Aga Khan University - Kenya, Nairobi, Kenya
National Hospital, Abuja, Nigeria.
BMJ Open. 2021 Mar 2;11(3):e041900. doi: 10.1136/bmjopen-2020-041900.
To evaluate medical resource utilisation and timeliness of access to specific aspects of a standard care pathway for breast cancer at tertiary centres in sub-Saharan Africa.
Data were retrospectively abstracted from records of patients with breast cancer treated within a prespecified 2-year period between 2014 and 2017. The study protocol was approved by local institutional review boards.
Six tertiary care institutions in Ghana, Kenya and Nigeria were included.
Health records of 862 patients with breast cancer were analysed: 299 in Ghana; 314 in Kenya; and 249 in Nigeria.
As directed by the treating physician.
Parameters selected for evaluation included healthcare resource and use, medical procedure turnaround times and out-of-pocket (OOP) payment patterns.
Use of mammography or breast ultrasonography was <45% in all three countries. Across the three countries, 78%-88% of patients completed tests for hormone receptors and human epidermal growth factor receptor 2 (HER2). Most patients underwent mastectomy (64%-67%) or breast-conserving surgery (15%-26%). Turnaround times for key procedures, such as pathology, surgery and systemic therapy, ranged from 1 to 5 months. In Ghana and Nigeria, most patients (87%-93%) paid for diagnostic tests entirely OOP versus 30%-32% in Kenya. Similarly, proportions of patients paying OOP only for treatments were high: 45%-79% in Ghana, 8%-20% in Kenya and 72%-89% in Nigeria. Among patients receiving HER2-targeted therapy, the average number of cycles was five for those paying OOP only versus 14 for those with some insurance coverage.
Patients with breast cancer treated in tertiary facilities in sub-Saharan Africa lack access to timely diagnosis and modern systemic therapies. Most patients in Ghana and Nigeria bore the full cost of their healthcare and were more likely to be employed and have secondary or postsecondary education. Access to screening/diagnosis and appropriate care is likely to be substantively lower for the general population.
评估撒哈拉以南非洲三级中心乳腺癌标准护理路径特定方面的医疗资源利用情况和获得及时性。
数据是从 2014 年至 2017 年期间规定的 2 年期间内接受治疗的乳腺癌患者的病历中回顾性提取的。该研究方案获得了当地机构审查委员会的批准。
纳入了加纳、肯尼亚和尼日利亚的六家三级保健机构。
分析了 862 例乳腺癌患者的健康记录：加纳 299 例；肯尼亚 314 例；尼日利亚 249 例。
按照治疗医生的指示。
在所有三个国家，乳腺 X 线摄影术或乳房超声检查的使用率均<45%。在这三个国家中，78%-88%的患者完成了激素受体和人表皮生长因子受体 2（HER2）的检测。大多数患者接受了乳房切除术（64%-67%）或保乳手术（15%-26%）。关键程序（如病理、手术和系统治疗）的周转时间从 1 至 5 个月不等。在加纳和尼日利亚，大多数患者（87%-93%）完全自费支付诊断性检查费用，而肯尼亚则为 30%-32%。同样，仅支付治疗费用的自费患者比例很高：加纳 45%-79%，肯尼亚 8%-20%，尼日利亚 72%-89%。在接受 HER2 靶向治疗的患者中，仅自费支付的患者平均接受了 5 个周期的治疗，而有部分保险覆盖的患者接受了 14 个周期的治疗。
在撒哈拉以南非洲的三级医疗机构接受治疗的乳腺癌患者无法及时获得诊断和现代系统治疗。加纳和尼日利亚的大多数患者承担了全部医疗费用，且更有可能受雇且具有中等或高等教育水平。一般人群获得筛查/诊断和适当治疗的机会可能会大大降低。
