Sociodemographic factors associated with cancer treatment completion among women with breast cancer at Butaro Cancer Center of Excellence (BCCOE) in Rwanda.

e19220 Background: Many barriers exist to delivering comprehensive breast cancer care in low-income countries. We examined sociodemographic factors associated with treatment completion among women receiving care for breast cancer at Butaro Cancer Center of Excellence (BCCOE), Rwanda’s first public cancer facility. Methods: We retrospectively measured treatment completion rates in women with early and locally advanced breast cancer diagnosed at BCCOE between July 1, 2012 and December 31, 2016. We defined treatment completion as receipt of surgery, 4 cycles of chemotherapy, and initiation of hormonal therapy for estrogen receptor positive (ER+) breast cancer. We used logistic regression to examine associations between socio-demographic and clinical factors and treatment completion. Travel time was estimated using a geographic information systems model using the WHO tool AccessMod 5.0. Results: Of 212 eligible women, 138 (65%) had surgery and 141 (66%) received 4 cycles of chemotherapy. Among 139 women with ER+ cancer, 59% initiated hormonal therapy. Overall 56% received all indicated treatment including surgery, chemotherapy, and hormonal therapy (if ER positive); 44% did not complete indicated treatment. Women who lived closer to the hospital ( <50 minutes travel time) were more likely than other women to complete treatment (OR 4.2; 95% CI 1.1-15.1). Women with early-stage disease were also more likely than women with locally advanced disease to complete treatment (OR 2.2, 95% CI 1.1-4.4). Among 100 women with available information about ubudehe (Rwandan social categorization used as a proxy for socioeconomic status), rates of treatment completion were higher for women who were eligible for social support (ie: transportation support or insurance subsidy) than women who were not (74% v. 63%), although this difference was not statistically significant (p= 0.51). Conclusions: Significant barriers exist for breast cancer patients receiving treatment in this low resource setting; nevertheless, over half of the patients completed therapy. Interventions are needed to facilitate care for women with long travel times and locally advanced disease to reduce disparities in outcomes for this population of patients. Further research is needed to determine the role of social support in treatment completion.

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Effect of chemotherapy and psychosocial distress parameters on perceived cognitive disturbances in Asian breast cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.9041 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 9041-9041

Author(s):

Yin Ting Cheung ◽

Maung Shwe Ham Guo ◽

Wai Keung Chui ◽

Rebecca Alexandra Dent ◽

Yoon Sim Yap ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Psychosocial Factors ◽

Hormonal Therapy ◽

Psychosocial Distress ◽

Cancer Center ◽

Breast Cancer Patients ◽

Cognitive Changes ◽

Factors Associated ◽

Cognitive Disturbances

9041 Background: A qualitative study has revealed that Asian breast cancer patients attributed their post-chemotherapy cognitive disturbances to psychosocial distress. To validate this claim, we aim to examine perceived cognitive disturbances, anxiety and quality of life (QoL) in Asian breast cancer patients and to identify clinical and psychosocial factors associated with perceived cognitive disturbances. Methods: A prospective, observational study was held at the largest cancer center in Singapore. Chemotherapy (CT) and non-chemotherapy (non-CT) receiving breast cancer patients completed self- reported questionnaires to assess the following domains: patients’ perceived impact of chemotherapy on cognitive disturbances (FACT-Cog), health-related QoL (EORTC QLQ-C30) and anxiety (Beck Anxiety Inventory). Multiple regression was conducted to delineate factors associated with perceived cognitive impairment. Results: A total of 166 (1:1 CT/non-CT) patients were recruited (age: 54.1±10.2 years; 78.9% Chinese; 53.6% post-menopausal). Most of the CT patients received anthracycline-based chemotherapy (93.1%) and anti-hormonal therapy (69.4%). Comparing to non-CT patients, CT patients experienced more fatigue (QLQ-C30 fatigue scores: 22.2 vs 33.3 points; p=0.005), more significant anxiety (8.6% vs 21.9%; p=0.002), and more cognitive disturbances (FACT-Cog scores: 110 vs 124 points; p<0.0001). Regression model identified chemotherapy, anti-hormonal therapy, emotional functioning and global health status to be strongly associated with cognitive disturbances in Asian breast cancer patients. The interacting effect between anxiety and fatigue, comparing to fatigue alone, was more associated with cognitive disturbances (β=-0.212; p=0.032 vs β=-0.07; p=0.25, respectively). Conclusions: This is the first study to demonstrate that Asian breast cancer patients experiencing both fatigue and anxiety are more predisposed to cognitive disturbances. Post-chemotherapy cognitive changes are observed in our patients, and our results suggest that psychosocial factors are impactful to identify cancer patients who are more susceptible to cognitive disturbances.

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Breast Cancer Surgery at a Cancer Center in Janakpurdham: An Initial Experience

Journal of Institute of Medicine ◽

10.3126/jiom.v42i1.37449 ◽

2020 ◽

Vol 42 (1) ◽

pp. 72

Author(s):

Pamesh Jha ◽

Anshu K Thakur ◽

Sanjay Gupta ◽

Richa Mishra ◽

Yogendra P Singh

Keyword(s):

Breast Cancer ◽

Advanced Disease ◽

Locally Advanced ◽

Paget’S Disease ◽

Paget's Disease ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

Cancer Center ◽

Locally Advanced Disease ◽

Cancer Hospital

Introduction Breast cancer is the second commonest cancer in Nepalese women. In most of the low income countries including Nepal, breast cancer is commonly diagnosed at late stage. The Binaytara Foundation Cancer Center (BTFCC), a 25 bed cancer hospital was established in Province 2, the most densely populated province, of Nepal in December 2018. We describe our experience of breast cancer surgery at the cancer hospital. MethodsSurgical service was started from April 2019 after establishing an equipped operating room and post-operative and ICU wards. Total 51 surgeries were performed for both benign and malignant diseases by the end of 2019. The commonest surgery was breast surgery in 18 patients. Retrospective analysis of all six patients who were operated for breast cancer at the cancer center was done. ResultSix female patients of this province were operated for breast cancer during this period. Age ranged from 40 to 56 years. Four patients were presented with locally advanced disease. Two patients received neo-adjuvant chemotherapy and two were subjected for upfront surgery. Modified radical mastectomy was done in four patients. For one patient with suspected hereditary localized breast cancer and one with Paget’s disease of the breast with non invasive ductal carcinoma, simple mastectomy was performed. Postoperative period was uneventful except one case with seroma formation. Other than one Paget’s disease of the breast, all were triple nipple breast cancer. ConclusionBreast cancer surgery is one of the important modality of treatment even for locally advanced disease in resource limited settings.

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Clinical and Epidemiological Profile of Breast Cancer in Mexico: Results of the Seguro Popular

Journal of Global Oncology ◽

10.1200/jgo.2016.007377 ◽

2017 ◽

Vol 3 (6) ◽

pp. 757-764 ◽

Cited By ~ 9

Author(s):

Nancy Reynoso-Noverón ◽

Cynthia Villarreal-Garza ◽

Enrique Soto-Perez-de-Celis ◽

Claudia Arce-Salinas ◽

Juan Matus-Santos ◽

...

Keyword(s):

Breast Cancer ◽

Social Protection ◽

Advanced Disease ◽

Early Stage ◽

Locally Advanced ◽

Pathologic Complete Response ◽

Cancer Center ◽

Seguro Popular ◽

Early Stage Disease ◽

Locally Advanced Disease

Purpose One half of the Mexican population lacks comprehensive health care coverage. In 2003, a reform to the General Health Law was approved that led to the creation of the System of Social Protection in Health and made universal health coverage mandatory. The main innovation of this reform was Seguro Popular, which provided coverage for breast cancer. Here we report the outcomes of women with breast cancer treated at a cancer center in Mexico under Seguro Popular. Materials and Methods This was a retrospective cohort study that included all patients with breast cancer treated in the Instituto Nacional de Cancerología in Mexico City between January 2007 and December 2013 with Seguro Popular coverage. Demographic and clinical information were collected and survival outcomes were analyzed. Results A total of 4,300 women with breast cancer were included in this analysis. Most patients had locally advanced disease at diagnosis (53%, n = 2,293), and 13% (n = 558) presented with stage IV disease. Neoadjuvant chemotherapy was administered to 1,834 patients (52%), with a pathologic complete response in 25.1% (n = 460). Median follow-up was 40.5 months. Five-year survival for the entire cohort was 82% (95% CI, 81% to 84%). Five-year survival was 97% for early-stage disease (95% CI, 95% to 98%), 82% for locally advanced disease (95% CI, 80% to 84%), and 36% for metastatic disease (95% CI, 30% to 42%). Conclusion This represents the first description of a cohort of patients with breast cancer treated in Mexico under Seguro Popular. Seguro Popular has allowed our institution, and other Mexican centers, to establish efficient standardized mechanisms to treat patients with breast cancer.

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