Updates in global oncology: Advancements and future directions.

Globally, cancer is the second leading cause of death, and low- and middle-income countries bear most of the disease burden. While cancer is increasingly recognized as a major global health issue, more work remains. Understanding the status of global cancer care will shape the next steps in ensuring equitable global access to cancer care. This article highlights ongoing initiatives in global oncology and the next steps in advancing the field.

Clinicopathologic Profile and Psychosocial Experiences of Nigerian Breast Cancer Survivors.

PURPOSE: Breast cancer survivors are a distinct category of patients with unique characteristics and needs. The population of survivors is expected to increase, given the rising incidence of breast cancer in Nigeria, and the improvements in breast cancer outcomes. This study evaluated the clinicopathologic characteristics and the psychosocial experiences of a cohort of Nigerian breast cancer survivors. METHODS: From an institutional breast cancer database, patients managed between January 2010 and December 2016 were evaluated. Clinicopathologic characteristics, treatment details, and survival estimates were assessed. These were compared with nonsurvivors managed during the same period. Survivors were defined as those who have been alive for at least 5 years from the date of presentation. Qualitatively, a purposive sample of 20 survivors was evaluated using one-on-one in-depth interviews to assess their experiences and coping mechanisms after treatment. RESULTS: Of the 355 patients in the database during the study period, there were 163 survivors (45.9%), while 192 (54.1%) died. Age, stage at presentation, tumor size, and receipt of multiple treatment modalities were significantly associated with survival. Five themes were identified in qualitative analysis: initial reaction to the diagnosis, experiences during treatment, social support, coping strategies, and advocacy. Strong family support and spirituality were prominent coping strategies identified in this cohort. CONCLUSION: Despite obvious infrastructural and manpower limitations, Nigerian patients who present early and receive multimodal therapy and different breast cancer treatments have better odds of survival. Survivors have some unmet psychosocial and physical needs requiring intervention.

Improving access to breast cancer screening and treatment in Nigeria: The triple mobile assessment and patient navigation model (NCT05321823): A study protocol.

BACKGROUND: In Nigeria, breast cancer incidence is rising, late presentation is common, and outcomes are poor. Patient-related factors such as lack of awareness and misperceptions in addition to health system deficiencies such as lack of a clearly defined framework for breast cancer screening and referral are some of the major drivers of this poor outlook. Guidelines for breast cancer screening in high-income countries have limited applicability in low-middle-income countries, hence the need for innovative, resource-compatible strategies to combat the negative trend. This manuscript presents our study protocol which aims to evaluate the impact of a novel breast cancer early detection program developed to address delayed presentation and lack of access to diagnostic and treatment facilities in South-West Nigeria. This entails the use of mobile technology (innovative handheld iBreast Exam [iBE] device, mobile breast ultrasound, and mobile mammography) and patient navigation as interventions at the community level. METHODS: The study (ClinicalTrials.gov identifier: NCT05321823) will adopt a randomized two group clinical trial design with one local government area (LGA) serving as an intervention arm and another serving as the control. Both LGAs will receive breast cancer awareness education but only one will receive the interventions. In the intervention arm, asymptomatic (40-70 years) and symptomatic (30-70 years) women will be invited for breast evaluation which will be performed by trained Community Health Nurses using Clinical Breast Exam (CBE), and iBE. Those with positive findings will proceed to imaging using mobile mammography and ultrasound brought to the LGA every month. Symptomatic women with negative findings on CBE and iBE will be scheduled for repeat clinical evaluation on a short-term basis (one month). The Radiologist will obtain core needle biopsies as indicated and transfer them for prompt pathological assessment. Women presenting to the Primary Healthcare Centers in the control LGA will be referred directly to Obafemi Awolowo University Teaching Hospitals Complex as per the current standard of care. Records of all breast cancer cases seen in the two LGAs during the study period will be obtained. The program metrics will include screening participation rate, cancer detection rate, stage at diagnosis, and timeline from detection to initiation of treatment. The stage at diagnosis and timeline from detection to treatment compared between the two LGAs will be used to assess the impact of the intervention. The study is proposed for 2 years; however, a descriptive analysis will be carried out at 1.5 years to evaluate the retention of the study participants. STUDY SIGNIFICANCE: It is anticipated that this study will provide vital data to support wider breast cancer screening efforts in Nigeria.

Evaluation of side effects and compliance to chemotherapy in breast cancer patients at a Nigerian tertiary hospital.

Background: Chemotherapy improves tumour control and survival, but it may be associated with side effects (SEs) which can impair treatment compliance and worsen outcomes. Assessment of patients in routine clinical practice, outside clinical trials, may provide the information on effects of chemotherapy on patients and its impacts on treatment compliance. Aim: To assess the SE and compliance to chemotherapy in breast cancer patients. Methodology: A prospective study involving 120 breast cancer patients receiving chemotherapy was carried out at the oncology clinics of the University College Hospital Ibadan. SEs reported were recorded and graded using Common Toxicity Criteria for Adverse Events version 5. Compliance was defined as a receipt of planned cycles of chemotherapy in the planned doses within the planned duration. The data collected were analysed using the Statistical Package for the Social Sciences software version 25. Results: The patients were all females with a mean age of 51.2 ± 11.8 years. Patients reported between 2 and 13 SE with a median of 8 SE. Forty-two (35.0%) missed at least one course of chemotherapy while 78 (65%) were compliant. The reasons for non-compliance were deranged blood test 17 (14.2%), chemotherapy SE symptoms related 11 (9.1%), financial constraints 10 (8.3%), disease progression 2 (1.7%) and transportation-related 2 (1.7%). Conclusion: Breast cancer patients encounter multiple SEs from chemotherapy which led to non-compliance with the treatment. Early identification and prompt treatment of these SEs will improve compliance with chemotherapy.

Immediate lymph node extraction improves retrieval rate following axillary lymph node dissection: an effective approach to improving guideline-concordant breast cancer care in Nigeria.

Background: Axillary lymph node staging is essential for making therapeutic decisions and for prognostication. A minimum of ten lymph nodes is recommended for accurate staging. This study describes the process and outcomes of an audit cycle that resulted in a novel intervention instituted to improve concordance with guidelines. Methods: The study began with a retrospective audit of lymph node retrieval following axillary lymph node dissection (ALND). Subsequent phases evaluated the efficacy of immediate lymph node extraction before fixation by comparing the mean number of lymph nodes and the proportion of guideline-concordant cases to retrospective data and concurrent cases without the intervention. Results: The mean number of lymph nodes retrieved in the retrospective phase was 5.2, which is less than the recommended threshold. The intervention resulted in a significant increase in lymph node retrieval over the baseline rate (13.7 versus 5.2, p = 0.026). There was also a significantly higher number of lymph nodes following the intervention compared to concurrent cases managed during the same period without the intervention (13.7 versus 7.9, p = 0.004). The concordance rate was 89% in the intervention group compared to 47% in the non-intervention group (p = 0.019). There was no significant difference when the intervention was administered by either surgeons or pathologists (13.5 versus 12, p = 0.25). Conclusion: Immediate extraction of lymph nodes resulted in significant improvement of concordant lymph node retrieval in all phases of the study. We recommend that this practice be validated in larger cohorts for possible recommendation as an effective way of improving lymph node retrieval following ALND.

The out-of-pocket cost of breast cancer care at a public tertiary care hospital in Nigeria: an exploratory analysis.

Introduction: in Nigeria, the incidence of breast cancer has increased by over 80% in the last four decades. This study quantifies the out-of-pocket (OOP) cost of breast cancer management and the associated rate of catastrophic healthcare expenditure (CHE) at a public tertiary care facility in Ile-Ife, Nigeria. Methods: patients treated between December 2017 - August 2018 were identified from a prospective breast cancer database. A questionnaire was developed to capture the total cost of care, including direct and indirect expenses. Three commonly used thresholds for a CHE were used in this analysis. The cost of radiotherapy and targeted therapy were captured separately. Results: data was collected from 22 eligible patients. Sixty-eight percent had no form of health insurance. The mean cost of diagnosis and treatment was $2,049 (SD $1,854). At a threshold of 10% and 25% of annual income, 95% and 86% of households experienced a CHE. Based on a household´s capacity-to-pay, 90% experienced a CHE. The mean cost of radiotherapy was $462 (SD $223) and the mean cost of trastuzumab was $6,568 (SD $2,766). Cost precluded surgery in 14% of patients with resectable disease. As a result of accessing treatment, 72% of households had to borrow money and 9% of households interrupted a child´s education. Conclusion: the out-of-pocket cost of breast cancer care in Nigeria is significant. This results in a CHE for 68-95% of households, which has significant health and economic sequelae. Greater financial protection is essential as the burden of breast cancer increases in Nigeria.

Breast cancer in elderly patients: a clinicopathological review of a Nigerian database.

Background: Breast cancer in the elderly population has not been evaluated in the Nigerian context. With the rising incidence of breast cancer and the changing demographics, it is likely that an increasing number of elderly patients will be managed in the coming years in Nigeria. This review describes the clinicopathological profile of elderly patients with breast cancer in a Nigerian database. Method: From a prospective institutional database, elderly patients (65 years and above) managed for breast cancer over a 9-year period were reviewed. Details of their socio-demographic characteristics, patterns of presentation, pathology, treatment and outcome were obtained and analysed. Results: Of the 607 patients managed during the study period, there were 87 older patients accounting for 14.3% of the total. There was a progressive rise in the number of patients with breast cancer towards the latter part of the study. Expectedly, they were all post-menopausal, with their ages ranging from 65 to 92 years, with a mean of 71 ± 6.58 years. Systemic hypertension was the commonest co-morbidity (29.8%). The mean tumour size at presentation was 10 cm, with the majority presenting with stage 3 disease. Invasive ductal carcinoma was the predominant histological type 83 (95.4%); 44.4% of those who had immunohistochemistry were oestrogen receptor-positive. Approximately half underwent mastectomy (52.8%), 63 (72.4%) had chemotherapy, 8 (44.4%) had hormonal therapy and only 6 (6.9%) had combined multimodal therapy in addition to surgery. Overall 5-year survival was 42.1%. Conclusion: The pattern of presentation and outcomes of care in this elderly cohort is similar to the general population. Early presentation and use of multimodal treatment is still the mainstay of survival.

Impact of the COVID-19 Pandemic on Surgical Residency Training: Perspective from a Low-Middle Income Country.

BACKGROUND: The COVID-19 pandemic has drastically impacted postgraduate training programmes worldwide. This study aims to evaluate the Nigerian situation with respect to surgical training, with a view to identifying gaps and proffering solutions. METHODS: A cross-sectional survey of surgical residents in Nigeria was conducted between 27 July 2020 and 14 August 2020. A structured questionnaire designed using the free software Google Forms® was utilised for the study. The questionnaire was electronically distributed randomly to 250 surgical residents via emails and social media platforms including WhatsApp and Telegram. The data obtained was analysed by Google Forms®. Ethical approval for the study was obtained from the ethics and research unit of the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Osun State, Nigeria. RESULTS: At the end of the study period, 207 surgical residents completed and submitted the questionnaire, giving a response rate of 82.8%. The majority of respondents reported a reduction (164, 79.2%) or cancellation (11, 5.3%) of postgraduate programmes in their institutions. Of those who had academic programmes, meetings were done using virtual technology in all instances. The majority of respondents reported seeing fewer patients in the outpatient clinics (173, 83.6%), as well as a reduction in the number of emergency and elective operations (58.5% and 90.8%, respectively). About a third of the respondents (70, 33.8%) were contemplating emigrating from the country. CONCLUSION: The COVID-19 pandemic has significantly affected the clinical, research and teaching components of surgical training in Nigeria. It has, however, led to increased adoption of digital technology which should be further explored in the face of current realities.

Introduction of Suturing Skills Acquisition into Undergraduate Surgical Education: Early Experience from Ile-Ife, Nigeria.

BACKGROUND: Undergraduate medical students of the Obafemi Awolowo University, Ile-Ife, Nigeria, had over the years acquired various skills informally without structured training in basic skills in wound closure. The Department of Surgery introduced suturing skills acquisition workshop into the curriculum of the Final-Year Medical Students in 2016. This study describes the preliminary experience and the perception of the participants. METHODS: All students undergoing the senior rotations in surgery and surgical specialties were taken through a day suturing skills workshop at the surgical skills laboratory. Skills were demonstrated using validated narrative videos followed by practical sessions supervised by senior registrars and consultant surgeons. All participants were requested to complete a feedback form after the workshop. RESULTS: One hundred and eighty students were trained in six workshop sessions per year over two academic sessions. There were 128 (71.1%) male and 52 (28.9%) female students trained by 9 consultants and 13 senior registrars with 15-17 students in each session. Self-assessment feedback after the workshop revealed that all but 3 (1.7%) students felt very confident in handling basic instruments, 102 (56.7%) were confident of their proficiency in basic suturing, 68 (37.8) were less confident, whereas 10 (5.6%) were not confident looking ahead and 82 students (46.1%) wanted additional skills to attain proficiency in some common surgical procedures prior to graduation. CONCLUSION: The department achieved the aim of introducing suturing skills acquisition into undergraduate surgical education. In the future, other surgical skills acquisition workshops may be considered as desired by the students.

Life Without a Breast: Exploring the Experiences of Young Nigerian Women After Mastectomy for Breast Cancer.

PURPOSE: The majority of women managed for breast cancer in Nigeria are relatively young, many in their forties. Mastectomy, the most common surgical treatment, raises psychosocial concerns. Understanding these concerns may help address the fears of women who refuse treatment and aid in the care of those who have had mastectomy. METHODS: Using qualitative methods, we purposively sampled women 45 years of age and younger who underwent mastectomy for breast cancer at a Nigerian teaching hospital. One-on-one in-depth interviews were conducted using an unstructured interview guide. Data were transcribed verbatim and analyzed to identify themes and subthemes. RESULTS: The study identified six major themes on the impact of mastectomy on psychosocial lives of women, namely decision for mastectomy, postmastectomy transition, body image changes, relationship with husband and sexual life, coping with life postmastectomy, and social support. CONCLUSION: Our findings highlight the importance of addressing individual patient's psychosocial needs and preferences when discussing breast cancer treatment with young women. The experiences of women described in this study reveal several useful themes for planning treatment protocols and postmastectomy care.

Severity, challenges, and outcome of retroperitoneal hematoma in a Nigeria Tertiary Hospital

Background: Retroperitoneal hematoma (RH) can present as an acute life-threatening condition, report on RH in low-income countries are lacking. Objective: We present the severity, pattern, challenges, and outcome of RH in a low-resource country such as Nigeria. Methods: This was a retrospective observational study of all patients with blunt or penetrating abdominal injury needing surgery, patients with RH among them were analyzed. Results: In the last one decade spanning 2005-2015, our operation database record showed that 247 patients had exploratory laparotomy for blunt and penetrating abdominal trauma. Out of the 115 patients with complete record available, only 43 had RH. The median age of the patients was 30 years, and the most affected age group was 20-29 years. Female to male ratio was 1:13. Only eight patients (18.6%) reached the hospital from the accident site within the first "Golden Hour" of accident, which is the first 1 h postrauma during which treatment intervention believed to have the best outcome. Only two patients (4.7%) got to operating theater within 1 h of reaching hospital. None of our patients had preoperative diagnosis of RH; overall, mortality was two patients (4.7%). Conclusion: Logistical infrastructural inadequacies such as lack of sterile theater bundle and drapes/nonavailability or busy theater space caused delay for patients between presentation in the Accident and Emergency Center and operating theater. None of our patients had a preoperative diagnosis of RH because of lack of access to computerized tomography scan dedicated to trauma in Accident and Emergency Center. The overall mortality of 4.7% in this study, which is on the low side, tends to suggest that mostly mild and stable cases which can make it to the operating table were eventually operated upon

Severity, Challenges, and Outcome of Retroperitoneal Hematoma in a Nigeria Tertiary Hospital.

BACKGROUND: Retroperitoneal hematoma (RH) can present as an acute life-threatening condition, report on RH in low-income countries are lacking. OBJECTIVE: We present the severity, pattern, challenges, and outcome of RH in a low-resource country such as Nigeria. METHODS: This was a retrospective observational study of all patients with blunt or penetrating abdominal injury needing surgery, patients with RH among them were analyzed. RESULTS: In the last one decade spanning 2005-2015, our operation database record showed that 247 patients had exploratory laparotomy for blunt and penetrating abdominal trauma. Out of the 115 patients with complete record available, only 43 had RH. The median age of the patients was 30 years, and the most affected age group was 20-29 years. Female to male ratio was 1:13. Only eight patients (18.6%) reached the hospital from the accident site within the first Golden Hour of accident, which is the first 1 h postrauma during which treatment intervention believed to have the best outcome. Only two patients (4.7%) got to operating theater within 1 h of reaching hospital. None of our patients had preoperative diagnosis of RH; overall, mortality was two patients (4.7%). CONCLUSION: Logistical infrastructural inadequacies such as lack of sterile theater bundle and drapes/nonavailability or busy theater space caused delay for patients between presentation in the Accident and Emergency Center and operating theater. None of our patients had a preoperative diagnosis of RH because of lack of access to computerized tomography scan dedicated to trauma in Accident and Emergency Center. The overall mortality of 4.7% in this study, which is on the low side, tends to suggest that mostly mild and stable cases which can make it to the operating table were eventually operated upon.