503 PMCID: PMC9536581 DOI: 10.1371/journal.pone.0275639] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/21/2022] [Indexed: 11/06/2022] Open
Abstract
Background Women with breast cancer in sub-Saharan Africa are commonly diagnosed at advanced stages. In Tanzania, more than 80% of women are diagnosed with stage III or IV disease, and mortality rates are high. This study explored factors contributing to delayed diagnostic evaluation among women with breast cancer in Tanzania. Methods A qualitative study was performed at Muhimbili National Hospital in Dar es Salaam, Tanzania. Twelve women with symptomatic pathologically proven breast cancer were recruited. In-depth, semi-structured interviews were conducted in Swahili. Interviews explored the women’s journey from symptom recognition to diagnosis, including the influence of breast cancer knowledge and pre-conceptions, health seeking behaviors, psychosocial factors, preference for alternative treatments, and the contribution of culture and norms. Audio-recorded interviews were transcribed and translated into English. Thematic analysis was facilitated by a cloud-based qualitative analysis software. Results All women reported that their first breast symptom was a self-identified lump or swelling. Major themes for factors contributing to delayed diagnostic presentation of breast cancer included lack of basic knowledge and awareness of breast cancer and misconceptions about the disease. Participants faced barriers with their local primary healthcare providers, including symptom mismanagement and delayed referrals for diagnostic evaluation. Other barriers included financial hardships, fear and stigma of cancer, and use of traditional medicine. The advice and influence of family members and friends played key roles in healthcare-seeking behaviors, serving as both facilitators and barriers. Conclusion Lack of basic knowledge and awareness of breast cancer, stigma, financial barriers, and local healthcare system barriers were common factors contributing to delayed diagnostic presentation of breast cancer. The influence of friends and family also played key roles as both facilitators and barriers. This information will inform the development of educational intervention strategies to address these barriers and improve earlier diagnosis of symptomatic breast cancer in Tanzania.
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Affiliation(s)
- Lulu Lunogelo Sakafu
- Department of Radiology, Muhimbili National Hospital, Dar es Salaam, Tanzania
- * E-mail: (LLS); (AYL)
| | | | | | - Lulu S. Fundikira
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Flora A. Lwakatare
- Department of Radiology, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Katherine Van Loon
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Beatrice P. Mushi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Rebecca J. DeBoer
- Division of Hematology/Oncology, Department of Medicine, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Stella A. Bialous
- Department of Social and Behavioral Sciences, University of California San Francisco (UCSF), San Francisco, California, United States of America
| | - Amie Y. Lee
- Department of Radiology and Biomedical Imaging, University of California San Francisco (UCSF), San Francisco, California, United States of America
- * E-mail: (LLS); (AYL)
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7
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Buckle GC, Mmbaga EJ, Paciorek A, Akoko L, Deardorff K, Mgisha W, Mushi BP, Mwaiselage J, Hiatt RA, Zhang L, Van Loon K. Risk Factors Associated With Early-Onset Esophageal Cancer in Tanzania. JCO Glob Oncol 2022; 8:e2100256. [PMID: 35113655 PMCID: PMC8853620 DOI: 10.1200/go.21.00256] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Eastern Africa is one of several regions affected by high incidence rates of esophageal squamous cell carcinoma (ESCC). A unique epidemiologic feature of ESCC in Eastern Africa is the high incidence in young people, with one-third of cases diagnosed at age < 45 years. This study aimed to investigate risk factors for early-onset ESCC in Tanzania through a secondary analysis of a matched case-control study. Data from Tanzania show esophageal cancer risk factors in East Africa may differ across age groups.![]()
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Affiliation(s)
- Geoffrey C Buckle
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA.,UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Elia J Mmbaga
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Alan Paciorek
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA.,Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA
| | - Larry Akoko
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Katrina Deardorff
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - William Mgisha
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Beatrice P Mushi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Robert A Hiatt
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA.,Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA
| | - Li Zhang
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA.,UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA.,Department of Epidemiology and Biostatistics, UCSF, San Francisco, CA
| | - Katherine Van Loon
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA.,UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
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Mushi BP, Mwachiro MM, Buckle G, Kaimila BN, Mulima G, Kayamba V, Kelly P, Akoko L, Mmbaga EJ, Selekwa M, Ringo Y, Pritchett N, White RE, Topazian MD, Fleischer DE, Dawsey SM, Van Loon K. Improving Access to Self-Expanding Metal Stents for Patients With Esophageal Cancer in Eastern Africa: A Stepwise Implementation Strategy. JCO Glob Oncol 2021; 7:118-126. [PMID: 33449802 PMCID: PMC8081508 DOI: 10.1200/go.20.00318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/29/2020] [Accepted: 10/29/2020] [Indexed: 01/25/2023] Open
Abstract
PURPOSE The eastern corridor of Africa is affected by a high burden of esophageal cancer (EC), with > 90% of patients presenting with advanced disease. Self-expanding metal stents (SEMS) have been previously reported as safe and effective for palliation of malignant dysphagia in resource-limited settings; however, access is limited throughout Eastern Africa. METHODS In response to demand for palliative interventions for patients with dysphagia because of EC, the African Esophageal Cancer Consortium (AfrECC) partnered with the Clinton Health Access Initiative to improve access to SEMS in Eastern Africa. We undertook a stepwise implementation approach to (1) identify barriers to SEMS access, (2) conduct a market analysis, (3) select an industry partner, (4) establish regulatory and procurement processes, (5) develop endoscopic training resources, (6) create a medical device registry, and (7) establish principles of accountability. RESULTS Following an evaluation of market demand and potential SEMS manufacturers, Boston Scientific Corporation announced its commitment to launch an access program to provide esophageal SEMS to patients in Tanzania, Kenya, Malawi, and Zambia at a subsidized price. Parallel regulatory and procurement processes were established in each participating country. Endoscopy training courses were designed and conducted, using the Training-of-Trainers model. A device registry was created to centralize data for quality control and to monitor channels of SEMS distribution. Principles of accountability were developed to guide the sustainability of this endeavor. CONCLUSION The AfrECC Stent Access Initiative is an example of a multisector partnership formed to provide an innovative solution to align regional needs with a supply chain for a high-priority medical device.
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Affiliation(s)
- Beatrice P. Mushi
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Geoffrey Buckle
- Global Cancer Program, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (UCSF), San Francisco, CA
| | | | | | | | - Paul Kelly
- University of Zambia School of Medicine, Lusaka, Zambia
| | - Larry Akoko
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Elia J. Mmbaga
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Msiba Selekwa
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Yona Ringo
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Natalie Pritchett
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | | | | | | | - Sanford M. Dawsey
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Katherine Van Loon
- Global Cancer Program, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (UCSF), San Francisco, CA
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Mmbaga EJ, Mushi BP, Deardorff K, Mgisha W, Akoko LO, Paciorek A, Hiatt RA, Buckle GC, Mwaiselage J, Zhang L, Van Loon K. A Case–Control Study to Evaluate Environmental and Lifestyle Risk Factors for Esophageal Cancer in Tanzania. Cancer Epidemiol Biomarkers Prev 2020; 30:305-316. [DOI: 10.1158/1055-9965.epi-20-0660] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/03/2020] [Accepted: 10/22/2020] [Indexed: 12/24/2022] Open
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