https://ecancer.org/en/journal/article/1097-radiotherapy-waiting-time-in-northern-nigeria-experience-from-a-resourcelimited-setting

Abstract

Background Access and availability of radiotherapy treatment is limited in most low- and middle-income countries, which leads to long waiting times and poor clinical outcomes. The aim of our study is to determine the magnitude of waiting times for radiotherapy in a resource-limited setting. Methods This is a retrospective cohort study of patients with the five most commonly treated cancers managed with radiotherapy between 2010 and 2014. Data includes diagnosis, patients’ demographics and treatment provided. The waiting time was categorised into intervals (1) between diagnosis and first radiation consultation (2) First consultation to radiotherapy treatment (3) Decision-to-treat to treatment and (4) Diagnosis to treatment. Results A total of 258 cases were involved, including cervical (50%; 129/258), breast (27.5%; 71/258), nasopharynx (12.8%; 33/258), colorectal (5%; 13/258) and prostate cancers (4.7%; 12/258). Mean age was 48 (±12.9) years. Treatment with radical intent comprised 67% (178/258) of cases, while 33% (80/258) had palliative treatment. The median time from diagnosis to first radiation consultation was 40 (IQR 17–157.75) days for all the patients, with prostate cancer having the longest time – 305 days (IQR 41–393.8). The median time between the first radiation oncology consultations and first radiotherapy treatment was 130.5 (IQR 14–211.5) days; cervical cancer patients waited a median of 139 (IQR 13–195.5) days. The median time between diagnosis and first radiotherapy for breast cancer patients was 329 (IQR 207–464) days, compared to 213 (IQR 101.5–353.5) days for all the patients. Conclusion The study shows that waiting time for radiotherapy in Nigeria was generally longer than what is recommended internationally. This reflects the need to improve access to radiotherapy in order to improve cancer treatment outcomes in resource-limited settings.

Cervical cancer treatment in Rwanda: Resource-driven adaptations, quality indicators, and patient outcomes

“…This timeline is remarkably similar to reports from across Africa. The median time from cervical cancer diagnosis to CRT initiation was 106 days in Zambia [28], 25 weeks (175 days) in Northern Nigeria [29], and 114-116.5 days in Botswana [16] (though this center subsequently reduced time to treatment from 108 to 39 days after implementation of a multidisciplinary clinic [30]). Two studies from Ethiopia, reporting median time to treatment of 3.8 months (116 days) and 137 days, demonstrated disease progression to higher stages during the waiting period [18,31].…”

Association between waiting time for radiotherapy initiation and disease progression among women with cervical cancer in Addis Ababa, Ethiopia

“…18,19 Similar long-waiting time for initiation of radiotherapy has been reported in other lowand middle income countries. For example, cervical cancer patients waited for receipt of radiotherapy from date of diagnosis for a median of 213 days in Northern Nigeria 20 and 113 days in Rio de Janeiro, Brazil. 11 These contrast with 43.7 days in the United Sates.…”

Assessment of Breast Cancer Management in Sub-Saharan Africa

“… 23 Extended radiotherapy waiting times in addition to other treatment pathway delays as experienced by several LMIC in SSA negatively affect survival. 12 , 24 A multipronged approach led by governments is required to reduce waiting times and ensure timely cancer management.…”

“…An inherent desire of patients with cancer in SSA to seek complementary interventions further worsens treatment delays and the patients' plight. 8 , 24 , 40 , 41 …”