Explaining disparities in oncology health systems delays and stage at diagnosis between men and women in Botswana: A cohort study

Abstract

Purpose Men in Botswana present with more advanced cancer than women, leading to poorer outcomes. We sought to explain sex-specific differences in time to and stage at treatment initiation. Methods Cancer patients who initiated oncology treatment between October 2010 and June 2017 were recruited at four oncology centers in Botswana. Primary outcomes were time from first visit with cancer symptom to treatment initiation, and advanced cancer (stage III/IV). Sociodemographic and clinical covariates were obtained retrospectively through interviews and medical record review. We used accelerated failure time and logistic models to estimate standardized sex differences in treatment initiation time and risk differences for presentation with advanced stage. Results were stratified by cancer type (breast, cervix, non-Hodgkin’s lymphoma, anogenital, head and neck, esophageal, other). Results 1886 participants (70% female) were included. After covariate adjustment, men experienced longer excess time from first presentation to treatment initiation (8.4 months) than women (7.0 months) for all cancers combined (1.4 months, 95% CI: 0.30, 2.5). In analysis stratified by cancer type, we only found evidence of a sex disparity (Men: 8.2; Women: 6.8 months) among patients with other, non-common cancers (1.4 months, 95% CI: 0.01, 2.8). Men experienced an increased risk of advanced stage (Men: 67%; Women: 60%; aRD: 6.7%, 95% CI: -1.7%, 15.1%) for all cancers combined, but this disparity was only statistically significant among patients with anogenital cancers (Men: 72%; Women: 50%; aRD: 22.0%, 95% CI: 0.5%, 43.5%). Conclusions Accounting for the types of cancers experienced by men and women strongly attenuated disparities in time to treatment initiation and stage. Higher incidence of rarer cancers among men could explain these disparities.

Advanced Stage Cancer Patients Experience in Seeking Treatment in Medan, Indonesia

“…Colon cancer in this study entirely occurs in men. This is related to the research conducted by Iyer et al, the type of cancer that often affects women, such as cervical cancer and breast cancer [11]. According to research conducted by the type of cancer that often experiences delays is a type of cancer experienced by men compared to the type of cancer associated with women.…”

“…This is because men are more masculine, so they tend to be less likely to seek help and less exposed to the health system [9], [10]. While women more often utilise health services related to pregnancy and role [11].…”

The Global Cohort of Doctoral Students: Building Shared Global Health Research Capacity in High- Income and Low- and Middle-Income Countries

“…Pairs have engaged in collaborative training programs in statistics and data science in Ethiopia, Rwanda, and Botswana and have hosted a seminar on research capacity building in global health in Boston. Research accomplishments include obtaining a competitive research grant and two published manuscripts [ 20 21 ]. Finally, the Global Cohort’s work was recognized with a student prize at the Consortium of Universities during Global Health’s 10 th meeting.…”

“…The GCDS program has enabled PhD students from HICs and LMICs to realize early career scientific contributions through collaborative efforts. So far, two pairs (one in Botswana and one in Ethiopia) have published research articles in peer-reviewed journals [ 20 21 ]; three pairs have developed research manuscripts; one pair (Ethiopia) developed a proposal to collect primary data on delay in presentation of TB cases and subsequent effects on household transmission that was later awarded by the World Health Organization; and one pair, with support from Harvard University and the University of Rwanda, conducted two courses on Quantitative Methods for Monitoring and Evaluation and simulations in R for lecturers, PhD students, and Masters students and employees at the University of Rwanda.…”

The hidden curve behind COVID-19 outbreak: the impact of delay in treatment initiation in cancer patients and how to mitigate the additional risk of dying – the head and neck cancer model

“…As parameters on the COCIC calculator, we considered a 40% reduction in cancer care during a 90-days outbreak, the baseline TTI was calculated using the data provided by the real-data scenarios and the literature for those continents and groups of HDI countries for a better representation of TTI (12)(13)(14)(15)(16)(17). We inputted these data and simulated different efforts of mitigation, varying from 50% to no mitigation at all.…”