Analysis of primary endocrine therapy in patients older than 70 years with breast cancer rejecting surgery from a single unit in South Africa including COVID-19 issues

Benn, Carol; Ramdas, Yastira; Smit, Teresa; Shaw, Vernon; Rapoport, Bernardo Leon

doi:10.1016/j.jgo.2021.02.024

Cited by 3 publications

(6 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A meta-analysis demonstrated that primary endocrine therapy (pET), even as monotherapy, has comparable response rates to neoadjuvant chemotherapy in patients with oestrogen receptor (ER) positive tumours, and with considerably lower toxicity [ 33 ]. Consistently, a retrospective study in South Africa revealed that pET can be a viable alternative for those patients over 70 years of age [ 34 ]. Not having an alternative modified treatment in LMICs is one of the missed opportunities to address those elderly patients who want to optimise all medical treatments except the surgery.…”

Section: Discussionmentioning

confidence: 81%

“How can a woman live without having a breast?”: challenges related to mastectomy in Ethiopia

Wondimagegnehu,

Teferra,

Assefa

et al. 2024

BMC Cancer

View full text Add to dashboard Cite

Background Although mastectomy is the standard treatment modality for breast cancer patients in Ethiopia, our previous study revealed that one in five patients do not receive the recommended procedure, half due to patient refusal or lack of returning to the hospital. Therefore, this study aimed to explore reasons for refusing mastectomy and identify challenges among breast cancer patients in Ethiopia. Methods An explorative qualitative study was conducted in four hospitals located in the towns of Woliso, Butajira, Hossana, and Assela. A total of 14 in-depth interviews (IDIs) and eight focus group discussions (FGDs) were held with breast cancer patients, patient relatives, and health professionals. Four semi-structured interview guides were used to facilitate the IDIs and FDGs. All recorded IDIs and FGDs were transcribed and translated verbatim and entered in NVivo 12 software. Emerging ideas were categorised and explained using an inductive content analysis approach. Results Our participants reported that particularly elderly and very young women refuse to have mastectomy. The main reasons identified in this study were summarised into six themes: (i) fear of the surgical procedure, (ii) religious beliefs and practice, (iii) utilisation of traditional treatments, (iv) in relation to having a baby and breastfeeding their children (young patients often request to remove only the lump, leaving their breast tissue intact), (v) lack of awareness about the disease, and (vi) sociocultural factors and advice from the community that influence women, since breasts are considered an attribute of femininity, beauty, and motherhood. In addition, knowing someone who died after mastectomy emerged as a main reason for not having breast cancer surgery. Conclusions High refusal rate for mastectomy has direct implication on increased breast cancer mortality. Hence, expansion of radiotherapy service is instrumental to initiate breast-conserving surgery as an alternative surgical procedure, especially for young women with early-stage breast cancer. Involving religious leaders, traditional healers, and breast cancer survivors could be an effective strategy to persuade newly diagnosed breast cancer patients. Addressing individual patient psychosocial needs and preferences may substantially improve retention of breast cancer patients in the health system.

show abstract

Section: Discussionmentioning

confidence: 81%

“How can a woman live without having a breast?”: challenges related to mastectomy in Ethiopia

Wondimagegnehu,

Teferra,

Assefa

et al. 2024

BMC Cancer

View full text Add to dashboard Cite

show abstract

“… 55 - 59 Eleven studies (85%) evaluated endocrine medications, one evaluated cytotoxic chemotherapies, 52 and one evaluated combined medications. 58 Two studies exclusively assessed rate, 55 , 57 two evaluated determinants, 56 , 59 and eight assessed both the rate and determinants of adherence. One randomized controlled trial (RCT) evaluated adherence-enhancing interventions.…”

Section: Resultsmentioning

confidence: 99%

“…According to the MMAT-Version 2018, three studies were rated as high quality, 47 , 49 , 50 six studies as average quality, 48 , 51 , 53 , 56 , 58 , 59 and the remaining four as low quality 52 , 54 , 55 , 57 (Data Supplement).…”

Section: Resultsmentioning

confidence: 99%

“…Investigators reviewed medical records in four studies to measure adherence rates. 54 , 55 , 57 , 58 A South African study reported that 64% of patients still received adjuvant endocrine therapy at the last follow-up. 54 A Nigerian study showed that over 5 years, 6.7% of patients received tamoxifen, with most patients having discontinued treatment, lost to follow-up, or died within the first year of treatment.…”

Section: Resultsmentioning

confidence: 99%

“…No operational definition for adherence was reported. 57 An Ethiopian study reported that 32.7% of patients were nonadherent to capecitabine, tamoxifen, or anastrozole. No operational definition of adherence was reported, but nonadherence was classified as a drug-related problem (DRP).…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Adherence to Oral Anticancer Medications Among Women With Breast Cancer in Africa: A Scoping Review

Onwusah

Ojewole

Chimbari

2023

JCO Global Oncology

View full text Add to dashboard Cite

PURPOSE Oral anticancer medications (OAMs) improve treatment outcomes and survival in women with breast cancer (BC). However, adherence to OAM therapy remains suboptimal. This scoping review provides evidence of adherence to OAMs among African women with BC. METHODS We searched four databases and gray literature, using guidance from the Joanna Briggs Institute. Thirteen studies on adherence rates, determinants, and interventions were included. NVivo 12 software was used to perform thematic analysis of the included studies. The determinants (barriers and facilitators) associated with adherence were analyzed according to the five dimensions of the WHO multidimensional adherence model. RESULTS Most studies (n = 11, 85%) focused on endocrine medication. Depending on the definition, measurements, and assessment period, the nonadherence rates ranged from 4.3% to 65.4% for endocrine medications, 80.9% for cytotoxic chemotherapies, and 32.7% for combined medications. The significant barriers associated with adherence include Islamic religion, concurrent comorbidities, mastectomy, anastrozole treatment, side effects, unawareness of treatment insurance coverage, and seeking treatment from traditional healers. Thorough therapeutic communication regarding treatment, neoadjuvant chemotherapy, and adequate social support significantly facilitate adherence. A randomized controlled trial of breast nursing interventions reported improved patient adherence. CONCLUSION The evidence mapped from studies that evaluated OAM adherence in women with BC indicates that nonadherence to OAMs is common. Applying context-specific standardized measures to assess adherence and facilitators or strategies targeting the identified barriers can optimize adherence and treatment outcomes. Effective interventions to improve adherence are limited. Therefore, further empirical and interventional studies in Africa are required to enhance the evidence.

show abstract

The impact of the COVID-19 pandemic on cancer care including innovations implemented in Sub-Saharan Africa: A systematic review

Rine,

Lara,

Bikomeye

et al. 2023

J Glob Health

View full text Add to dashboard Cite

BackgroundThe coronavirus 2019 (COVID-19) pandemic has caused disruptions in the delivery and utilisation of cancer services. The impact of these interruptions is disproportionately borne by low-and middle-income countries in Sub-Saharan Africa (SSA). There are speculations of increased late-stage presentation and mortality as services are returning to the pre-pandemic state. This review aims to explore the extent to which the COVID-19 pandemic impacted cancer services across SSA and to identify innovations implemented across SSA to mitigate the impacts.Methods Using database-specific search strategies, a systematic literature search was conducted in PubMed, Ovid (MedLine), Web of Science, and African Index Medicus. Eligible studies included original research, reports, perspectives and summaries of national or regional outcomes published in the English language. The primary outcome was changes in the delivery and utilisation of cancer prevention and screening, diagnosis, treatment and follow-up services. The secondary outcome was to identify implemented innovations to mitigate the impact of the pandemic on service delivery. ResultsOut of the 167 articles identified in the literature search, 46 were included in the synthesis. A majority (95.7%) of the included articles described suspension and/or delay of screening, diagnosis, and treatment services, although two studies (4.3%) described the continuation of services despite the lockdown. Care was additionally impacted by transportation limitations, shortages of staff and personal protective equipment, disruption of the medication supply chain and patients' fears and stigma associated with contracting COVID-19. A major innovation was the use of telemedicine and virtual platforms for patient consultation and follow-up during the pandemic in SSA. Furthermore, drones and mobile applications were used for sample collection, medication delivery and scheduling of treatment. In some instances, medication routes and treatment protocols were changed. ConclusionsThe delivery and utilisation of cancer services decreased substantially during the pandemic. Cancer centres initiated innovative methods of care delivery, including telehealth and drone use, with long-term potential to mitigate the impact of the pandemic on service delivery. Cancer centres in SSA must explore sustainable, facility or country-specific innovations as services return to the pre-pandemic state. RegistrationThe review was registered in PROSPERO with registration number CRD42022351455.

show abstract

Analysis of primary endocrine therapy in patients older than 70 years with breast cancer rejecting surgery from a single unit in South Africa including COVID-19 issues

Cited by 3 publications

References 9 publications

“How can a woman live without having a breast?”: challenges related to mastectomy in Ethiopia

“How can a woman live without having a breast?”: challenges related to mastectomy in Ethiopia

Adherence to Oral Anticancer Medications Among Women With Breast Cancer in Africa: A Scoping Review

The impact of the COVID-19 pandemic on cancer care including innovations implemented in Sub-Saharan Africa: A systematic review

Contact Info

Product

Resources

About