Health system experiences of breast cancer survivors in urban South Africa

Abstract

Background: Breast cancer is the most common cancer globally and among South African women. Women from socioeconomically disadvantaged South African communities more often present later and receive total mastectomy compared to those from more affluent communities who have more breast conserving surgery (which is less invasive but requires mandatory radiation treatment post-operatively). Standard chemotherapy and total mastectomy treatments are known to cause traumatizing side effects and emotional suffering among South African women; moreover, many women face limited communication with physicians and psychological support. Objective: This article investigates the experiences of women seeking breast cancer treatment at the largest public hospital in South Africa. Methods We interviewed 50 Black women enrolled in the South African Breast Cancer Study to learn more about their health system experiences with detection, diagnosis, treatment, and follow-up care for breast cancer. Each interview was between 2–3 hours, addressing perceptions, experiences, and concerns associated with breast cancer and comorbidities such as HIV and hypertension. Results: We found most women feared diagnosis, in part, because of the experience of chemotherapy and physical mutilation related to mastectomy. The importance of social support from family, religion, and clinical staff was fundamental for women coping with their condition and adhering to treatment and medication. Conclusions: These findings exemplify how interventions might promote early detection of breast cancer and better adherence to treatment. Addressing community perceptions of breast cancer, patient needs and desires for treatment, structural barriers to intensive therapies, and the burden of invasive treatments are imperative next steps for delivering better breast cancer care in Soweto and other resource-constrained settings.

Socio-demographic determinants of mammography uptake among women 40 years and above in Calabar, South-South, Nigeria: a cross-sectional study

“…Another dimension for justifying the need for targeted education as core element in effective breast cancer control programmes, as supported by findings of this study, is that it would debunk ignorance and myths associated with breast cancer, since significant proportion of this study respondents identified psychosocial factors as barrier to mammography uptake. This notion corroborates the findings in other studies where low uptake of mammography was attributed to embarrassment from the procedure, fear from painful sensation, fear of cancer diagnosis, fear from exposure to radiation and spousal refusal [ 23 , 31 ]. Furthermore, the need for awareness creation in breast cancer control programmes is underscored by a significant proportion of respondents in this study who reported that they would uptake a mammography screening if encouraged by healthcare providers.…”

“…[ 30 ] also observed that marital status was not independently associated with disease morbidity and mortality. It is generally believed that those who are married tend to utilize health services better than the singles, probably due to the support and reinforcement of addressing health needs by significant others [ 31 ]. This notion is supported by the findings in this study where significant proportion of respondents identified encouragement by family members as a potential facilitator of mammography uptake.…”

“…In this present study, religious denominational affiliation was observed to be statistically significantly associated with uptake of mammography screening, though the frequencies of our religious denominational affiliation variable were relatively small to make strong statement. Nonetheless, faith and religion have been shown to have strong correlation with uptake of health services [ 31 , 33 ]. Chatters [ 33 ] reported that the overall better physical health status was associated with higher levels of religious involvement.…”

Validating an Instrument for Direct Patient Reporting of Distress and Chemotherapy-Related Toxicity among South African Cancer Patients

“…Unfortunately, this is also consistent with other African populations. Studies in Uganda, Nigeria, Eswatini and South Africa have all previously identified financial strain as major contributors to distress, non-adherence with cancer related care or both [ 39 , 40 , 41 , 42 , 43 , 44 ].…”

Breakthrough in breast reconstruction in the context of COVID-19: safety and efficiency of endoscopic breast reconstruction at a day surgery center

“…To minimize surgical trauma and promote recovery, breast cancer surgery has evolved from radical surgery and extended radical surgery to modified radical surgery and breast-conserving surgery (1)(2)(3)(4). However, for patients with more diffuse lesions, breast-conserving surgery is less safe, but the loss of the breast can also be very psychologically taxing for the patient (5)(6)(7). Breast reconstruction surgery is becoming an increasingly popular alternative.…”