Financial barriers related to breast cancer screening and treatment: A cross-sectional survey of women in Kenya

Subramanian, Sujha; Gakunga, Robai; Jones, Madeleine; Kinyanjui, Asaph; Ochieng, Emily; Gikaara, Nancy; Maluni,; Wata, David; Korir, Anne; Ali, Zipporah

doi:10.1016/j.jcpo.2019.100206

Cited by 11 publications

(28 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Six key elements were identified among financing-related factors: high costs of treatment and investigations, lack of insurance or limited insurance coverage, expensive private insurance and discrimination by private insurance. For instance, some of the breast cancer patients were often not eligible for private health insurance [ 47 ]. The high cost of treatment was reported as an important factor influencing women’s access to breast cancer treatment in 11 studies [ 26 – 30 , 37 , 46 – 50 ].…”

Section: Resultsmentioning

confidence: 99%

“…Lack of or limited insurance coverage was also mentioned as a barrier to care. In the study conducted by Subramanian et al in Kenya, 78% out of 400 women with breast cancer reported borrowing money from family or friends to cover out-of-pocket medical and related expenses [ 47 ]. In another study conducted in the Ivory Coast, 36% out of 126 patients declared having had a delayed diagnosis due to lack of financial resources [ 33 ].…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Health system factors that influence diagnostic and treatment intervals in women with breast cancer in sub-Saharan Africa: a systematic review

et al. 2021

View full text Add to dashboard Cite

Background Breast cancer patients in sub-Saharan Africa experience long time intervals between their first presentation to a health care facility and the start of cancer treatment. The role of the health system in the increasing treatment time intervals has not been widely investigated. This review aimed to identify existing information on health system factors that influence diagnostic and treatment intervals in women with breast cancer in sub-Saharan Africa to contribute to the reorientation of health policies in the region. Methods PubMed, ScienceDirect, African Journals Online, Mendeley, ResearchGate and Google Scholar were searched to identify relevant studies published between 2010 and July 2020. We performed a qualitative synthesis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Related health system factors were extracted and classified according to the World Health Organization’s six health system building blocks. The quality of qualitative and quantitative studies was assessed by using the Critical Appraisal Skills Program Quality-Assessment Tool and the National Institute of Health Quality Assessment Tool, respectively. In addition, we used the Confidence in the Evidence from Reviews of Qualitative Research tool to assess the evidence for each qualitative finding. Results From 14,184 identified studies, this systematic review included 28 articles. We identified a total of 36 barriers and 8 facilitators that may influence diagnostic and treatment intervals in women with breast cancer. The principal health system factors identified were mainly related to human resources and service delivery, particularly difficulty accessing health care, diagnostic errors, poor management, and treatment cost. Conclusion The present review shows that diagnostic and treatment intervals among women with breast cancer in sub-Saharan Africa are influenced by many related health system factors. Policy makers in sub-Saharan Africa need to tackle the financial accessibility to breast cancer treatment by adequate universal health coverage policies and reinforce the clinical competencies for health workers to ensure timely diagnosis and appropriate care for women with breast cancer in this region.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Health system factors that influence diagnostic and treatment intervals in women with breast cancer in sub-Saharan Africa: a systematic review

et al. 2021

View full text Add to dashboard Cite

show abstract

“…In another study conducted in the Ivory Coast, 36% out of 126 patients declared having had a delayed diagnosis due to lack of nancial resources [34]. Many women reported having no insurance coverage [47][48][49]. For instance, Okoronkwo et al found that 71.8% out of 194 patients studied in Nigeria did not have health insurance coverage [48].…”

Section: Health Nancingmentioning

confidence: 99%

“…Unavailability of drugs and equipment failure were the most common factors among those related to medication access and technologies [28,30,32,44,46,47]. Diagnostic assessments were not available in small health centres, and multiple visits were required for X-rays or blood tests or to obtain a biopsy sample, according to interviewees.…”

Section: Medication Access and Technologiesmentioning

confidence: 99%

“…Lack of or limited insurance coverage was also mentioned as a barrier to care. In the study conducted by Subramanian et al in Kenya, 78% out of 400 women with breast cancer reported borrowing money from family or friends to cover out-of-pocket medical and related expenses [47]. In another study conducted in the Ivory Coast, 36% out of 126 patients declared having had a delayed diagnosis due to lack of nancial resources [34].…”

Section: Health Nancingmentioning

confidence: 99%

See 1 more Smart Citation

Health System Factors That Influence Treatment Delay in Women With Breast Cancer in Sub-saharan Africa: A Systematic Review

Gbenonsi

Boucham

Belrhiti

et al. 2021

Preprint

View full text Add to dashboard Cite

BackgroundBreast cancer patients in sub-Saharan Africa experience long delays between their first presentation to a health care facility and the start of cancer treatment. The role of the health system in the increasing delays in treatment has not been widely investigated. This review aimed to identify existing information on health system factors that influence treatment delays in women with breast cancer in sub-Saharan Africa to contribute to the reorientation of health policies in the region.MethodsPubMed, ScienceDirect, African Journals Online, Mendeley, ResearchGate and Google Scholar were searched to identify relevant studies published between 2010 and July 2020. We performed a qualitative synthesis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Related health system factors were extracted and classified according to the World Health Organization’s six health system building blocks. The quality of qualitative and quantitative studies was assessed by using the Critical Appraisal Skills Program quality-assessment tool and the National Institute of Health Quality Assessment Tool, respectively. In addition, we used the Confidence in the Evidence from Reviews of Qualitative Research tool to assess the evidence for each qualitative finding.ResultsFrom 14,184 identified studies, this systematic review included 28 articles. We identified a total of 36 barriers and 8 facilitators that may influence treatment delay in women with breast cancer. The principal health system factors identified were mainly related to human resources and service delivery, particularly difficulty accessing health care, diagnostic errors, poor management, and treatment cost.ConclusionThe present review shows that treatment delay among women with breast cancer in sub-Saharan Africa is influenced by many related health system factors. Policy makers in sub-Saharan Africa need to tackle the financial accessibility to breast cancer treatment by adequate universal health coverage policies and reinforce the clinical competencies for health workers to ensure timely diagnosis and appropriate care for women with breast cancer in this region.

show abstract

Financial Toxicity Among Patients With Breast Cancer Worldwide

Ehsan

Minasian

et al. 2023

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceFinancial toxicity (FT) is the negative impact of cost of care on financial well-being. Patients with breast cancer are at risk for incurring high out-of-pocket costs given the long-term need for multidisciplinary care and expensive treatments.ObjectiveTo quantify the FT rate of patients with breast cancer and identify particularly vulnerable patient populations nationally and internationally.Data SourcesA systematic review and meta-analysis were conducted. Four databases—Embase, PubMed, Global Index Medicus, and Global Health (EBSCO)—were queried from inception to February 2021. Data analysis was performed from March to December 2022.Study SelectionA comprehensive database search was performed for full-text, English-language articles reporting FT among patients with breast cancer. Two independent reviewers conducted study screening and selection; 462 articles underwent full-text review.Data Extraction and SynthesisA standardized data extraction tool was developed and validated by 2 independent authors; study quality was also assessed. Variables assessed included race, income, insurance status, education status, employment, urban or rural status, and cancer stage and treatment. Pooled estimates of FT rates and their 95% CIs were obtained using the random-effects model.Main Outcomes and MeasuresFT was the primary outcome and was evaluated using quantitative FT measures, including rate of patients experiencing FT, and qualitative FT measures, including patient-reported outcome measures or patient-reported severity and interviews. The rates of patients in high-income, middle-income, and low-income countries who incurred FT according to out-of-pocket cost, income, or patient-reported impact of expenditures during breast cancer diagnosis and treatment were reported as a meta-analysis.ResultsOf the 11 086 articles retrieved, 34 were included in the study. Most studies were from high-income countries (24 studies), and the rest were from low- and middle-income countries (10 studies). The sample size of included studies ranged from 5 to 2445 people. There was significant heterogeneity in the definition of FT. FT rate was pooled from 18 articles. The pooled FT rate was 35.3% (95% CI, 27.3%-44.4%) in high-income countries and 78.8% (95% CI, 60.4%-90.0%) in low- and middle-income countries.Conclusions and RelevanceSubstantial FT is associated with breast cancer treatment worldwide. Although the FT rate was higher in low- and middle-income countries, more than 30% of patients in high-income countries also incurred FT. Policies designed to offset the burden of direct medical and nonmedical costs are required to improve the financial health of vulnerable patients with breast cancer.

show abstract

Financial barriers related to breast cancer screening and treatment: A cross-sectional survey of women in Kenya

Cited by 11 publications

References 19 publications

Health system factors that influence diagnostic and treatment intervals in women with breast cancer in sub-Saharan Africa: a systematic review

Health system factors that influence diagnostic and treatment intervals in women with breast cancer in sub-Saharan Africa: a systematic review

Health System Factors That Influence Treatment Delay in Women With Breast Cancer in Sub-saharan Africa: A Systematic Review

Financial Toxicity Among Patients With Breast Cancer Worldwide

Contact Info

Product

Resources

About