Psychosocial aspects of breast cancer treatement in Accra, Ghana

Objectives: To evaluate psychosocial influences and effects of breast cancer treatment.Design: Cohort questionnaire survey.Setting: Surgical Outpatient Department, Korle Bu Teaching Hospital (KBTH), Accra, Ghana.Subjects: Women previously treated for breast cancer, including those still on hormonal therapy.Main outcome measures: Perception of quality of treatment and psychosocial support; and patients’ felt needs for alternative treatment.Results: Eighty nine women treated one to 22 years previously were interviewed. The majority (86%) had mastectomy. Chemotherapy was the most unpleasant aspect of treatment in 58(65.2%), and 27 (30.3%) were not warned about complications of treatment. Thirty eight (42.7%) reported being afraid (frightened or terrified) at the diagnosis; other reactions were shock, devastation, weeping and depression. Twenty two (24.7%) received no counselling and 15 (18.5%) did not have opportunity to express their fears of death 55 (61.8%), mastectomy/deformity 27 (30.3%) and financial incapability 23 (25.8%). Forty four (49.4%) used alternate ‘treatment’, mainly prayer camps (25 cases) and herbs (22 cases), before and during hospital treatment. Use of alternate treatment led to delays in treatment in 23 women. They had complaints about the care they received: lack of sympathy and emotional support (16 cases), lack of information and communication (13 cases), lack of counselling (9 cases) and slow processes (8 cases).Conclusions: Many patients utilise prayer camps and herbs leading to delays in treatment. Breast cancer patients in Ghana (West Africa) are not receiving satisfactory emotional support, communication and counseling. Adequate psychosocial interventions need to be implemented

Pattern of Breast Diseases in Accra: Review of Mammography Reports

Objectives: To document the mammographic patterns in females seeking medical attention in Accra.Design: An analytic retrospective study was conducted using data extracted from mammography request forms and corresponding radiological reports of 180 females. Setting: The radiology departments of Korle-Bu Teaching Hospital, the Trust Hospital and Medical Imaging Ghana, all located in Accra.Results: One hundred and eighty radiologic request forms for mammographic evaluations and their corresponding reports from the study period were reviewed. The mean age of the study population was 48.7 years (SD=10.0), and the median age group was the 41–50 group. There were more screening mammography evaluations (115 examinations) than diagnostic mammography evaluations (65 examinations). Most of the cases diagnosed as breast cancer were in the age group 41–50 years. Benign lesions were commoner than cancer (55 and 16 cases respectively). The commonest presenting complaint was of pain.Conclusion: The larger number of screening mammographic evaluations conducted for asymptomatic females during the study period, as compared to diagnostic mammographic evaluations for symptomatic females, suggests that educational programs on early breast cancer detection are having a positive impact on the target population. The observation that 22.8% of lesions had features suggestive of breast cancer in the study is significantly high to also warrant intensification of the existing awareness programs. As non-specific masses were the most common radiographically observed lesions, hospitals equipped with sonography and biopsy facilities that compliment their mammography are better suited for thorough breast disease evaluation.Keywords: Mammography, sonography, screening study, diagnostic study, ductal carcinoma in situ, invasive ductal carcinoma

Patient age at diagnosis and the clinicopathological features of breast cancer in women

BackgroundBreast cancer (BC) is diagnosed commonly in younger Ghanaian women compared to women in western countries.AimsThe aim of this study was to compare the clinico-pathological features of BC in young women (≤39 years) with older women (≥40 years) and draw conclusions.Methods This was a retrospective review (2001–2014).Results Approximately 19.6per cent of the study population were women aged ≤39 years (Group A). Bilateral BCs were commoner in group A compared to B (women aged 40 years or older), [(1.1per cent vs. 0.6per cent), (p=0.002]. About 60.7 per cent of group A had skin involvement compared to 71.3 per cent for B, (p=0.002). About 75.7 per cent of group A women presented with breast lumps after 3 months of onset (late), compared to 70.1 per cent of group B women (p=0.000). The mean size of primary BC for A was 5.6cm compared to 5.1cm for B, (p=0.004). Positive tumour margins were found in 27.7 per cent of BCs in A and 24.2 per cent in B, (p=0.003). Grade 3 tumours were common in group A than B [(35.8 per cent vs. 31.0 per cent), p=0.002]. Approximately, 70.5 per cent group A women had positive nodes compared to 88.8 per cent of group B (p=0.001). Higher TNM stages were found in group A compared to B [(58.1 per cent vs. 51.1 per cent, p=0.033)].ConclusionThe study found that 19.6 per cent of the women were age 39 years or younger. Features of advanced BC were common in younger women. Routine self-breast examination is recommended for all Ghanaian women to enhance early detection and management of neoplastic lesions

An Audit of Aspects of Informed Consent and Pain Relief in General Surgical Units of Korle Bu Teaching Hospital

There is the need to adequately inform patients about their disease, treatment options, surgery and post-operative complications. Adequate pain relief after surgery leads to less morbidity. Two important aspects of surgical practice are being addressed in this paper, the need for informed consent and post operative pain relief. A questionnaire survey was carried out in 100 patients on the four general surgical wards of the Korle Bu Teaching Hospital, just before they were discharged from hospital. They were asked what they knew or had been informed about their diagnosis, operation and complications of surgery. On pain relief, patients were asked about their experiences on the first post-operative day and what relief they had from analgesics. Twenty four did not know the diagnosis and 36 were not told what operation they were going to have before surgery. Although 75 were eventually told what operation they had, only 64 said they knew the operation. Sixty eight did not know what to expect after surgery; 87 did not know about possible complications. On the first post-operative day there was significant pain (scores 4 and 5) felt by 24 patients at rest and 46 on movement. The most frequently prescribed analgesic was pethidine. Patient information in General surgery at the Korle Bu Teaching Hospital is unsatisfactory. Post-operative analgesia is also poor. There is the need for surgeons to either train doctors to administer consent or administer it themselves. Anaesthetists should assume a leading role in managing post-operative pain