Inequities in breast cancer treatment in sub-Saharan Africa: findings from a prospective multi-country observational study
Inequities in breast cancer treatment in sub-Saharan Africa: findings from a prospective multi-country observational study
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DOI：
10.1186/s13058-019-1174-4
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发表时间：
2019-08-13
影响因子：
7.4
通讯作者：
McCormack, Valerie
中科院分区：
文献类型：
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作者：
Foerster, Milena;Anderson, Benjamin O.;McCormack, Valerie
提高撒哈拉以南非洲（SSA）乳腺癌生存率是迫切需要的，需要早期诊断和改善治疗。然而，关于该地区接受乳腺癌治疗的类型和障碍的数据有限，尚未在不同的撒哈拉以南非洲国家和治疗环境之间进行比较。方法：在乌干达、尼日利亚和纳米比亚前瞻性非洲乳腺癌-结果差异队列研究的不同医疗保健机构中，我们评估了接受癌症治疗（系统性、手术和/或放疗）的新诊断乳腺癌患者的百分比及其社会人口统计学和临床决定因素。治疗数据是从医疗记录中系统提取的，以及在6个月的随访访谈中妇女的自我报告，并用于生成诊断后12个月内接受治疗的二元指标（是/否），并通过逻辑回归进行分析。结果在1325名女性中，227名（17%）女性和185名（14%）I-III期疾病女性在诊断后1年内未开始癌症治疗。在尼日利亚的两家地区医院，未接受治疗的比例最高，314名妇女中有38%未接受治疗（I-III期为32%）。在乌干达的一家国家转诊医院，430名妇女中有18%没有得到治疗（15%在I-III期）。相比之下，在纳米比亚温得和克的一个癌症护理中心，所有非黑人妇女（100%）和几乎所有黑人妇女（98.7%）都开始接受治疗，该中心向病人提供免费治疗。来自社会经济地位较低群体的妇女、相信传统医学的妇女以及乌干达艾滋病毒阳性妇女的未经治疗妇女的死亡率较高。自我报告的治疗障碍证实治疗费用和拒绝治疗是不接受治疗的原因。结论：需要提供财政支持，以确保治疗的获得和治疗益处的教育，以改善撒哈拉以南非洲地区乳腺癌患者的治疗机会，特别是在区域治疗中心，社会经济地位较低的群体，以及艾滋病毒阳性的乳腺癌妇女。
Background Improving breast cancer survival in sub-Saharan Africa (SSA) is urgently needed, requiring early diagnosis and improved access to treatment. However, data on the types of and barriers to receiving breast cancer therapy in this region are limited and have not been compared between different SSA countries and treatment settings. Methods In different health care settings across Uganda, Nigeria and Namibian sites of the prospective African Breast Cancer - Disparities in Outcomes cohort study, we assessed the percentage of newly diagnosed breast cancer patients who received treatment (systemic, surgery and/or radiotherapy) for cancer and their socio-demographic and clinical determinants. Treatment data were systematically extracted from medical records, as well as self-reported by women during 6-month follow-up interviews, and were used to generate a binary indicator of treatment received within 12 months of diagnosis (yes/no), which was analysed via logistic regression. Results Of 1325 women, cancer treatment had not been initiated treatment within 1 year of diagnosis for 227 (17%) women and 185 (14%) of women with stage I-III disease. Untreated percentages were highest in two Nigerian regional hospitals where 38% of 314 women were not treated (32% among stage I-III). At a national referral hospital in Uganda, 18% of 430 women were not treated (15% among stage I-III). In contrast, at a cancer care centre in Windhoek, Namibia, where treatment is provided free to the patient, all non-black (100%) and almost all (98.7%) black women had initiated treatment. Percentages of untreated women were higher in women from lower socio-economic groups, women who believed in traditional medicine and, in Uganda, in HIV+ women. Self-reported treatment barriers confirmed treatment costs and treatment refusal as contributors to not receiving treatment. Conclusions Financial support to ensure treatment access and education of treatment benefits are needed to improve treatment access for breast cancer patients across sub-Saharan Africa, especially at regional treatment centres, for lower socio-economic groups, and for the HIV-positive woman with breast cancer.