Access to care and financial burden for patients with breast cancer in Ghana, Kenya, and Nigeria.

Abstract

6562 Background: Breast cancer is the most frequently diagnosed malignancy and the most common cause of cancer-related death in women in Ghana, Kenya, and Nigeria. We evaluated healthcare resource use and financial burden for patients treated at tertiary cancer centers in these countries. Methods: Records of breast cancer patients treated at the following government/private tertiary centers were included – Ghana: Korle-Bu Teaching Hospital and Sweden Ghana Medical Centre; Kenya: Kenyatta National Hospital and Aga Khan University Hospital; Nigeria: National Hospital Abuja and Lakeshore Cancer Center. Patients presenting within a prespecified 2-year period were followed until death or loss to follow-up. Results: The study included 299 patient records from Ghana, 314 from Kenya, and 249 from Nigeria. The use of common screening modalities (eg, mammogram, breast ultrasound) was < 45% in all 3 countries. Use of core needle biopsy was 76% in Kenya and Nigeria, but only 50% in Ghana. Across the 3 countries, 91-98% of patients completed blood count/chemistry, whereas only 78-88% completed tests for hormone receptor and human epidermal growth factor receptor 2 (HER2). Most patients underwent surgery: mastectomy (64-67%) or breast-conserving Most patients in Ghana and Nigeria (87-93%) paid for their diagnostic tests entirely out of pocket (OOP) compared with 30-32% in Kenya. Similar to diagnostic testing, the proportion of patients paying OOP only for treatments was high: 72-89% in Nigeria, 45-79% in Ghana, and 8-20% in Kenya. Among those receiving HER2-targeted therapy, average number of cycles was 5 for patients paying OOP only vs 14 for patients with some level of insurance coverage. Conclusions: Patients treated in tertiary facilities in sub-Saharan African countries lack access to common imaging modalities and systemic therapies. Most patients in Ghana and Nigeria bore the full cost of their breast cancer care, suggestive of privileged financial status. Access to screening/diagnosis and appropriate care is likely to be substantively lower for the general population.

Breast Cancer Diagnostics, Therapy, and Outcomes in Sub-Saharan Africa: A Population-Based Registry Study

“…Limited access to these main forms of therapy has been described for SSA, 12 linked to both geographic and financial inaccessibility, with most women having to pay out-of-pocket for healthcare. 13,14 In this study, surgery was the most available therapy option, with 64.2% of women in the traced cohort having a record of surgery. Still, many women never received surgery because of either inoperable or stage IV disease, fear of disfigurement, lack of access to surgery, or options to use neoadjuvant chemotherapy.…”

Socioeconomic impact of breast cancer on young women in Ghana: A qualitative study

“…With these financial challenges faced by these women, they had to rely on family members, employers and other people for assistance to enable them go through treatment. A lot of studies have reported similar findings (Sanuade et al, 2018;Twahir et al, 2019;White-Means, Dapremont, Davis, & Thompson, 2020). Amid the financial difficulties, some employers promised to assist some participants with payment of hospital bills;…”

“…The high cost of breast cancer treatments as reported in the study supports several similar findings from different context including low‐ and middle‐income countries (Ekwueme & Trogdon, 2016; Pisu et al., 2017). Currently, financing cancer treatment in Ghana comes as the sole responsibility of the individual patients and the treatment begins with a series of diagnostic investigations that are typically financed out of pocket payment (Twahir et al., 2019; Vanderpuye et al., 2017). Furthermore, the three available treatment strategies: chemotherapy, surgical interventions and radiotherapy are associated with exorbitant costs over a long period (Vanderpuye et al., 2017).…”

Effect of a novel pilot support group on distress and quality of life in breast cancer patients in Nigeria

“…With the high level of poverty in Nigeria, most patients still bear the full cost of their breast cancer screening/diagnosis and treatment from out of pocket indicating that only the privileged may be able to afford cancer care. 19 Provision of electronic online support group system may increase the number of willing patients and help to reduce attrition rate.…”