Pathways to Breast Cancer Diagnosis and Treatment Among Women in Ghana: A Qualitative Study

Abstract

Background: Breast cancer is the leading cause of cancer death among Ghanaian women and most women are identified once they develop symptoms. Women then must navigate a complex health care system to get diagnosed and receive orthodox medicine. We describe Ghanaian women's pathways of care from breast cancer-related symptom detection to treatment receipt. Methods: We conducted a qualitative study using an empirical phenomenological approach. We used a purposive sampling technique to recruit 31 women with breast cancer who were receiving treatment at Komfo Anokye Teaching Hospital in Kumasi, Ghana. They participated in semistructured in-depth interviews between November 2019 and March 2020. All interviews were transcribed verbatim and analyzed using a deductive coding approach. Results: Women navigate approximately nine steps from symptom detection to receiving orthodox breast cancer treatment. The breast cancer care pathway is not linear and women frequently move among different management approaches, including alternative therapy (faith healing and traditional herbal healing). All the women detected the symptoms themselves. Some of the women sought orthodox medicine due to information from the media. Conclusions: Alternative therapy providers play a critical role in the breast cancer diagnosis and care pathways in Ghana underscoring the need to formally integrate them into the health care system. Breast cancer awareness programs through the media and educational programs aimed at alternative therapy providers may reduce the time from symptom detection to receipt of orthodox medicine.

Household treatment cost of breast cancer and cost coping strategies from a tertiary facility in Ghana

“…This assertion is confirmed by previous studies [10,12]. The mean age observed in our patients was comparable to data from similar breast cancer patients' population across Ghana [17,18]. Also consistent with our findings, Dedey et al [17] and Mburu et al [18] reported that majority of breast cancer patients subscribed to the national health insurance scheme (89% & 97% respectively), which is at variance with the estimated national enrollment figure for women (66%) [19].…”

“…The mean age observed in our patients was comparable to data from similar breast cancer patients' population across Ghana [17,18]. Also consistent with our findings, Dedey et al [17] and Mburu et al [18] reported that majority of breast cancer patients subscribed to the national health insurance scheme (89% & 97% respectively), which is at variance with the estimated national enrollment figure for women (66%) [19]. Amoako et al [20] reported on summarized data from the Kumasi Cancer Registry and found that breast cancer accounted for 30% of all female cancers and was the leading cause of cancer in the Kumasi metropolis of Ghana.…”

“…[1], Not at all [2], Mildly [3], Moderately [4], Severely/Extremely) in relation to fear, stress, depression and physical pain. The aggregated score from these four questions were re-categorized into 'Low' (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24), 'Moderate' (28-37) and 'High' (38-48) cost using the descriptive statistics tertile approach.…”

Development of Quality Indicators in the Management of Breast Cancer: A Systematic Review

“…Most indicators focused on breast cancer management from referral to follow-up. This is supported by Mburu and his colleagues that management of breast cancer requires a holistic approach consisting of early detection, diagnosis through treatment, consistent follow-ups and review (32).…”

What influences cancer treatment service access in Ghana? A critical interpretive synthesis

“… 3 8 23 31 36 44–46 Some women sought over the counter medications for pain management. 37 Seeking assistance from someone other than a nurse or doctor was associated with a larger mass at diagnosis for breast cancer, which could include a diverse mix of pluralist and community supports. 44 Some health professionals also advised herbal alternatives, delaying medical cancer treatment.…”