PurposeAs breast cancer incidence and mortality rise in sub-Saharan Africa, it is
critical to identify strategies for delivery of high-quality breast cancer
care in settings with limited resources and few oncology specialists. We
investigated the quality of treatments received by a cohort of patients with
breast cancer at Butaro Cancer Center of Excellence (BCCOE), Rwanda’s
first public cancer center.Patients and MethodsWe reviewed medical records of all female patients diagnosed with invasive
breast cancer at BCCOE between July 2012 and December 2013. We evaluated the
provision of chemotherapy, endocrine therapy, surgery, and chemotherapy dose
densities. We also applied modified international quality metrics and
estimated overall survival using interval-censored analysis.ResultsAmong 150 patients, 28 presented with early-stage, 64 with locally advanced,
and 53 with metastatic disease. Among potentially curable patients (ie,
those with early-stage or locally advanced disease), 74% received at least
four cycles of chemotherapy and 63% received surgery. Among hormone
receptor–positive patients, 83% received endocrine therapy within 1
year of diagnosis. Fifty-seven percent of potentially curable patients
completed surgery and chemotherapy and initiated endocrine therapy if
indicated within 1 year of biopsy. Radiotherapy was not available. At the
end of follow-up, 62% of potentially curable patients were alive, 24% were
dead, and 14% were lost to follow-up.ConclusionAppropriate delivery of chemotherapy and endocrine therapy for breast cancer
is possible in rural sub-Saharan African even without oncologists based on
site. Performing timely surgery and ensuring treatment completion were key
challenges after the opening of BCCOE. Further investigation should examine
persistent quality gaps and the relationship between treatment quality and
survival.
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