Optimisation of the continuum of supportive and palliative care for patients with breast cancer in low-income and middle-income countries: executive summary of the Breast Health Global Initiative, 2014

Distelhorst, Sandra R.; Cleary, James F.; Ganz, Patricia A.; Beşe, Nuran; Camacho-Rodríguez, Rolando; Cardoso, Fátima; Ddungu, Henry; Gralow, Julie R.; Yip, Cheng Har; Anderson, Benjamin O.

doi:10.1016/s1470-2045(14)70457-7

Cited by 42 publications

(37 citation statements)

References 26 publications

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“…In resource‐limited settings such as Uganda, both the BHGI and NCCN have prioritized early diagnosis based on the promotion of awareness of early signs and symptoms, obtaining a medical history, CBE, and ultrasound with tissue sampling, 9 along with prompt referral to diagnosis 10,11 . These recommendations subsequently were integrated into the NCCN's guidelines for the management of invasive cancer at basic and core levels, corresponding to the increasing availability of resources 12 .…”

Section: Discussionmentioning

confidence: 99%

Breast cancer early detection and diagnostic capacity in Uganda

Giglou

Segel

Orem

et al. 2020

Cancer

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BACKGROUND: Greater than 80% of women presenting for breast cancer treatment in Uganda have late-stage disease, which is attributable to a dysfunctional referral system and a lack of recognition of the early signs and symptoms among primary health care providers, and compounded by the poor infrastructure and inadequate human capacity. Improving the breast health care system requires a systemic approach beginning with situational analysis to identify systematic gaps that prevent sustainable improvements in outcome. METHODS:The authors performed a situational analysis of the breast health care system using methods developed by the Breast Health Global Initiative. Based on their findings, they developed a series of recommendations for strengthening the health system for the early diagnosis of breast cancer based on clinical detection, referral, tissue sampling, and diagnosis. RESULTS: Deficits in the recognition of breast cancer signs and symptoms, the underuse of clinical breast examination as a diagnostic and/or screening tool, the centralization of diagnostic tests (radiology and pathology), reliance on excisional biopsies rather than needle biopsies, and a lack of trained professionals and knowledge of the referral system all contribute to significant health system delays. CONCLUSIONS: To strengthen referral networks and improve the early diagnosis of breast cancer in Uganda, national referral hospitals should provide educational programs to primary health care providers in community health centers (CHCs), at which the majority of women first present with symptoms. At secondary district-level facilities in which imaging and tissue sampling can be performed, the capacity for diagnostic testing could be increased through task shifting of basic interpretation (abnormal vs normal) from specialists to nonspecialists using networking technology to facilitate remote oversight from specialists at the national referral hospitals. Cancer 2020;126:2469-2480.

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Section: Discussionmentioning

confidence: 99%

Breast cancer early detection and diagnostic capacity in Uganda

Giglou

Segel

Orem

et al. 2020

Cancer

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“…Supportive and survivorship care, i.e., the prevention and management of the adverse effects of cancer and its treatment are increasingly recognized as critical components of quality cancer care and cancer control programs. Yet, in resource-constrained health systems, survivorship care is often overlooked [56–58]. Consensus statements and recommendations have been developed, mainly for breast cancer, to illustrate how health systems in LMICs can provide appropriate cancer care, including survivorship care, taking resource constraints into account [22, 56, 59].…”

Section: Discussionmentioning

confidence: 99%

“…Scheduled follow-up visits, and the name of the health professional responsible for post-treatment care, should be documented in a patient’s individual care and survivorship plan [60]. This document should also include details of the patient’s treatment protocol so that potential specific treatment-related complications and long-term physical side effects can be considered [56, 59]. Importantly, assessment of psychosocial needs, including depression, anxiety, emotional distress, and changes to social roles, should be part of the follow-up care provided.…”

Section: Discussionmentioning

confidence: 99%

Health-related quality of life and psychological distress among cancer survivors in Southeast Asia: results from a longitudinal study in eight low- and middle-income countries

Kimman

Jan

Peters

et al. 2017

BMC Med

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BackgroundA better understanding of health-related quality of life (HRQoL) and psychological distress in cancer survivors can raise awareness, promote the development of policies in cancer survivorship care, and facilitate better targeted use of limited resources in low- and middle-income countries (LMICs). The main objectives of this paper were therefore to assess HRQoL and the prevalence of psychological distress amongst cancer survivors in Southeast Asia and identify risk factors of these outcomes.MethodsThe ACTION study was a longitudinal study in eight LMICs in Southeast Asia with 5249 first time cancer survivors followed up at 1 year after diagnosis. HRQoL was assessed using the EORTC QLQ-C30 and EQ-5D. Psychological distress (anxiety and depression) was assessed using the Hospital Anxiety and Depression Scale. General linear models and multiple logistic regression were used to identify independent predictors of HRQoL and psychological distress.ResultsOne year after diagnosis, the mean EORTC QLQ-C30 global health score for survivors was 66.2 out of 100 (SD 22.0), the mean index score on the EQ-5D was 0.74 (SD 0.23), 37% of survivors had at least mild levels of anxiety, and 46% showed at least mild levels of depression. Poorest HRQoL and highest prevalence of anxiety and depression were seen in patients with lung cancer and lymphomas, while highest scores and least psychological distress were seen in female patients with breast and cervical cancer. The most significant predictor of poor HRQoL and psychological distress outcomes was cancer stage at diagnosis. Age, co-morbidities, treatment, and several socioeconomic factors were associated with HRQoL and psychological distress.ConclusionsCancer survivors in LMICs in Southeast Asia have impaired HRQoL and substantial proportions have psychological distress. Patients with advanced cancer stages at diagnosis and those in a poor socioeconomic position were most at risk of such poor outcomes. Supportive interventions for cancer patients that address wider aspects of patient wellbeing are needed, as well as policies that address financial and other barriers to timely treatment.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-016-0768-2) contains supplementary material, which is available to authorized users.

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“…This is coupled with the need for countries to have funding mechanisms in place for palliative care. A financing allocation can be undertaken using a resource-stratification approach to the cancer care pathway, incorporating supportive and palliative care 58 . More advocacy activity is required to sensitize policy-makers and decisionmakers to promote investment and secure the resources required for palliative care; this is the case for low and middle-income countries globally 59 .…”

Section: Discussionmentioning

confidence: 99%

Barriers to, and opportunities for, palliative care development in the Eastern Mediterranean Region

Fadhil

Lyons

Payne

2017

The Lancet Oncology

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The 22 countries of the World Health Organization's Eastern Mediterranean Region (EMR) are experiencing an increase in the burden of non-communicable diseases, including cancer. Of the six WHO regions, the EMR is projected to have the highest increase in incidence of cancer over the next 15 years. Furthermore, most cancers are diagnosed at a late stage, resulting in a lower cancer survival rate than in Europe and the Americas. Therefore, with increasing numbers of cancer deaths, it is important that palliative care is available to relieve suffering for patients with advanced disease and at the end of life.In the Region, it is evident that the palliative care offer is patchy and inconsistent. Gaps include: the lack of inclusion within national policies and limited partnership working; insufficient palliative care education for health professionals and volunteers; lack of public awareness; and a gap in access to essential pain relief medicines. Addressing these barriers would result in improvements to palliative care delivery in the EMR. To this end, this review explores the current status of palliative care in the region, including challenges and opportunities. It explores data and evidence from published literature, WHO meeting reports, cancer control mission reports, and the WHO global non-communicable diseases country capacity survey.

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Optimisation of the continuum of supportive and palliative care for patients with breast cancer in low-income and middle-income countries: executive summary of the Breast Health Global Initiative, 2014

Cited by 42 publications

References 26 publications

Breast cancer early detection and diagnostic capacity in Uganda

Breast cancer early detection and diagnostic capacity in Uganda

Health-related quality of life and psychological distress among cancer survivors in Southeast Asia: results from a longitudinal study in eight low- and middle-income countries

Barriers to, and opportunities for, palliative care development in the Eastern Mediterranean Region

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