School of Nursing, University of Botswana, Gaborone, Botswana.
Botswana Rutgers Partnership for Health, Gaborone, Botswana.
JCO Glob Oncol. 2024 Sep;10:e2400196. doi: 10.1200/GO.24.00196. Epub 2024 Sep 30.
The growing cancer burden in Botswana has been linked to aging, lifestyle factors, and high HIV infection prevalence. The government has designated four geographically distributed hospitals as public oncology centers (POCs). A needs assessment was undertaken to ascertain the characteristics of cancer care at these centers.
A multisite cross-sectional survey study of cancer care was conducted with oncology staff at Princess Marina Hospital (PMH), Nyangabgwe Referral Hospital (NRH), Sekgoma Memorial Hospital (SMH), and Letsholathebe II Memorial Hospital (LMH) from February to April 2021. At each POC, a focal person (experienced nurse working in oncology) identified relevant oncology staff and confirmed service availability.
Only PMH and NRH had a broad array of diagnostic, surgical, and treatment services. In addition, PMH was the only center with a a dedicated inpatient oncology service, a multidisciplinary committee to review patients, and a palliative care team. To support the only national cancer screening program, for cervical cancer, all POCs offered Pap tests. Mammography, available at PMH and NRH, was used solely for diagnosis. Patients from POCs requiring radiation therapy were referred to Gaborone Private Hospital at government expense. For perceived service availability, 51 staff, mainly oncologists, physicians, and nurses, were surveyed (66% based at PMH). Perceptions of services revealed a few concerns, for example, numerous staff considered hysterectomies for cervical cancer available when they were only performed at PMH.
Despite Botswana's efforts to increase the proximity of cancer services to patients, there are marked gaps, particularly at the two district-level POCs, SMH and LMH. In the future, SMH and LMH could provide selected services for specific prevalent cancers on-site, as well as follow-up and palliative care.
博茨瓦纳不断增长的癌症负担与老龄化、生活方式因素以及高 HIV 感染率有关。政府已指定四家分布在不同地理位置的医院作为公立肿瘤中心（POC）。为了确定这些中心的癌症治疗特点，进行了一次需求评估。
2021 年 2 月至 4 月，对 Princess Marina 医院（PMH）、Nyangabgwe 转诊医院（NRH）、Sekgoma 纪念医院（SMH）和 Letsholathebe II 纪念医院（LMH）的肿瘤科工作人员进行了一项多地点的癌症护理横断面调查研究。在每个 POC，一名焦点人物（在肿瘤科工作的经验丰富的护士）确定了相关的肿瘤科工作人员，并确认了服务的可用性。
只有 PMH 和 NRH 拥有广泛的诊断、手术和治疗服务。此外，PMH 是唯一拥有专门的住院肿瘤服务、多学科委员会来审查患者以及姑息治疗团队的中心。为了支持唯一的国家癌症筛查计划（宫颈癌筛查），所有 POC 都提供巴氏涂片检查。仅在 PMH 和 NRH 提供的乳房 X 光检查，仅用于诊断。需要放射治疗的 POC 患者由政府出资转至 Gaborone 私立医院。对于感知到的服务可用性，对 51 名工作人员（主要是肿瘤学家、医生和护士）进行了调查（基于 PMH 的 66%）。对服务的看法揭示了一些问题，例如，许多工作人员认为宫颈癌的子宫切除术可以在 PMH 进行，但实际上只有 PMH 可以进行。
尽管博茨瓦纳努力使癌症服务更接近患者，但仍存在明显的差距，特别是在 SMH 和 LMH 这两个地区级的 POC。未来，SMH 和 LMH 可以在现场为特定的常见癌症提供特定的服务，以及后续治疗和姑息治疗。
