Effect Of Socio-Cultural Beliefs On Late Stage Presentation Of Breast Cancer Among Ghanaian Women

ABSTRACT EFFECT OF SOCIO-CULTURAL BELIEFS ON LATE STAGE PRESENTATION OF BREAST CANCER AMONG GHANAIAN WOMEN. Yehoda M. Martei; Verna Vanderpuye; and Beth A. Jones. Yale University, School of Medicine, New Haven, CT. New data emphasizes the increasing burden of cancer in the developing world, which has led to an increasing move to prioritize cancer care on the global health agenda. Breast cancer is the leading cause of cancer mortality among women globally. In Ghana, most women present with advanced stage breast cancer. There is currently no national screening program, and insight into why women present late stage is limited. The aim of this study is to characterize why women present with advanced stage breast cancer in Ghana. We used a Qualitative study based on in-person and in-depth interviews with 31 breast cancer patients seen at the Korle-bu Teaching Hospital in Ghana. The interview data was transcribed, and coded based on the Grounded theory method. Data was organized using NVivo 9 software. Five recurrent themes emerged from our study with four explicitly related to late stage at presentation: 1) Study participants expressed some awareness of breast cancer, but with varying depths of knowledge; 2) most patients present late because they do not associate a painless breast lump with possible breast malignancy; 3) women with a confirmed breast cancer diagnosis, delay treatment because of the fear of mastectomy; 4) religion plays an important supportive role for breast cancer patients. 5) A fifth factor was not explicitly related to delayed presentation. Breast cancer treatment presents a significant financial burden but was not stated as an explicit reason for delayed presentation. We concluded that despite efforts to increase awareness, there are still significant knowledge gaps, and social and cultural factors that need to be addressed to enable patients translate this information to their personal health. The church\u27s current role can be leveraged to augment current efforts to increase breast cancer awareness and utilization of the current services available. Successful design and implementation of cancer programs hinge on attention to socio-cultural influences on advanced stage presentation

Breast Cancer and HIV in Sub-Saharan Africa: A Complex Relationship

Introduction: The number and lifespan of individuals living with HIV have increased significantly with the scale-up of antiretroviral therapy. Furthermore, the incidence of breast cancer in women with HIV is growing, especially in sub-Saharan Africa (SSA). However, the association between HIV infection and breast cancer is not well understood. Methods: A literature search was performed to identify articles published in journals pertaining to breast cancer and HIV, with an emphasis on SSA. Selected US-based studies were also identified for comparison. Results: Among the 56 studies reviewed, the largest study examined 314 patients with breast cancer and HIV in the United States. There is no consensus on whether HIV infection acts as a pro-oncogenic or antioncogenic factor in breast cancer, and it may have no relation to breast cancer. A higher incidence of breast cancer is reported in high-income countries than in SSA, although breast cancer in SSA presents at a younger age and at a more advanced stage. Some studies show that patients with breast cancer and HIV experience worse chemotherapy toxicity than do patients without HIV. Data on treatment outcomes are limited. The largest study showed worse treatment outcomes in patients with HIV, compared with their counterparts without HIV. Conclusion: HIV infection has not been associated with different clinical presentation of breast cancer. However, some evidence suggests that concurrent diagnosis of HIV with breast cancer is associated with increased therapy-related toxicity and worse outcomes. Systematic prospective studies are needed to establish whether there is a specific association between breast cancer and HIV

Availability of WHO Essential Medicines for Cancer Treatment in Botswana

Purpose: Stock outs of cancer drugs are potentially fatal but have not been systematically studied in low- and middle-income countries. The aim of this study was to determine the availability and alignment of the Botswana National Essential Medicines List (NEML) for cancer drugs with the WHO’s Essential Medicines List (EML). Methods: The availability and cost of cancer drugs were analyzed using data from a weekly stock catalog sent by Botswana’s Central Medical Store to all pharmacy departments in government hospitals. Comparative data were extracted from the WHO EML and the “International Drug Price Indicator Guide-2014” from the Management Sciences for Health. Interviews with key informants were used to collect data on the Botswana NEML and the drug supply chain in the public sector. Results: The 2015 Botswana NEML for cancer had 80.5% alignment with the WHO EML. At least 40% of essential drugs were out of stock for a median duration of 30 days in 2015. Stock outs affected chemotherapy drugs included in first-line regimens for treating potentially curable diseases such as cervical, breast, and colorectal cancer and were not associated with buyer price of therapy. Analyses showed that the median price ratio for procured drugs was greater than 1 for 61% of the NEML drugs, which suggests inefficiency in procurement in the public sector. Conclusions: Botswana has one of the highest alignments of NEML to the WHO EML in the sub-Saharan African region, which is consistent with investment in the health care system evident in other clinical spheres. Better quantification of chemotherapy requirements using data from the National Cancer Registry and resource-sensitive treatment guidelines can help reduce stock outs and facilitate more effective and efficient procurement processes

Methodology to Forecast Volume and Cost of Cancer Drugs in Low- and Middle-Income Countries

Purpose: In low- and middle-income countries (LMICs), frequent outages of the stock of cancer drugs undermine cancer care delivery and are potentially fatal for patients with cancer. The aim of this study is to describe a methodologic approach to forecast chemotherapy volume and estimate cost that can be readily updated and applied in most LMICs. Methods: Prerequisite data for forecasting are population-based incidence data and cost estimates per unit of drug to be ordered. We used the supplementary guidelines from the WHO list of essential medicines for cancer to predict treatment plans and ordering patterns. We used de-identified aggregate data from the Botswana National Cancer Registry to estimate incident cases. The WHO Management Sciences for Health International Price Indicator was used to estimate unit costs per drug. Results: Chemotherapy volume required for incident cancer cases was estimated as the product of the standardized dose required to complete a full treatment regimen per patient, with a given cancer diagnosis and stage, multiplied by the total number of incident cancer cases with the respective diagnosis. The estimated chemotherapy costs to treat the 10 most common cancers in the public health care sector of Botswana is approximately 2.3 million US dollars. An estimated 66% of the budget is allocated to costs of rituximab and trastuzumab alone, which are used by approximately 10% of the cancer population. Conclusion: This method provides a reproducible approach to forecast chemotherapy volume and cost in LMICs. The chemotherapy volume and cost outputs of this methodology provide key stakeholders with valuable information that can guide budget estimation, resource allocation, and drug-price negotiations for cancer treatment. Ultimately, this will minimize drug shortages or outages and reduce potential loss of lives that result from an erratic drug supply

Cancer care workforce in Africa:Perspectives from a global survey

BackgroundWhile the burden of cancer in Africa is rapidly rising, there is a lack of investment in healthcare professionals to deliver care. Here we report the results of a survey of systemic therapy workload of oncologists in Africa in comparison to oncologists in other countries.MethodsAn online survey was distributed through a snowball method via national oncology societies to chemotherapy-prescribing physicians in 65 countries. The survey was distributed within Africa through a network of physicians associated with the African Organisation for Research and Training in Cancer (AORTIC). Workload was measured as the annual number of new cancer patient consults seen per oncologist. Job satisfaction was ranked on a 10-point Likert scale; scores of 9-10 were considered to represent high job satisfaction.ResultsThirty-six oncologists from 18 countries in Africa and 1079 oncologists from 47 other countries completed the survey. Compared to oncologists from other countries, African oncologists were older (median age 51 vs 44years, p=0.007), more likely to prescribe chemotherapy and radiation [61% (22/36) vs 10% (108/1079), p500 consults/year was 31% (11/36) in Africa compared to 12% (129/1079) in other countries (p=0.001). African oncologists were more likely than global colleagues to see all cancer sites [72% (26/26) vs 24% (261/1079), p<0.001]. Oncologists in Africa were less likely than other oncologists to have high job satisfaction [17% (6/36) vs 30% (314/1079), p=0.013].ConclusionAfrican oncologists within the AORTIC network have a substantially higher clinical workload and lower job satisfaction than oncologists elsewhere in the world. There is an urgent need for governments and health systems to improve the oncologist-to-patient ratio and develop new models of capacity building, retention and skills enhancement to strengthen the wide variety of cancer care systems across continental Africa

Corrigendum: Training Global Oncologists: Addressing the Global Cancer Control Problem

[This corrects the article on p. 80 in vol. 5, PMID: 25905040.]