Understanding the causes of breast cancer treatment delays at a teaching hospital in Ghana

Abstract

Poor outcome for breast cancer in Ghana have been attributed to late presentation of symptoms at biomedical facilities. This study explored factors accounting for delays in initiation of breast cancer treatment at the Korle-Bu Teaching Hospital in Accra. Focus group discussions were conducted with twenty women with breast cancer. A theory-driven thematic analysis identified three multilevel factors influencing treatment seeking delays: (1) patient (e.g misinterpretation of symptoms, fear); (2) healthcare provider (e.g negative attitudes); and (3) health systems (e.g shortage of medicines). Addressing treatment delays will require multilevel interventions, including culturally congruent education, psychosocial counselling/support, and strengthening health systems.

Socioeconomic impact of breast cancer on young women in Ghana: A qualitative study

“…With these financial challenges faced by these women, they had to rely on family members, employers and other people for assistance to enable them go through treatment. A lot of studies have reported similar findings (Sanuade et al, 2018;Twahir et al, 2019;White-Means, Dapremont, Davis, & Thompson, 2020). Amid the financial difficulties, some employers promised to assist some participants with payment of hospital bills;…”

Health System Factors That Influence Treatment Delay in Women With Breast Cancer in Sub-saharan Africa: A Systematic Review

“…Logistical di culties included different waiting times for an appointment (medical or specialist consultation), investigations (imaging, biopsy), test results, referral or treatment (surgery, radiotherapy) [23][24][25][26][27][28][29][30][31]. A long waiting time for test results, more speci cally for the biopsy results, was a factor in uencing the time to treatment in 11 included studies [24,[26][27][28][29][30][32][33][34][35][36]. Seven included studies reported that referral was delayed for women who had visited other health facilities 1 to 4 times or more before visiting the diagnostic centre [23,24,30,[36][37][38][39].…”

“…The geographical inaccessibility of healthcare facilities and the insu ciency of diagnostic centres are part of the infrastructure problems [28][29][30][31]41]. In Uganda, for instance, one patient interviewed said, 'The health centre nearby the community does not offer screening services, and someone may nd it hard to leave this place [Ssisa sub-county] to go to Kampala; but if they bring the services closer to the community, some will nd it easier to visit them.'…”

“…(P07) [29] Symptom misinterpretation and misdiagnosis were the most frequent reasons for prolongation of the primary care interval. In six studies, caregivers mismanaged breast cancer patients by giving incorrect medical prescriptions or incorrect advice [27,28,30,36,43,44]. For instance, Pruitt et al reported that the majority of women described receiving oral medication or injections, usually antibiotics, sometimes for months or years before being referred or making an independent decision to seek care elsewhere [27].…”

“…The shortage of health workers and strikes were also identi ed as factors delaying women's access to breast cancer treatment [25,27,28,32,36,42,44]. Studies have reported that various hospital departments turned women away because a doctor was not available [32].…”