Quality of Breast Cancer Treatment at a Rural Cancer Center in Rwanda
| Autor: | Tharcisse Mpunga, Jean Marie Vianney Dusengimana, Nancy L. Keating, Daniel S. O’Neil, Lydia E. Pace, Vedaste Hategekimana, Aline Umwizera, Lawrence N. Shulman |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Rural Population Cancer Research medicine.medical_specialty Epidemiology Breast Neoplasms Disease Cancer Care Facilities lcsh:RC254-282 Outcomes Research 03 medical and health sciences 0302 clinical medicine Breast cancer Internal medicine Epidemiology of cancer Breast Cancer medicine Humans Quality of Care 030212 general & internal medicine Aged Quality of Health Care Gynecology Aged 80 and over Population and observational studies (SEER WHI observational etc.) business.industry Incidence (epidemiology) Medical record Rwanda Cancer ORIGINAL REPORTS Middle Aged lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens medicine.disease 3. Good health Oncology 030220 oncology & carcinogenesis Cohort Female business |
| Zdroj: | Journal of Global Oncology Journal of Global Oncology, Vol 4, Pp 1-11 (2017) |
| ISSN: | 2378-9506 |
| Popis: | Purpose As breast cancer incidence and mortality rise in sub-Saharan Africa, it is critical to identify strategies for delivery of high-quality breast cancer care in settings with limited resources and few oncology specialists. We investigated the quality of treatments received by a cohort of patients with breast cancer at Butaro Cancer Center of Excellence (BCCOE), Rwanda’s first public cancer center. Patients and Methods We reviewed medical records of all female patients diagnosed with invasive breast cancer at BCCOE between July 2012 and December 2013. We evaluated the provision of chemotherapy, endocrine therapy, surgery, and chemotherapy dose densities. We also applied modified international quality metrics and estimated overall survival using interval-censored analysis. Results Among 150 patients, 28 presented with early-stage, 64 with locally advanced, and 53 with metastatic disease. Among potentially curable patients (ie, those with early-stage or locally advanced disease), 74% received at least four cycles of chemotherapy and 63% received surgery. Among hormone receptor–positive patients, 83% received endocrine therapy within 1 year of diagnosis. Fifty-seven percent of potentially curable patients completed surgery and chemotherapy and initiated endocrine therapy if indicated within 1 year of biopsy. Radiotherapy was not available. At the end of follow-up, 62% of potentially curable patients were alive, 24% were dead, and 14% were lost to follow-up. Conclusion Appropriate delivery of chemotherapy and endocrine therapy for breast cancer is possible in rural sub-Saharan African even without oncologists based on site. Performing timely surgery and ensuring treatment completion were key challenges after the opening of BCCOE. Further investigation should examine persistent quality gaps and the relationship between treatment quality and survival. |
| Databáze: | OpenAIRE |
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