Mapanga Witness, Ayeni Oluwatosin A, Chen Wenlong Carl, Jacobson Judith S, Neugut Alfred I, Ruff Paul, Cubasch Herbert, O'Neil Daniel S, Buccimazza Ines, Čačala Sharon, Stopforth Laura W, Farrow Hayley A, Nietz Sarah, Phakathi Boitumelo, Chirwa Tobias, McCormack Valerie A, Joffe Maureen
Faculty of Health Sciences, Strengthening Oncology Services Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
Faculty of Health Sciences, DSI-NRF Centre of Excellence in Human Development, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.
PLOS Glob Public Health. 2023 Oct 24;3(10):e0002432. doi: 10.1371/journal.pgph.0002432. eCollection 2023.
The South African Breast Cancer and HIV Outcomes prospective cohort (SABCHO) study was established to investigate survival determinants among HIV-positive and HIV-negative SA women with breast cancer. This paper describes common and unique characteristics of the cancer centres and their participants, examining disparities in pathways to diagnosis, treatment resources and approaches adopted to mitigate resource constraints. The Johannesburg (Jhb), Soweto (Sow), and Durban (Dbn) sites treat mainly urban, relatively better educated and more socioeconomically advantaged patients whereas the Pietermaritzburg (Pmb) and Empangeni (Emp) sites treat predominantly rural, less educated and more impoverished communities The Sow, Jhb, and Emp sites had relatively younger patients (mean ages 54 ±14.5, 55±13.7 and 54±14.3 respectively), whereas patients at the Dbn and Pmb sites, with greater representation of Asian Indian women, were relatively older (mean age 57 ±13.9 and 58 ±14.6 respectively). HIV prevalence among the cohort was high, ranging from 15%-42%, (Cohort obesity (BMI ≥ 30 kg/m2) at 60%, self-reported hypertension (41%) and diabetes (13%). Direct referral of patients from primary care clinics to cancer centre occurred only at the Sow site which uniquely ran an open clinic and where early stage (I and II) proportions were highest at 48.5%. The other sites relied on indirect patient referral from regional hospitals where significant delays in diagnostics occurred and early-stage proportions were a low (15%- 37.3%). The Emp site referred patients for all treatments to the Dbn site located 200km away; the Sow site provided surgery and endocrine treatment services but referred patients to the Jhb site 30 Km away for chemo- and radiation therapy. The Jhb, Dbn and Pmb sites all provided complete oncology treatment services. All treatment centres followed international guidelines for their treatment approaches. Findings may inform policy interventions to address national and regional disparities in breast cancer care.
南非乳腺癌与艾滋病毒转归前瞻性队列研究（SABCHO）旨在调查感染艾滋病毒和未感染艾滋病毒的南非乳腺癌女性患者的生存决定因素。本文描述了癌症中心及其参与者的共同特征和独特特征，探讨了诊断途径、治疗资源以及为缓解资源限制所采用方法方面的差异。约翰内斯堡（Jhb）、索韦托（Sow）和德班（Dbn）的癌症中心主要治疗城市患者，这些患者受教育程度相对较高，社会经济条件相对优越；而彼得马里茨堡（Pmb）和恩庞吉尼（Emp）的癌症中心主要治疗农村患者，这些患者受教育程度较低，且更为贫困。索韦托、约翰内斯堡和恩庞吉尼的患者相对年轻（平均年龄分别为54±14.5岁、55±13.7岁和54±14.3岁），而德班和彼得马里茨堡的患者相对年长（平均年龄分别为57±13.9岁和58±14.6岁），其中亚洲印度裔女性占比较大。该队列中的艾滋病毒感染率很高，在15%至42%之间，队列中的肥胖率（体重指数≥30kg/m²）为60%，自我报告的高血压患病率为41%，糖尿病患病率为13%。只有索韦托的癌症中心有从初级保健诊所直接转诊患者的情况，该中心设有一家开放式诊所，早期（I期和II期）患者比例最高，为48.5%。其他中心依靠地区医院间接转诊患者，诊断过程出现显著延误，早期患者比例较低（15%至37.3%）。恩庞吉尼的癌症中心将所有治疗的患者转诊到200公里外的德班癌症中心；索韦托的癌症中心提供手术和内分泌治疗服务，但将患者转诊到30公里外的约翰内斯堡癌症中心进行化疗和放疗。约翰内斯堡、德班和彼得马里茨堡的癌症中心都提供完整的肿瘤治疗服务。所有治疗中心的治疗方法均遵循国际指南。研究结果可为解决乳腺癌护理方面的国家和地区差异的政策干预提供参考。
