Neoadjuvant or Adjuvant Chemotherapy for Breast Cancer in Sub-Saharan Africa: A Retrospective Analysis of Recurrence and Survival in Women Treated for Breast Cancer at the Korle Bu Teaching Hospital in Ghana

Abstract

PURPOSE It is established that addition of systemic therapy to locoregional treatment for breast cancer improves survival. However, reliable data are lacking about the outcomes of such treatment in women with breast cancer in low middle-income countries. We compared the outcomes of treatment in patients who had received neoadjuvant chemotherapy (NACT) or adjuvant chemotherapy and examined the factors associated with breast cancer recurrence and survival at the National Radiotherapy Oncology and Nuclear Medicine Centre, Korle Bu Teaching Hospital, Ghana. METHODS This was a retrospective cohort study. The medical charts of women with breast cancer managed at the National Radiotherapy Oncology and Nuclear Medicine Centre from 2005 to 2014 were reviewed. A total of 388 patients with a median follow-up of 48 months were included in the study. Logistic regression was used to estimate the risk of recurrence. Survival was estimated using cox proportional hazards model. All models were adjusted with clinicopathologic variables. A P value of < .05 was considered statistically significant. RESULTS Fifty-nine percent received adjuvant chemotherapy. In an adjusted logistic model, no difference was observed in locoregional recurrence between patients receiving NACT compared with those receiving adjuvant chemotherapy (odds ratio = 1.05; 95% CI, 0.44 to 2.47). However, NACT recipients had a higher likelihood of distant recurrence (odds ratio = 1.97; 95% CI, 1.24 to 3.15). In a multivariable analysis, no differences were observed in overall survival between the two chemotherapy groups (hazard ratio = 1.43; 95% CI, 0.91 to 2.26). CONCLUSION NACT yields similar outcomes compared with adjuvant chemotherapy; however, recipients of NACT with advanced disease may have more distant failures. Early detection in a resource-limited setting is therefore crucial to optimal outcomes, significantly limiting recurrence and improving survival.

Assessing the utilization of cancer medicines in Rwanda: an analysis of treatment patterns

“…It is useful to consider our results in the context of other studies. In comparison to our study (33% of neoadjuvant chemotherapy (NACT) for breast cancer), an analysis of 388 patients with cancer seen from 2005 to 2014 at the National Radiotherapy Oncology and Nuclear Medicine Centre in Ghana showed that 41% of patients with breast cancer received NACT [14]. Our findings are contrary to a study evaluating cancer utilisation in Saudi Arabia that found most chemotherapy to be utilised in neoadjuvant settings [12].…”

“…Different from a study done in Saudi Arabia looking at the drug utilisation and expenditure of anticancer drugs for breast cancer, 80% of patients utilised fluorouracil, epirubicin and cyclophosphamide (FEC) [ 12 ], in our study ACT was most commonly utilised, which is consistent with current national and international cancer guidelines [ 17 ]. In contrast, regional variation within Africa exists, and a recent study from Ghana found 72% used doxorubicin, cyclophosphamide and fluorouracil, while ACT was only used in 23% [ 14 ]. This study also found most patients had advanced stage presentation, with approximately 73% of breast cancer patients having node positive disease [ 14 ].…”

“…In contrast, regional variation within Africa exists, and a recent study from Ghana found 72% used doxorubicin, cyclophosphamide and fluorouracil, while ACT was only used in 23% [ 14 ]. This study also found most patients had advanced stage presentation, with approximately 73% of breast cancer patients having node positive disease [ 14 ].…”