Health system strengthening: Integration of breast cancer care for improved outcomes

Horton, Susan; Rodríguez, Rolando Camacho; Anderson, Benjamin O.; Aung, Soe Yu; Awuah, Baffour; Pebé, Lucia Delgado; Duggan, Catherine; Dvaladze, Allison; Kumar, Somesh; Murillo, Raúl; Mra, Rai; Rositch, Anne F.; Mutumba, Songiso; Sullivan, Richard; Tsunoda, Audrey Tieko; Teo, Soo Hwang; Gelband, Hellen

doi:10.1002/cncr.32871

Cited by 33 publications

(43 citation statements)

References 20 publications

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“…To minimize the intergenerational effects of breast cancer deaths in sub-Saharan Africa, preventing breast cancer deaths through early diagnosis and improved timely treatment should form an essential part of every cancer control plan. [8][9][10] In parallel, support mechanisms are needed for affected families because maternal deaths impact the children's education, 11 development, nutrition, and mortality, 12 as described in a joint report by the United Nations Programme on HIV/AIDS, the United Nations Children's Fund, and the US Agency for International Development. 13 Because women are the cornerstone of many African families, there is often great upheaval after their death.…”

Section: Discussionmentioning

confidence: 99%

Maternally Orphaned Children and Intergenerational Concerns Associated With Breast Cancer Deaths Among Women in Sub-Saharan Africa

et al. 2021

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IMPORTANCE Low breast cancer survival in sub-Saharan Africa's young population increases the likelihood that breast cancer deaths result in maternal orphans, ie, children (<18 years) losing their mother.OBJECTIVE To estimate the number of maternal orphans and their ages for every 100 breast cancer deaths in sub-Saharan African settings during 2014-2019 and to describe family concerns about the orphaned children.DESIGN, SETTING, AND PARTICIPANTS Deaths occurring between September 1, 2014, and July 1, 2019, in the African Breast Cancer-Disparities in Outcomes (ABC-DO) were examined in a cohort of women diagnosed with breast cancer during 2014-2017 at major cancer treatment hospitals in Namibia, Nigeria, Uganda, and Zambia. The cohort was actively followed up for vital status via a trimonthly mobile phone call to each woman or her next of kin (typically a partner, husband, or child). MAIN OUTCOMES AND MEASURESThe number (Poisson counts) and ages of new orphans at the time of maternal death.RESULTS This cohort study found that a total of 795 deaths resulted in 964 new maternal orphans, with deaths occurring in women younger than 50 years accounting for 85% of the orphans. For every 100 deaths in women younger than 50 years, there were 210 new orphans (95% CI, overall, with country-specific estimates of 189 in Nigerian, 180 in Namibian, 222 in Ugandan, and 247 in Zambian Black women. For every 100 deaths of the women at any age, there were 121 maternal orphans, 17% of whom were younger than 5 years, 32% aged 5 to 9 years, and 51% aged 10 to 17 years at the time of maternal death. In follow-up interviews, families' concerns for children's education and childcare were reported to be exacerbated by the financial expenses associated with cancer treatment. CONCLUSIONS AND RELEVANCEThis study provides evidence that the number of maternal orphans due to breast cancer exceeds the number of breast cancer deaths among women in sub-Saharan Africa. The intergenerational consequences associated with cancer deaths in sub-Saharan Africa appear to be large and support the need for continued action to improve survival.

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Section: Discussionmentioning

confidence: 99%

Maternally Orphaned Children and Intergenerational Concerns Associated With Breast Cancer Deaths Among Women in Sub-Saharan Africa

et al. 2021

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“…This phased approach illuminates a central implementation science concept that scientific methodology promoting the systematic uptake of evidence‐based management strategies into routine practice makes possible the improvement of quality and effectiveness for health care delivery in real world settings and resource‐constrained contexts (for a resource‐stratified summary of selected support systems, see Table 2). 71 Phased implementation roadmaps for executing stepwise implementation strategies need to be defined for a given health care context, reviewed by experts and key stakeholders, and then applied by policy makers in correctly selected health care environments.…”

Section: Phased‐implementation Steps and Strategiesmentioning

confidence: 99%

The Breast Health Global Initiative 2018 Global Summit on Improving Breast Healthcare Through Resource‐Stratified Phased Implementation: Methods and overview

Duggan

Dvaladze

Rositch

et al. 2020

Cancer

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BACKGROUND:The Breast Health Global Initiative (BHGI) established a series of resource-stratified, evidence-based guidelines to address breast cancer control in the context of available resources. Here, the authors describe methodologies and health system prerequisites to support the translation and implementation of these guidelines into practice. METHODS: In October 2018, the BHGI convened the Sixth Global Summit on Improving Breast Healthcare Through Resource-Stratified Phased Implementation. The purpose of the summit was to define a stepwise methodology (phased implementation) for guiding the translation of resource-appropriate breast cancer control guidelines into real-world practice. Three expert consensus panels developed stepwise, resource-appropriate recommendations for implementing these guidelines in low-income and middle-income countries as well as underserved communities in high-income countries. Each panel focused on 1 of 3 specific aspects of breast cancer care: 1) early detection, 2) treatment, and 3) health system strengthening. RESULTS: Key findings from the summit and subsequent article preparation included the identification of phased-implementation prerequisites that were explored during consensus debates. These core issues and concepts are key components for implementing breast health care that consider real-world resource constraints. Communication and engagement across all levels of care is vital to any effectively operating health care system, including effective communication with ministries of health and of finance, to demonstrate needs, outcomes, and cost benefits. CONCLUSIONS: Underserved communities at all economic levels require effective strategies to deploy scarce resources to ensure access to timely, effective, and affordable health care. Systematically strategic approaches translating guidelines into practice are needed to build health system capacity to meet the current and anticipated global breast cancer burden. Cancer 2020;126:2339-2352.

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“…The consideration of health system factors is therefore critical for early diagnosis programs. 12 , 109 , 110 …”

Section: Prompt Investigation and Diagnosismentioning

confidence: 99%

“… 118 The intervention has been accompanied by workforce development, which was identified as a barrier to cancer care delivery in Zambia. 109 …”

Section: Prompt Investigation and Diagnosismentioning

confidence: 99%

Conceptual Framework to Guide Early Diagnosis Programs for Symptomatic Cancer as Part of Global Cancer Control

Koo

Unger‐Saldaña

Mwaka

et al. 2021

JCO Global Oncology

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Diagnosing cancer earlier can enable timely treatment and optimize outcomes. Worldwide, national cancer control plans increasingly encompass early diagnosis programs for symptomatic patients, commonly comprising awareness campaigns to encourage prompt help-seeking for possible cancer symptoms and health system policies to support prompt diagnostic assessment and access to treatment. By their nature, early diagnosis programs involve complex public health interventions aiming to address unmet health needs by acting on patient, clinical, and system factors. However, there is uncertainty regarding how to optimize the design and evaluation of such interventions. We propose that decisions about early diagnosis programs should consider four interrelated components: first, the conduct of a needs assessment (based on cancer-site–specific statistics) to identify the cancers that may benefit most from early diagnosis in the target population; second, the consideration of symptom epidemiology to inform prioritization within an intervention; third, the identification of factors influencing prompt help-seeking at individual and system level to support the design and evaluation of interventions; and finally, the evaluation of factors influencing the health systems’ capacity to promptly assess patients. This conceptual framework can be used by public health researchers and policy makers to identify the greatest evidence gaps and guide the design and evaluation of local early diagnosis programs as part of broader cancer control strategies.

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Health system strengthening: Integration of breast cancer care for improved outcomes

Cited by 33 publications

References 20 publications

Maternally Orphaned Children and Intergenerational Concerns Associated With Breast Cancer Deaths Among Women in Sub-Saharan Africa

Maternally Orphaned Children and Intergenerational Concerns Associated With Breast Cancer Deaths Among Women in Sub-Saharan Africa

The Breast Health Global Initiative 2018 Global Summit on Improving Breast Healthcare Through Resource‐Stratified Phased Implementation: Methods and overview

Conceptual Framework to Guide Early Diagnosis Programs for Symptomatic Cancer as Part of Global Cancer Control

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