Caring for patients with surgically resectable cancers: experience from a specialised centre in rural Rwanda

Abstract

Surgical care was provided for many cancer patients referred to BCCOE. However, challenges such as inadequate surgical infrastructure and skills, and patients presenting late with advanced and unresectable disease can limit the ability to manage all cases. This study highlights opportunities and challenges in cancer care relevant to other hospitals in rural settings.

Surgical oncology at a major referral center in Ghana: Burden, staging, and outcomes

“…Similar to other reports in the literature from SSA, the most common cancer types seen here were breast, colorectal, and foregut . Majority of all admitted patients went on to undergo surgery (208, 61%) which is slightly higher than rates previously reported from Rwanda, where 46% of patients presenting for surgical evaluation underwent an operation . In addition, most patients in our study who underwent surgery did so with curative intent (124, 60%).…”

“…Adequate staging is critical to inform cancer care; however, it requires a host of expensive consumable materials, specific infrastructure (eg, consistent refrigeration, lab equipment, computed tomography/positron emission tomography (CT/PET) scanners), and specialized human resources (pathologists, diagnostic radiologists, nuclear medicine physicians, etc) often not readily accessible to many LMIC patients . These challenges in providing adequate staging information are especially acute in SSA, hindering appropriate allocation of treatment and ultimately worsening patient outcomes …”

A national framework for breast cancer control: A report on Rwanda’s inaugural symposium on the management of breast cancer

“…Patients who saw a traditional healer in Rwanda before a nurse or doctor were also significantly more likely to have delay in presentation to a health care facility [17]. Lack of education on BC, its risk factors, presentation, and management can also result in delayed presentation to a health facility [15][16][17]21,22].…”

“…Rwanda has been a leader in advancing the NCD agenda in LMICs, targeting an even more ambitious goal to reduce pre-mature mortality from all NCDs including injuries by 80% in individuals younger than 40 years by the year 2020 (the "80 × 40 × 20" agenda) [14]. In this context, controlling cancer, an NCD, has been a national priority for the MOH in Rwanda [15].…”

“…But diagnosis and treatment of cancer, especially breast cancer, the most common adult cancer diagnosed at referral facilities in Rwanda, lags behind [15]. In order to build capacity for and access to cancer diagnosis and treatment, in July 2012, with financial and technical support from PIH and DFCI, the MOH opened a national cancer referral center at a rural district hospital, Butaro Cancer Center of Excellence (BCCOE) [16].…”