Barriers to timely surgery for breast cancer in Rwanda

Schleimer, Lauren E.; Dusengimana, Jean-Marie Vianney; Butonzi, John; Kigonya, Catherine; Natarajan, Abirami; Umwizerwa, Aline; O’Neil, Daniel S.; Costas‐Chavarri, Ainhoa; Majyambere, Jean-Paul; Shulman, Lawrence N.; Keating, Nancy L.; Shyirambere, Cyprien; Mpunga, Tharcisse; Pace, Lydia E.

doi:10.1016/j.surg.2019.06.021

Cited by 8 publications

(9 citation statements)

References 18 publications

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“…An initial search identified 6391 articles of which 193 underwent full-text review (figure 2). Fifty-seven studies were included in our final sample and data extracted 23–78. The full data extraction output is included in the online supplemental appendix 2.…”

Section: Resultsmentioning

confidence: 99%

Delays in seeking, reaching and access to quality cancer care in sub-Saharan Africa: a systematic review

Lombe

Mwamba

Msadabwe³

et al. 2023

BMJ Open

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ObjectivesLate presentation and delays in diagnosis and treatment consistently translate into poor outcomes in sub-Saharan Africa (SSA). The aim of this study was to collate and appraise the factors influencing diagnostic and treatment delays of adult solid tumours in SSA.DesignSystematic review with assessment of bias using Risk of Bias in Non-randomised Studies of Exposures (ROBINS-E) tool.Data sourcesPubMed and Embase, for publications from January 1995 to March 2021.Eligibility criteriaInclusion criteria: quantitative or mixed-method research, publications in English, on solid cancers in SSA countries. Exclusion criteria: paediatric populations, haematologic malignancies, and assessments of public perceptions and awareness of cancer (since the focus was on patients with a cancer diagnosis and treatment pathways).Data extraction and synthesisTwo reviewers extracted and validated the studies. Data included year of publication; country; demographic characteristics; country-level setting; disease subsite; study design; type of delay, reasons for delay and primary outcomes.Results57 out of 193 full-text reviews were included. 40% were from Nigeria or Ethiopia. 70% focused on breast or cervical cancer. 43 studies had a high risk of bias at preliminary stages of quality assessment. 14 studies met the criteria for full assessment and all totaled to either high or very high risk of bias across seven domains. Reasons for delays included high costs of diagnostic and treatment services; lack of coordination between primary, secondary and tertiary healthcare sectors; inadequate staffing; and continued reliance on traditional healers and complimentary medicines.ConclusionsRobust research to inform policy on the barriers to quality cancer care in SSA is absent. The focus of most research is on breast and cervical cancers. Research outputs are from few countries. It is imperative that we investigate the complex interaction of these factors to build resilient and effective cancer control programmes.

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Section: Resultsmentioning

confidence: 99%

Delays in seeking, reaching and access to quality cancer care in sub-Saharan Africa: a systematic review

Lombe

Mwamba

Msadabwe³

et al. 2023

BMJ Open

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“…This work discussed nine barriers to accessing cancer care that included financial burden, fear, problems posed by patient-provider communications, transportation and travelling long distances [37]. A report from Rwanda in Africa also highlighted financial, social and systemic factors leading to delay and disruption in cancer care in women with breast cancer [38]. Our finding of disruptions to health insurance coverage associated with financial hardships was also reported in high-income countries [39].The need for comprehensive national health insurance scheme to support cancer patients has been highlighted for Nepal, a neighbouring country of India [40].…”

Section: Lack Of Information and Indecisiveness Led To Delaysmentioning

confidence: 99%

Journeys: understanding access, affordability and disruptions to cancer care in India

Datta¹,

Ghose²,

Ghosh³

et al. 2022

ecancer

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Background: Much of the global cancer burden is in low-and middle-income countries (LMICs). Along with the high incidence of cancer, most LMICs have unevenly distributed health care resources. This study is a qualitative exploration of the journey of patients accessing cancer care in India and their caregivers. Methods:The study followed a cross-sectional qualitative design. Participants were recruited by stratified purposive sampling, and all common cancers in India as reported by the GLOBOCAN database were included in the study. Consenting patients and their caregivers were interviewed using in-depth interview techniques. The data was analysed using principles of qualitative content analysis.Results: Cancer patients (n = 100) and their caregivers (n = 48) were interviewed for the study. The six themes that emerged were related to a) the journey of patients to access care, b) the psychological journey of patients, c) stigma of cancer patients, d) decisionmaking and adherence to treatment, e) economic costs of cancer care and its impact and f) modifiers to accessing cancer care. Conclusions:Planning and policymaking in the future of cancer care delivery need to consider the views expressed by the cancer patients and their caregivers as regards to access, adherence and disruptions to cancer care in India. Future policies will hopefully address some of the difficulties faced by patients.

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“…The percentage of patients who received curative-intent surgery at HUM (80%) was on par with other reports from the Caribbean and other LICs; a recent study from Trinidad reported 86% surgery completion rates, while one from Rwanda reported 76% [ 24 , 25 ]. However, of the 63 patients who did not receive surgery, 73% were lost to follow up.…”

Section: Discussionmentioning

confidence: 61%

“…These times are on par with other studies in similar settings; in a review from sub-Saharan Africa, more than half of the patients had upfront surgery delays exceeding 3 months. [ 30 ] Similarly, a Rwandan cohort noted time to surgery of over 50 days among those who received NAC [ 25 ]. These times are substantially longer than those in the United States, where the median time from initial consultation to breast surgery is 29 days for those receiving upfront surgery [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

“…Second, the 12-week definition of treatment delays represents an artificial binary cutoff. Although 12 weeks was chosen based on the cohort distribution and based on other studies’ thresholds of clinically meaningful delays, shorter delays of as little as 4 weeks may also have clinical consequences [ 12 , 25 ]. While examining a range of time delays, such as 4–8, 9–12 weeks, > 12 weeks, would have been optimal, this analysis was not possible due to the limited study sample size.…”

Section: Discussionmentioning

confidence: 99%

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Gaps in completion and timeliness of breast surgery and adjuvant therapy: a retrospective cohort of Haitian patients with nonmetastatic breast cancer

Fadelu

Erfani

Lormil³

et al. 2022

Breast Cancer Res Treat

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Background There are limited data on breast surgery completion rates and prevalence of care-continuum delays in breast cancer treatment programs in low-income countries. Methods This study analyzes treatment data in a retrospective cohort of 312 female patients with non-metastatic breast cancer in Haiti. Descriptive statistics were used to summarize patient characteristics; treatments received; and treatment delays of > 12 weeks. Multivariate logistic regressions were performed to identify factors associated with receiving surgery and with treatment delays. Exploratory multivariate survival analysis examined the association between surgery delays and disease-free survival (DFS). Results Of 312 patients, 249 (80%) completed breast surgery. The odds ratio (OR) for surgery completion for urban vs. rural dwellers was 2.15 (95% confidence interval [CI]: 1.19–3.88) and for those with locally advanced vs. early-stage disease was 0.34 (95%CI: 0.16–0.73). Among the 223 patients with evaluable surgery completion timelines, 96 (43%) experienced delays. Of the 221 patients eligible for adjuvant chemotherapy, 141 (64%) received adjuvant chemotherapy, 66 of whom (47%) experienced delays in chemotherapy initiation. Presentation in the later years of the cohort (2015–2016) was associated with lower rates of surgery completion (75% vs. 85%) and with delays in adjuvant chemotherapy initiation (OR [95%CI]: 3.25 [1.50–7.06]). Exploratory analysis revealed no association between surgical delays and DFS. Conclusion While majority of patients obtained curative-intent surgery, nearly half experienced delays in surgery and adjuvant chemotherapy initiation. Although our study was not powered to identify an association between surgical delays and DFS, these delays may negatively impact long-term outcomes.

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Barriers to timely surgery for breast cancer in Rwanda

Cited by 8 publications

References 18 publications

Delays in seeking, reaching and access to quality cancer care in sub-Saharan Africa: a systematic review

Delays in seeking, reaching and access to quality cancer care in sub-Saharan Africa: a systematic review

Journeys: understanding access, affordability and disruptions to cancer care in India

Gaps in completion and timeliness of breast surgery and adjuvant therapy: a retrospective cohort of Haitian patients with nonmetastatic breast cancer

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