scholarly journals What If All Patients with Breast Cancer in Malaysia Have Access to the Best Available Care: How Many Deaths Are Avoidable?

2017 ◽  
Vol 9 (8) ◽  
pp. 32 ◽  
Author(s):  
G. F. Ho ◽  
N. A. Taib ◽  
R. K. Pritam Singh ◽  
C. H. Yip ◽  
M. M. Abdullah ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Care ◽  
Safety Net ◽  
Public Hospitals ◽  
Sensitivity Analyses ◽  
Term Survival ◽  
Middle Income ◽  
Avoidable Deaths ◽  
Low Middle Income Countries ◽  
Under Performing

BACKGROUND: Cancer is a leading cause of death in the world and the fourth leading cause in Malaysia. A widening disparity in cancer burden has emerged between high and low-middle income countries. A similar disparity due to differential access to cancer care between affluent and deprived groups is likely to exist within developing country too. We assess this inequality by estimating the number of deaths due to cancer that would be avoidable if all patients had access to the best available care in Malaysia, a high middle income country.METHODS: The number of avoidable deaths is the difference between the number of deaths estimated by GLOBOCAN12 for Malaysia (which is consistent with published estimates on cancer survival), and the expected number of deaths if all patients with Breast Cancer (BC) had experienced the age-ethnic-stage specific survival outcomes observed in a leading private cancer centre in Malaysia. Data on age-ethnic-stage composition of the general BC population were from local cancer registry and public hospitals providing safety net cancer services.FINDINGS: Of the 2312 excess deaths due to BC, 2048 (88%) were avoidable. Of these avoidable deaths, 1167 (57%) were attributable to late stage presentation while 881 (43%) were due to lack of access to optimal treatment. Sensitivity analyses however show that the 88% avoidable deaths may be as low as 50%, taking into account differences in socio-economic status, over-diagnosis and lack of very long term survival data.INTERPRETATION: The huge number of avoidable deaths highlights the high cancer mortality rate among the deprived and the vast disparity in access to cancer care between the rich and poor within Malaysia, which mirrors the global cancer divide between rich and poor countries.Cancer care system that deliver such disastrous and inequitable outcomes is clearly under-performing. It is in urgent need of reform.

scholarly journals Effective coverage and budget implications of skill-mix change to improve neonatal nursing care: an explorative simulation study in Kenya

2019 ◽  
Vol 4 (6) ◽  
pp. e001817 ◽  
Author(s):  
Apostolos Tsiachristas ◽  
David Gathara ◽  
Jalemba Aluvaala ◽  
Timothy Chege ◽  
Edwine Barasa ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Neonatal Mortality ◽  
Nursing Care ◽  
Public Hospitals ◽  
Sensitivity Analyses ◽  
Full Time ◽  
Skill Mix ◽  
Neonatal Nursing ◽  
Low Middle Income Countries

IntroductionNeonatal mortality is an urgent policy priority to improve global population health and reduce health inequality. As health systems in Kenya and elsewhere seek to tackle increased neonatal mortality by improving the quality of care, one option is to train and employ neonatal healthcare assistants (NHCAs) to support professional nurses by taking up low-skill tasks.MethodsMonte-Carlo simulation was performed to estimate the potential impact of introducing NHCAs in neonatal nursing care in four public hospitals in Nairobi on effectively treated newborns and staff costs over a period of 10 years. The simulation was informed by data from 3 workshops with >10 stakeholders each, hospital records and scientific literature. Two univariate sensitivity analyses were performed to further address uncertainty.ResultsStakeholders perceived that 49% of a nurse full-time equivalent could be safely delegated to NHCAs in standard care, 31% in intermediate care and 20% in intensive care. A skill-mix with nurses and NHCAs would require ~2.6 billionKenyan Shillings (KES) (US$26 million) to provide quality care to 58% of all newborns in need (ie, current level of coverage in Nairobi) over a period of 10 years. This skill-mix configuration would require ~6 billion KES (US$61 million) to provide quality of care to almost all newborns in need over 10 years.ConclusionChanging skill-mix in hospital care by introducing NHCAs may be an affordable way to reduce neonatal mortality in low/middle-income countries. This option should be considered in ongoing policy discussions and supported by further evidence.

scholarly journals Triaging and adaptations of surveillance of cancer services in the COVID pandemic

2020 ◽  
pp. 1-3
Author(s):  
Shirley Lewis ◽  
Lavanya Gurram ◽  
Umesh Velu ◽  
Krishna Sharan
Keyword(s):  
Cancer Patients ◽  
Clinical Examination ◽  
Cancer Care ◽  
Middle Income ◽  
Face To Face ◽  
Middle Income Countries ◽  
Cancer Services ◽  
Low Middle Income Countries

Abstract Introduction: Coronavirus disease (COVID-19) has significantly challenged the access to cancer care and follow-up for a patient with cancer. Methods: Based on published literature and our experiences, it is reasonable to presume that clinical examination and follow-up visits have been significantly curtailed worldwide in order to adhere to the new norms during the pandemic. Although telephonic and telemedicine consultations may help bridge a few gaps, completely dispensing with in-person consultation has its challenges, especially in low middle-income countries. Telephonic consultations could facilitate triaging of ambulatory cancer patients and allocation of face-to-face consultations for high priority patients. Conclusions: We propose a telephonic consultation-based triaging approach for ambulatory cancer patients in order to identify those needing in-hospital consultations.

Evaluation of Patterns in Access to Breast Cancer Care and Breast Cancer Presentation in a Safety Net Patient Population

2021 ◽  
pp. 000313482096628
Author(s):  
Erica Choe ◽  
Hayoung Park ◽  
Ma’at Hembrick ◽  
Christine Dauphine ◽  
Junko Ozao-Choy
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Cancer Care ◽  
Patient Population ◽  
Safety Net ◽  
Minority Women ◽  
Breast Cancer Care ◽  
Safety Net Hospital ◽  
Screening Mammograms

Background While prior studies have shown the apparent health disparities in breast cancer diagnosis and treatment, there is a gap in knowledge with respect to access to breast cancer care among minority women. Methods We performed a retrospective analysis of patients with newly diagnosed breast cancer from 2014 to 2016 to evaluate how patients presented and accessed cancer care services in our urban safety net hospital. Patient demographics, cancer stage, history of breast cancer screening, and process of referral to cancer care were collected and analyzed. Results Of the 202 patients identified, 61 (30%) patients were younger than the age of 50 and 75 (63%) were of racial minority background. Only 39% of patients with a new breast cancer were diagnosed on screening mammogram. Women younger than the age of 50 ( P < .001) and minority women ( P < .001) were significantly less likely to have had any prior screening mammograms. Furthermore, in patients who met the screening guideline age, more than half did not have prior screening mammograms. Discussion Future research should explore how to improve breast cancer screening rates within our county patient population and the potential need for revision of screening guidelines for minority patients.

scholarly journals National Breast Cancer Chemotherapy Program in Haiti

2016 ◽  
Vol 2 (3_suppl) ◽  
pp. 20s-20s
Author(s):  
Estefania Santamaria ◽  
Jean Ronald Cornely ◽  
Georges Dubuche ◽  
Vincent DeGennaro
Keyword(s):  
Breast Cancer ◽  
Low Income ◽  
Cancer Care ◽  
Conflicts Of Interest ◽  
Public Hospitals ◽  
Practical Training ◽  
Breast Cancer Chemotherapy ◽  
Low Income Country ◽  
National Breast ◽  
Treatment Plans

Abstract 19 Background: Project Medishare launched a breast cancer program in Port-au-Prince in 2013 at the request of local partners. In 2015, the program was expanded as part of a national breast cancer treatment program with Equal Health International. With the mission of strengthening Haiti’s Ministry of Health (MSPP) cancer care infrastructure, the program seeks to decentralize cancer care for women living up to eight hours driving distance from Port-au-Prince by building hospital capacity for cancer screening, diagnosis, chemotherapy and hormone therapy provision at outlying hospitals. Methods: In 2013, two physicians and three nurses were trained to handle, mix and administer chemotherapy by American nurses and doctors. To expand the national program in January 2015, 20 additional physicians and 32 nurses from all ten geographic regions underwent a three-day training in Port-au-Prince on treatment algorithms and practical training for breast cancer. As patients came in for treatment at the local institutions, Project Medishare nurses were on site to supervise mixing and administration of chemotherapy. Physicians continued their practical training via telemedicine to confirm treatment plans and dosage calculations. Results: By September 2015, onsite practical training and chemotherapy had occurred at the primary public hospitals in Gonaives, Jacmel, and Les Cayes. One physician and three nurses were fully trained at each site and seven patients with breast cancer have been treated thus far at the new sites. Future efforts will focus on quality improvement and continuing onsite training at the other hospitals as well as encouraging more doctors and patients to utilize regional programs instead of coming to the capital for treatment. Conclusion: To our knowledge, this is the first regularly-operating multi-site chemotherapy program in a low-income country. Our experiences may inform others to expand already established protocol-based cancer programs in low-resource settings. Next steps include working with MSPP to expand chemotherapy access to Cap-Haitien and to launch breast reconstruction programs through similar trainings in Port-au-Prince. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST: No COIs from the authors.

Disparity of cervical cancer care delivery in low-middle income countries

2014 ◽  
Vol 133 ◽  
pp. 190
Author(s):  
L.T. Chuang ◽  
S.S. Tedjarati ◽  
F.V. Price ◽  
W.T. Creasman
Keyword(s):  
Cervical Cancer ◽  
Cancer Care ◽  
Care Delivery ◽  
Middle Income ◽  
Middle Income Countries ◽  
Low Middle Income Countries

scholarly journals Breast Cancer in West Java: Where Do We Stand and Go?

2020 ◽  
Vol 14 (3) ◽  
pp. 91
Author(s):  
Yohana Azhar ◽  
Hasrayati Agustina ◽  
Maman Abdurahman ◽  
Dimyati Achmad
Keyword(s):  
Breast Cancer ◽  
Cancer Registry ◽  
Cancer Care ◽  
Breast Conserving Surgery ◽  
Treatment Needs ◽  
West Java ◽  
Middle Income ◽  
Aggressive Approach ◽  
Care Pattern ◽  
Care Patterns

Background: Breast cancer is the most common cancer in Indonesia, a low-middle income country in Southeast Asia. We provide a regional hospital-based cancer registry of the central hospital in West Java, Indonesia. This study aims to characterize the presentation, diagnosis, evaluation, and management of breast cancer; to develop a regional breast cancer registry in West Java to monitor cancer care patterns; to evaluate cancer treatment outcomes.Methods: The data were collected from the medical records deposited in the Hasan Sadikin General Hospital Information System. The team has been contracted to operate the registry & organize an advisory board to standardize definitions of coding terminology of the registry’s reporting system and to monitor the cancer care pattern. Data validation was conducted by a team in the cancer registry, consisting of health officers, pathologists, and registrars. Data management and analysis were conducted by the cancer registry team.Results: A total of 913 women diagnosed with breast cancer, from January 2014 until December 2018, were studied. The median age was 49.5 years old. The initial diagnosis was at the age of 42.4 years old on average. About 64.5% were diagnosed with stage-3 and -4 cancers, and 75.1% had undergone a mastectomy, of which 47.3% of the intent was palliative. Of those who have hormonal receptors, only 26.9% were positive, and 36.5% were not assessed for immunohistochemistry evaluation. Inappropriate surgical management of breast cancer was common at the community level, which included indiscriminate diagnostic lumpectomy (21.9%), incomplete mastectomy and omission, or suboptimal lymph node axillary clearance (47.4%). Only 3.0% of patients received breast-conserving surgery and were treated with mastectomy and reconstruction. Conclusions: Breast cancer in West Java is often recognized at the late stage. Treatment was suboptimal, leading to poor survival. A more aggressive approach to early detection and treatment needs to be developed to improve the outcomes of this potentially curable disease.

scholarly journals The Feasibility and Performance of the Patient Navigation Programme in Improving Breast Cancer Care in Malaysia

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 95s-95s
Author(s):  
M. Jaganathan ◽  
N.H. Zainal ◽  
N. Rajaram ◽  
T. Soo Hwang ◽  
M.Y. Abdul Wahab
Keyword(s):  
Breast Cancer ◽  
Cancer Care ◽  
Patient Navigation ◽  
Poor Adherence ◽  
Adherence To Treatment ◽  
Breast Cancer Care ◽  
Middle Income ◽  
Treatment Delays ◽  
And Performance ◽  
The Impact

Background: Breast cancer is the most common cancer in Malaysia and it is anticipated that incidence will increase by 49% from 2012 to 2025. Unfortunately, survival remains poor because of late presentation and poor adherence to evidence-based medicine. Barriers to early presentation include inadequate knowledge about the disease, financial issues, negative influence of relatives and perceived poor quality of care and services in state-run hospitals. Poor adherence to treatment is also a common struggle, and is further exacerbated by the use of traditional, alternative healing methods. While patient navigation (PN) programs have been shown to improve breast cancer outcomes in the US, its implementation and performance in low and middle income countries is not well studied. Aim: We sought to determine the impact of a PN program in reducing treatment delays and improving adherence to treatment and patient satisfaction, as well as to evaluate the barriers faced by women seeking breast cancer care in Malaysia. Methods: We established a nurse-led patient navigation center at a secondary government hospital in Klang. This clinical team involved the surgery, pathology, radiology and nursing departments and provided patient-centered care, including patient tracking and call reminder systems, family counseling, health education and decision aids. The community team involved a Patient Navigator Program Coordinator and a Community Navigator. We compared treatment delays and adherence to treatment between navigated patients and patients registered in the year prior to the PN program. We used Student t-tests and Pearson χ2 or Fisher's Exact tests to compare timeliness between navigated patients and patients registered in the year prior. Results: Of the 136 Malaysian women enrolled in the PNP in 2015, 48.9% were diagnosed with advanced disease (stage 3 or 4). Women with advance disease had a lower median monthly household income compared with women with early disease (USD $350 vs $540, P = 0.023). Women with advance disease were also less likely to have personal transportation to the hospital (36.4% vs 56.5%, P = 0.048). Compared with the year before PN, more navigated patients underwent mammography within 7 days of their first visit (96.4% vs 74.4%, P < 0.001) and received their diagnosis within 14 days of their first visit (80.0% vs 58.5%, P < 0.001). The proportion of women who met timeliness to treatment initiation was similar for navigated patients and patients in the year prior. The proportion of defaulters were marginally lesser among navigated patients compared with the year prior (4.4% vs 11.5%, P = 0.048). Conclusion: We found that integrating PN within a breast clinic of a middle income country is feasible, and in the long run, could improve outcomes for breast cancer patients. Long-term follow-up is needed to assess the impact of the PN program on improving treatment completion and survival.

scholarly journals Closing the global cancer divide- performance of breast cancer care services in a middle income developing country

BMC Cancer ◽  
2014 ◽  
Vol 14 (1) ◽  
Author(s):  
Gerard CC Lim ◽  
◽  
Emran N Aina ◽  
Soon K Cheah ◽  
Fuad Ismail ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Developing Country ◽  
Cancer Care ◽  
Breast Cancer Care ◽  
Middle Income ◽  
Care Services

scholarly journals Challenges in the Delivery of Quality Breast Cancer Care: Initiation of Adjuvant Hormone Therapy at an Urban Safety Net Hospital

2014 ◽  
Vol 10 (2) ◽  
pp. e107-e112 ◽  
Author(s):  
Meaghan M. Crowley ◽  
Molly E. McCoy ◽  
Sharon M. Bak ◽  
Sarah E. Caron ◽  
Naomi Y. Ko ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Treatment ◽  
Hormone Therapy ◽  
Cancer Care ◽  
Safety Net ◽  
Breast Cancer Treatment ◽  
Breast Cancer Care ◽  
Adjuvant Hormone Therapy ◽  
Safety Net Hospital ◽  
Urban Safety

Urgently needed interventions to reduce disparities in breast cancer treatment should take into account obstacles inherent among immigrant and indigent populations and complexities of multidisciplinary cancer care.

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