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Le Touquet – Paris-Plage, France

Kantelhardt E.J.,Martin Luther University of Halle Wittenberg | Zerche P.,Martin Luther University of Halle Wittenberg | Mathewos A.,Addis Ababa Institute of Technology | Trocchi P.,Martin Luther University of Halle Wittenberg | And 13 more authors.
International Journal of Cancer | Year: 2014

There is little information on breast cancer (BC) survival in Ethiopia and other parts of sub-Saharan Africa. Our study estimated cumulative probabilities of distant metastasis-free survival (MFS) in patients at Addis Ababa (AA) University Radiotherapy Center, the only public oncologic institution in Ethiopia. We analyzed 1,070 females with BC stage 1-3 seen in 2005-2010. Patients underwent regular follow-up; estrogen receptor-positive and-unknown patients received free endocrine treatment (an independent project funded by AstraZeneca Ltd. and facilitated by the Axios Foundation). The primary endpoint was distant metastasis. Sensitivity analysis (worst-case scenario) assumed that patients with incomplete follow-up had events 3 months after the last appointment. The median age was 43.0 (20-88) years. The median tumor size was 4.96 cm [standard deviation (SD) 2.81 cm; n = 709 information available]. Stages 1, 2 and 3 represented 4, 25 and 71%, respectively (n = 644). Ductal carcinoma predominated (79.2%, n = 1,070) as well as grade 2 tumors (57%, n = 509). Median follow-up was 23.1 (0-65.6) months, during which 285 women developed metastases. MFS after 2 years was 74% (69-79%), declining to 59% (53-64%) in the worst-case scenario. Patients with early stage (1-2) showed better MFS than patients with stage 3 (85 and 66%, respectively). The 5-year MFS was 72% for stages 1 and 2 and 33% for stage 3. We present a first overview on MFS in a large cohort of female BC patients (1,070 patients) from sub-Saharan Africa. Young age and advanced stage were associated with poor outcome. What's new? There is little information on breast cancer survival in Ethiopia and other parts of sub-Saharan Africa. This study is the first to report on outcome of a large cohort of sub-Saharan patients with newly diagnosed breast cancer receiving standardized therapy in the only oncologic referral center in Ethiopia. Based on 1,070 patients with a median follow-up of 23 months, the study found a distant metastasis-free survival (MFS) after 2 years of 74%-a rather favorable outcome considering the limited resources. The effect of potential determinants on MFS was estimated, with young age and advanced stage both associated with poor outcome. © 2013 UICC. Source

de Ver Dye T.,SUNY Upstate Medical University | de Ver Dye T.,University Paris Diderot | Bogale S.,Radiotherapy Center | Hobden C.,Global Health Systems and Research | And 5 more authors.
Global Public Health | Year: 2011

A large proportion of breast cancer patients in Ethiopia present for biomedical care too late, or not at all, resulting in high mortality. This study was conducted to better learn of beliefs and practices among patients accessing breast cancer services in a large referral centre in Ethiopia. Using a mixed-method design, we interviewed 69 breast cancer patients presenting for care at Tikur Anbessa Hospital in Addis Ababa, Ethiopia, about their beliefs, experiences and perspectives on breast cancer. Awareness of breast cancer is low in Ethiopia and even among those who are aware of the disease, a sense of hopelessness and fatalism is common. Early signs/symptoms are frequently ignored and patients often first present to traditional healers. Breast cancer is perceived as being caused typically from humoral anomalies or difficulties resulting from breast feeding, and study participants indicate that stigmatisation and social isolation complicate discussion and action around breast cancer. Consistent with other studies, this study shows that traditional beliefs and practices are common around breast cancer and that numerous barriers exist to identification and treatment in Ethiopia. Integrating health beliefs and practice into public health action in innovative ways may reduce stigma, increase awareness and promote survivability among breast cancer patients. © 2010 Taylor & Francis. Source

Kantelhardt E.J.,Martin Luther University of Halle Wittenberg | Mathewos A.,Addis Ababa Institute of Technology | Aynalem A.,Addis Ababa Institute of Technology | Wondemagegnehu T.,Addis Ababa Institute of Technology | And 11 more authors.
BMC Cancer | Year: 2014

Background: In contrast with breast cancers (BCs) in other parts of the world, most previous studies reported that the majority of BCs in sub-Saharan Africa are estrogen-receptor (ER) negative. However, a recent study using the US SEER database showed that the proportion of ER-negative BC is comparable between US-born blacks and West-African born blacks but substantially lower in East African-born blacks, with over 74% of patients Ethiopians or Eritreans. In this paper, we provide the first report on the proportion of ER-negative BC in Ethiopia, and the relation to progesterone-receptor (PgR) status. Methods: We analysed 352 female patients with ER results available out of 1208 consecutive female BC patients treated at Addis Ababa-University Hospital, Ethiopia, from June 2005 through December 2010. The influences of age, stage, and histology on the probability of ER-negative tumours were assessed by a log-linear regression model. Results: Of the 352 patients, only 35% were ER-negative. The proportion of ER-negative tumours decreased with advancing age at diagnosis and was not affected by histology or stage. For age, the proportion decreased by 6% for each additional 5 years (stage-adjusted prevalence ratio PR = 0.94, 95% CI: 0.89-1.00). About 31% were ER- and PgR-negative, and 69% were ER- and/or PgR-positive. Conclusions: Contrary to most previous reports in other parts of sub-Saharan Africa, the majority of patients in Ethiopia are ER-positive rather than ER-negative. These findings are in line with low proportions of ER-negative BCs from East African immigrants within the SEER database, and they have clinical implications for management of BC patients in Ethiopia and other parts of sub-Saharan Africa where ER-status is not ascertained as part of routine management of the disease. Since the majority of patients showed ER-positive BC, Tamoxifen-therapy should be given to all patients even with unknown ER status. © 2014 Kantelhardt et al. Source

Dye T.D.,Axios International | Dye T.D.,New York University | Bogale S.,Addis Ababa Institute of Technology | Hobden C.,Axios International | And 5 more authors.
Cancer | Year: 2010

BACKGROUND: As the global visibility and importance of breast cancer increases, especially in developing countries, ensuring that countries strengthen and develop health systems that support prevention, diagnosis, and treatment of a complex chronic disease is a priority. Understanding how breast cancer patients navigate health systems to reach appropriate levels of care is critical in assessing and improving the health system response in countries to an increasing breast cancer burden in their populations. Ethiopia has accelerated attention to breast cancer, expanding clinical and public health efforts at diagnosing and treating breast cancer earlier and more efficiently. METHODS: This project used a mixed-method approach to assessing patient navigation of the healthcare system that resulted in care at the cancer referral hospital for Ethiopia (Tikur Anbessa Hospital [TAH]). In total, 69 patients representative of the entire breast cancer clinical population at TAH were interviewed. RESULTS: Navigation chains are widely divergent and typically involve 3 or more care nodes until they reach the referral hospital. Patients who consult traditional healers have significantly more care nodes to reach the referral hospital than others, and patients who have direct access to local and regional hospitals have the smallest number of care nodes. Patients report moving laterally from 1 health institution to another or regressing to lower levels of care, sometimes complicated by reinvolving traditional healers. CONCLUSIONS: The care system can be streamlined for breast cancer patients in Ethiopia to facilitate patient access to available and clinically effective diagnostic and treatment services in the country, largely through improving local primary care and hospital capacity to provide basic breast cancer services and improve detection and referral. © 2009 American Cancer Society. Source

Ladner J.,University of Rouen | Tekinturhan E.,Axios International | Tavolacci M.-P.,University of Rouen | Audureau E.,University of Paris Descartes | Saba J.,Axios International
Journal of Health Care for the Poor and Underserved | Year: 2013

Background. Th e Glivec International Patient Assistance Program (GIPAP) is designed to provide access to the cancer therapy Imatinib (Glivec), which is indicated for the treatment of chronic myelogenous leukemia (CML) and gastrointestinal stromal tumors (GIST). Objectives. To identify factors those infl uence the quality of care and structural improvements. Design. Physicians (n=50), hospital administrators (n=10) and Ministry of Health officials (n=7) in 39 developing countries participated in qualitative interviews. Th e interviews focused on the impact of GIPAP on service delivery, patient tracking systems and cancer registries, health financing, and workforce. Results. Service delivery, patient management, access to care, diagnostic capacity, and health workers' skills improved at participants' institutions following implementation of GIPAP. Conclusions. Positive institutional changes that improve care of CML/ GIST patients arose from GIPAP. Some of these changes may strengthen institutions' capacity to treat other diseases as well. Th e GIPAP model could be deployed to improve access to care for patients with other chronic diseases. © Meharry Medical College. Source

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