Breast Cancer in Low- and Middle-Income Countries

Martei, Yehoda M.; Pace, Lydia E.; Brock, Jane E.; Shulman, Lawrence N.

doi:10.1016/j.cll.2017.10.013

Cited by 73 publications

(57 citation statements)

References 65 publications

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“…The studies in this scoping review focused mainly on women’s cancers, predominantly breast and cervical cancer [6, 32, 34, 35, 37, 39–43], highlighting another gap in the evidence on patient navigation in cancer care. The over-representation of women’s cancers in this literature might be because breast and cervical cancer are among the most common cancer types in women in LMICs, and also because women often face additional social and/or cultural barriers [26, 44, 45] that can impact their opportunities to seek care for a new symptom, to be diagnosed at earlier stage of disease [46] and to complete their care pathway, from diagnosis through treatment and follow-up care.…”

Section: Discussionmentioning

confidence: 99%

Patient navigation services for cancer care in low-and middle-income countries: A scoping review

Dalton

Holzman

Erwin³

et al. 2019

PLoS ONE

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BackgroundNearly 70% of all cancer deaths occur in low- and middle-income countries (LMICs) and many of these cancer deaths are preventable. In high-income countries (HICs), patient navigation strategies have been successfully implemented to facilitate the patient’s journey at multiple points along the cancer care continuum. The purpose of this scoping review is to understand and describe the scope of patient navigation interventions and services employed in LMICs.MethodsA systematic search of published articles was conducted including Medline, Biosis, Embase, Global Health, and Web of Science. Articles were examined for evidence of patient navigation interventions used in cancer care in LMICs. Evidence was synthesized by navigation service provided and by type of outcome.ResultsFourteen studies reported on patient navigation interventions in cancer care in low-income and middle-income countries in Asia, South America, and Africa. Most studies reported on women’s cancers and included navigation interventions at most points along the cancer care continuum i.e. awareness, education, screening participation, adherence to treatment and surveillance protocols.ConclusionFew studies report on cancer patient navigation in LMICs. With the use of an implementation science framework, patient navigation research can explore a broader range of outcomes to better evaluate its potential role in improving cancer control in LMICs.

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Section: Discussionmentioning

confidence: 99%

Patient navigation services for cancer care in low-and middle-income countries: A scoping review

Dalton

Holzman

Erwin³

et al. 2019

PLoS ONE

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“…Limited diagnostic pathology capacity is also a recognized barrier in the delivery of breast cancer care in low‐resource settings [37, 38]. Diagnostic pathology capacity in Haiti was centralized to a few labs in the capital city of Port‐au‐Prince until 2016.…”

Section: Discussionmentioning

confidence: 99%

Patient Characteristics and Outcomes of Nonmetastatic Breast Cancer in Haiti: Results from a Retrospective Cohort

Fadelu

Damuse²,

Lormil³

et al. 2020

The Oncologist

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Background There are few studies on breast cancer outcomes in the Caribbean region. This study identified a retrospective cohort of female patients with nonmetastatic breast cancer in Haiti and conducted survival analyses to identify prognostic factors that may affect patient outcomes. Methods The cohort included 341 patients presenting between June 2012 and December 2016. The primary endpoint was event‐free survival (EFS), defined as time to disease progression, recurrence, or death. Descriptive summaries of patient characteristics and treatments were reported. Survival curves were plotted using Kaplan‐Meier estimation. Multivariate survival analyses were performed using Cox proportional hazards regression. Results Median age at diagnosis was 49 years, with 64.2% being premenopausal. Most patients (55.1%) were staged as locally advanced. One hundred and sixty patients received neoadjuvant therapy: 33.3% of patients with early stage disease and 61.2% of those with locally advanced stage disease. Curative‐intent surgery was performed in 278 (81.5%) patients, and 225 patients received adjuvant therapy. Adjuvant endocrine therapy was used in 82.0% of patients with estrogen receptor–positive disease. During the follow‐up period, 28 patients died, 77 had disease recurrence, and 10 had progressive disease. EFS rates at 2 years and 3 years were 80.9% and 63.4%, respectively. After controlling for multiple confounders, the locally advanced stage group had a statistically significant adjusted hazard ratio for EFS of 3.27 compared with early stage. Conclusion Patients with nonmetastatic breast cancer in Haiti have more advanced disease, poorer prognostic factors, and worse outcomes compared with patients in high‐income countries. Despite several limitations, curative treatment is possible in Haiti. Implications for Practice Patients with breast cancer in Haiti have poor outcomes. Prior studies show that most Haitian patients are diagnosed at later stages. However, there are no rigorous studies describing how late‐stage diagnosis and other prognostic factors affect outcomes in this population. This study presents a detailed analysis of survival outcomes and assessment of prognostic factors in patients with nonmetastatic breast cancer treated in Haiti. In addition to late‐stage diagnosis, other unfavorable prognostic factors identified were young age and estrogen receptor‐negative disease. The study also highlights that the availability of basic breast cancer treatment in Haiti can lead to promising early patient outcomes.

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“…Finally, detailed BC registries are of ultimate importance to assess every country's disease burden, which will guide disease prioritization and allocation of resources for BC care [ 118 ], along with longitudinal registries for BC patients to capture COVID-19 infection behavior.…”

Section: Future Perspectivesmentioning

confidence: 99%

Implementation of Breast Cancer Continuum of Care in Low- and Middle-Income Countries During the COVID-19 Pandemic

et al. 2020

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Breast cancer is the most common malignancy among women worldwide. The current COVID-19 pandemic represents an unprecedented challenge leading to care disruption, which is more severe in low- and middle-income countries (LMIC) due to existing economic obstacles. This review presents the global perspective and preparedness plans for breast cancer continuum of care amid the COVID-19 outbreak and discusses challenges faced by LMIC in implementing these strategies. Prioritization and triage of breast cancer patients in a multidisciplinary team setting are of paramount importance. Deescalation of systemic and radiation therapy can be utilized safely in selected clinical scenarios. The presence of a framework and resource-adapted recommendations exploiting available evidence-based data with judicious personalized use of current resources is essential for breast cancer care in LMIC during the COVID-19 pandemic.

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Breast Cancer in Low- and Middle-Income Countries

Cited by 73 publications

References 65 publications

Patient navigation services for cancer care in low-and middle-income countries: A scoping review

Patient navigation services for cancer care in low-and middle-income countries: A scoping review

Patient Characteristics and Outcomes of Nonmetastatic Breast Cancer in Haiti: Results from a Retrospective Cohort

Implementation of Breast Cancer Continuum of Care in Low- and Middle-Income Countries During the COVID-19 Pandemic

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