Emerging Use of Public-Private Partnerships in Public Radiotherapy Facilities in Nigeria.

PURPOSE: Radiotherapy (RT) treatment at public hospitals in Nigeria is often interrupted by prolonged periods of machine breakdown because of insufficient funds for maintenance and repair. These delays have prompted the uptake of public-private partnerships (PPPs) to acquire and maintain RT equipment. This study aimed to understand Nigeria's current RT capacity and the impact of PPPs on RT availability and cost. METHODS: Eleven radiation oncologists, each representing one of the 11 RT centers in Nigeria (eight public and three private), were invited to complete a survey on the type, status, acquisition, and maintenance plan of existing RT equipment, cost incurred by patients for external-beam radiation (EBRT) and brachytherapy treatment, and number of patients treated per year on each machine. Type and status of equipment at nonresponding facilities were obtained through literature review and confirmed with the facility. RESULTS: A total of eight (81%) respondents completed the survey, all representing public centers, three of which reported PPP use. They reported 11 megavoltage units in total (seven linear accelerators [LINACs] and four Cobalt-60s) and 10 brachytherapy afterloaders. Of those, 57% (4/7) of the LINACs, 100% (4/4) of the Cobalt-60s, and 63% (7/11) of the afterloaders were in clinical use. All commissioned equipment supported by PPPs (three LINACs and one afterloader) were in operation. The public EBRT equipment were nonfunctional 35% of the year (resulting in 60% fewer patients treated per year). The PPP EBRT and afterloaders did not experience any periods of breakdown, but PPP costs were 338% higher than public equipment. CONCLUSION: This study characterizes the use of PPP as a more reliable method of RT delivery in Nigeria, albeit at higher costs.

Implementing Patient-Directed Cancer Education Materials Across Nigeria.

PURPOSE: As access to cancer care expands in low-income countries, developing tools to educate patients is paramount. We took a picture booklet, which was initially developed by the nonprofit Global Oncology for Malawi and Rwanda, and adapted it for use in Nigeria. The primary goal was to assess acceptability and provide education. The secondary goals were (1) to describe the collaboration, (2) to assess knowledge gained from the intervention, (3) to assess patient understanding of their therapy intent, and (4) to explore patient's experiences via qualitative analysis. METHODS: We piloted the original English booklet at a single site and requested feedback from patients and providers. The booklet was updated; translated into Hausa, Yoruba, Igbo, and Pidgin English; and used at three additional sites. For the three-site cohort, we collected basic demographics, pretest and post-test assessing content in the booklet, and performed a qualitative analysis. RESULTS: The original booklet was widely acceptable and recommended by patients at site one (n = 31) and by providers (N = 26) representing all four sites. In the three-site cohort (n = 103), 94% of patients recommended the booklet. An immediate post-test focusing on when patients should present to care showed a statistically significant improvement in one of the seven questions. Fifty-one percent of the patients (n = 103) knew their treatment intent (curative v palliative). Qualitative analysis highlighted that the patient's thoughts on cancer are dominated by negative associations, although curability and modern therapy are also frequently cited. CONCLUSION: We adapted an educational booklet to a novel context and had it delivered by local partners. The booklet was widely recommended to future patients. The booklet had an impact on patient's knowledge of cancer treatment, potentially allowing for decreased abandonment.

The perceptions of physicians in southeast Nigeria on truth-telling for cancer diagnosis and prognosis.

BACKGROUND: The perceptions of Nigerian physicians on truth-telling for cancer diagnosis and prognosis have not been widely studied. There is a need to know the perception of the doctors on truth telling so as to inform appropriate professional education on the subject. OBJECTIVES: To ascertain the perceptions of the physicians on truth-telling for cancer diagnosis and prognosis. METHODS: A cross-sectional study was done with a self-administered questionnaire to 228 physicians available in the clinics and seminars at the hospital between January and April 2010. RESULTS: A total of 173 questionnaires were returned. Eighty-one (46.8%) always, 54 (31.2%) generally, and 38 (22%) rarely disclose cancer diagnosis and favorable prognosis to patients. Only 7.5% would disclose the truth of the prognosis to patients when the cancer is advanced. Physicians' age, specialty, training in palliative care, and doctors' views on truth disclosure if he/she had cancer significantly influenced the doctors' practice of truth-telling for cancer diagnosis. CONCLUSION: The physicians who treat cancer patients in southeast Nigeria tend to practice truth-telling for cancer diagnosis but not for a poor prognosis. Most of the physicians need training in physician-patient communication.

Histopathological patterns of ovarian tumours seen in Lagos University Teaching Hospital: a ten year retrospective study.

BACKGROUND: Among gynaecological cancers, ovarian malignancy is the most lethal, largely due to the fact that it is not diagnosed until late stage. Information concerning the frequency and pattern of ovarian tumours in Lagos is scant. OBJECTIVE: To present a 10 year retrospective histologic study of ovarian tumours in Lagos, Nigeria. The aim is to document the histologic pattern, prevalence and age distribution of ovarian tumours. METHOD: The materials consisted slides, paraffin embedded tissue blocks, patients' case files and histology request forms of all ovarian biopsies received at the Morbid Anatomy department of Lagos University Teaching Hospital Idi-Araba, Lagos from 1991 to 2000. RESULTS: A total of 486 ovarian biopsies were studied out of which 203 specimens were true ovarian neoplasms. One hundred and sixty three (80.3%) of the true neoplasms were benign while malignant ovarian tumours constituted 40 (19.7%). Ovarian malignancy constituted about 7% of 203 gynaecological malignant tumours in the 10 year period under review. Tumours of germ cell origin were the commonest, accounting for 107 (52.7%) of the true ovarian neoplasm seen. Surface epithelial tumours constituted 56 (27.6%), while sex cord-stromal tumours contributed 32 (15.8%). Mature teratoma was the commonest benign tumour, accounting for 98 (60.1%) cases of benign ovarian tumours. It showed a wide age range of occurrence, with peak occurrence between 20 and 29 years. Serous cystadenocarcinoma (42.5%) was the commonest ovarian malignancy. Serous cystadenocarcinoma occurred between the ages of 20 and 69 years with highest frequency in 30-39 years age group, CONCLUSION: The germ cell tumours were the commonest ovarian neoplasm followed by surface epithelial tumours. This pattern is seen in most parts of Nigeria and Africa.