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Pumpalova YS, Ramakrishnan A, May M, Pentz A, Minkowitz S, Doherty S, Singh E, Chen WC, Rebbeck TR, Neugut AI, Joffe M. Biochemical progression free and overall survival among Black men with stage IV prostate cancer in South Africa: Results from a prospective cohort study. Cancer Med 2023; 13:e6739. [PMID: 38158645 PMCID: PMC10807684 DOI: 10.1002/cam4.6739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 11/07/2023] [Accepted: 11/15/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Men of African descent are disproportionately affected by prostate cancer (PCa), and many have metastatic disease at presentation. In South Africa (SA), androgen deprivation therapy (ADT) is the first-line treatment for stage IV PCa. OBJECTIVE To identify predictors of overall survival (OS) in Black South African men with stage IV PCa treated with ADT. DESIGN, SETTING, AND PARTICIPANTS Men diagnosed with prostate cancer (3/22/2016-10/30/2020) at Chris Hani Baragwanath Academic Hospital in Soweto, Johannesburg, were recruited for the Men of African Descent with Cancer of the Prostate study. We included men with newly diagnosed stage IV PCa treated with ADT who had a prostate-specific antigen (PSA) level drawn prior to initiation of ADT and had ≥1 PSA drawn ≥12 weeks after ADT start. OUTCOMES MEASURES AND STATISTICAL ANALYSIS We used Kaplan-Meier statistics to estimate OS and Cox regression models to identify predictors of OS. RESULTS AND LIMITATIONS Of the 1097 men diagnosed with prostate cancer, we included 153 men with stage IV PCa who received ADT and met PSA requirements. The median age was 68.0 years (interquartile range 64-73 years). Median OS from time of ADT initiation was 3.39 years (95% confidence interval (CI): 3.14%-noncalculable), while biochemical progression-free survival was 2.36 years (95% CI: 2.03%-3.73%). Biochemical progression (HR 3.52, 95% CI: 1.85%-6.70%), PSA nadir level >4 ng/mL (HR 3.77, 95% CI: 1.86%-7.62%), alkaline phosphatase level at diagnosis >150 IU/dL (HR 3.09, 95% CI: 1.64%-5.83%), and hemoglobin at diagnosis <13.5 g/dL (HR 2.90, 95% CI: 1.28%-6.56%) were associated with worse OS. CONCLUSIONS In this study, we identified factors associated with poor OS among Black South African men with stage IV PCa treated with ADT. These factors may be useful in identifying patients for upfront treatment escalation, including the use of docetaxel chemotherapy or escalation of therapy at the time of biochemical progression. PATIENT SUMMARY In this study, we found that high alkaline phosphatase level, anemia at diagnosis, and high PSA nadir after initiation of androgen deprivation therapy are associated with worse overall survival among Black South African men treated with androgen deprivation therapy for metastatic prostate cancer.
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Affiliation(s)
- Yoanna S. Pumpalova
- Department of Medicine, Vagelos College of Physicians and SurgeonsColumbia UniversityNew York CityNew YorkUSA
| | - Adarsh Ramakrishnan
- Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew York CityNew YorkUSA
| | - Michael May
- Department of Medicine, Vagelos College of Physicians and SurgeonsColumbia UniversityNew York CityNew YorkUSA
| | - Audrey Pentz
- Strengthening Oncology Services Research Unit, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Shauli Minkowitz
- Division of Urology, Department of Surgery, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Sean Doherty
- Division of Urology, Department of Surgery, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Elvira Singh
- National Cancer RegistryNational Health Laboratory ServiceJohannesburgSouth Africa
| | - Wenlong Carl Chen
- Strengthening Oncology Services Research Unit, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
- National Cancer RegistryNational Health Laboratory ServiceJohannesburgSouth Africa
- Sydney Brenner Institute for Molecular BioscienceFaculty of Health Sciences, University of the WitwatersrandJohannesburgSouth Africa
| | - Timothy R. Rebbeck
- Dana Farber Cancer InstituteBostonMassachusettsUSA
- Harvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Alfred I. Neugut
- Department of Medicine, Vagelos College of Physicians and SurgeonsColumbia UniversityNew York CityNew YorkUSA
- Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew York CityNew YorkUSA
- Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and SurgeonsColumbia UniversityNew York CityNew YorkUSA
| | - Maureen Joffe
- Division of Urology, Department of Surgery, Faculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
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Onwusah DO, Ojewole EB, Manyangadze T, Chimbari MJ. Barriers and Facilitators of Adherence to Oral Anticancer Medications Among Women with Breast Cancer: A Qualitative Study. Patient Prefer Adherence 2023; 17:2821-2839. [PMID: 37953981 PMCID: PMC10637192 DOI: 10.2147/ppa.s416843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 08/29/2023] [Indexed: 11/14/2023] Open
Abstract
Purpose Despite the life-saving benefits of oral anticancer medications (OAMs) to women with breast cancer (BC), adherence remains suboptimal and, in many cases, not well documented. The study examined barriers and facilitators of adherence to OAMs among women receiving BC treatment in Nigeria. Patients and Methods The study was framed within the World Health Organization (WHO) Multidimensional Model of Adherence. We conducted qualitative in-depth interviews of 16 purposively sampled women in two tertiary hospitals in Southern Nigeria. The interviews were audio-recorded and transcribed verbatim. The interview data were analyzed using the Framework Method. Results The key barriers to OAM adherence mentioned were socioeconomic factors (high cost of medication) and therapy-related factors (medication side effects). The key facilitating mechanisms for adherence to OAMs mentioned included; (i) patient-related psychosocial factors such as self-encouragement and self-discipline in sticking to the prescription, taking the medication at a particular time each day, receiving practical support from family members; and (ii) healthcare team/system factors such as obtaining an adequate supply of the medication at the pharmacy. Conclusion Barriers and facilitators to OAM adherence are multidimensional. The study findings highlight the potential benefit of a multifaceted intervention (such as patient education and monitoring or strategies promoting cost-containment and side effects management) to optimize adherence. Therefore, our findings may inform the designing and evaluating of context-specific adherence measures and multifaceted intervention strategies targeting key barriers and approaches that enable adherence to enhance patient outcomes.
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Affiliation(s)
- Deborah Obehi Onwusah
- Discipline of Pharmaceutical Sciences, School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Elizabeth Bolanle Ojewole
- Discipline of Pharmaceutical Sciences, School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Tawanda Manyangadze
- Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
- Geosciences, School of Geosciences, Disasters and Sustainable Development, Faculty of Science and Engineering, Bindura University of Science Education, Bindura, Mashonaland Central, Zimbabwe
| | - Moses John Chimbari
- Discipline of Public Health Medicine, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
- Department of Public Health, School of Medical and Health Sciences, Great Zimbabwe University, Masvingo, Zimbabwe
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Joosse IR, van den Ham HA, Mantel-Teeuwisse AK, Suleman F. Alignment in the registration, selection, procurement and reimbursement of essential medicines for childhood cancers in South Africa. BMJ Glob Health 2023; 8:e012309. [PMID: 37730243 PMCID: PMC10846849 DOI: 10.1136/bmjgh-2023-012309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/30/2023] [Indexed: 09/22/2023] Open
Abstract
INTRODUCTION The effectiveness of a health system in providing access to medicines is in part determined by the alignment of several core pharmaceutical processes. For South Africa's public health sector, these include the registration of medicines, selection and subsequent procurement through national tenders. Registration, selection and reimbursement are key processes in the private sector. This study assessed the alignment of forementioned processes for essential paediatric oncology medicines in South Africa. METHODS A selection of priority chemotherapeutics, antiemetics and analgesics in the treatment of five prevalent childhood cancers in South Africa was compared with those listed in 1) the WHO Essential Medicines List for Children (WHO EMLc) 2021, 2) the registered health products database of South Africa, 3) the relevant South African National Essential Medicines Lists (NEML), 4) bid packs and awarded tenders for oncology medicines for 2020 and 2022 and 5) oncology formularies from the leading Independent Clinical Oncology Network (ICON) and two private sector medical aid schemes. Consistency between these sources was assessed descriptively. RESULTS There was full alignment for 25 priority chemotherapeutics for children between the NEML, the products registered in South Africa and those included on tender. Due to unsuccessful procurement, access to seven chemotherapeutics was potentially constrained. For antiemetics and analgesics, eight of nine active ingredients included on the WHO EMLc were also registered in South Africa and on its NEML. An exploratory assessment of private sector formularies showed many gaps in ICON's formulary and two medical scheme formularies (listing 33% and 24% of the chemotherapeutics, respectively). CONCLUSION Despite good alignment in public sector pharmaceutical processes, access constraints to essential chemotherapeutics for children may stem from unsuccessful tenders. Private sector formularies show major gaps; however, it is unclear how this translates to access in clinical practice.
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Affiliation(s)
- Iris R Joosse
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Hendrika A van den Ham
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Aukje K Mantel-Teeuwisse
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Fatima Suleman
- WHO Collaborating Centre for Pharmaceutical Policy and Evidence Based Practice, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Mohamed TIA, Oyelade ON, Ezugwu AE. Automatic detection and classification of lung cancer CT scans based on deep learning and ebola optimization search algorithm. PLoS One 2023; 18:e0285796. [PMID: 37590282 PMCID: PMC10434933 DOI: 10.1371/journal.pone.0285796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/02/2023] [Indexed: 08/19/2023] Open
Abstract
Recently, research has shown an increased spread of non-communicable diseases such as cancer. Lung cancer diagnosis and detection has become one of the biggest obstacles in recent years. Early lung cancer diagnosis and detection would reliably promote safety and the survival of many lives globally. The precise classification of lung cancer using medical images will help physicians select suitable therapy to reduce cancer mortality. Much work has been carried out in lung cancer detection using CNN. However, lung cancer prediction still becomes difficult due to the multifaceted designs in the CT scan. Moreover, CNN models have challenges that affect their performance, including choosing the optimal architecture, selecting suitable model parameters, and picking the best values for weights and biases. To address the problem of selecting optimal weight and bias combination required for classification of lung cancer in CT images, this study proposes a hybrid metaheuristic and CNN algorithm. We first designed a CNN architecture and then computed the solution vector of the model. The resulting solution vector was passed to the Ebola optimization search algorithm (EOSA) to select the best combination of weights and bias to train the CNN model to handle the classification problem. After thoroughly training the EOSA-CNN hybrid model, we obtained the optimal configuration, which yielded good performance. Experimentation with the publicly accessible Iraq-Oncology Teaching Hospital / National Center for Cancer Diseases (IQ-OTH/NCCD) lung cancer dataset showed that the EOSA metaheuristic algorithm yielded a classification accuracy of 0.9321. Similarly, the performance comparisons of EOSA-CNN with other methods, namely, GA-CNN, LCBO-CNN, MVO-CNN, SBO-CNN, WOA-CNN, and the classical CNN, were also computed and presented. The result showed that EOSA-CNN achieved a specificity of 0.7941, 0.97951, 0.9328, and sensitivity of 0.9038, 0.13333, and 0.9071 for normal, benign, and malignant cases, respectively. This confirms that the hybrid algorithm provides a good solution for the classification of lung cancer.
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Affiliation(s)
- Tehnan I. A. Mohamed
- Department of Computer Science, Faculty of Mathematical and Computer Sciences, University of Gezira, Wad Madani, Sudan
- School of Mathematics, Statistics, and Computer Science, University of KwaZulu-Natal, King Edward Avenue, Pietermaritzburg Campus, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Olaide N. Oyelade
- Department of Computer Science, Faculty of Physical Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Absalom E. Ezugwu
- Unit for Data Science and Computing, North-West University, Potchefstroom, South Africa
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Stark MC, Joubert AM, Visagie MH. Molecular Farming of Pembrolizumab and Nivolumab. Int J Mol Sci 2023; 24:10045. [PMID: 37373192 DOI: 10.3390/ijms241210045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/09/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
Immune checkpoint inhibitors (ICIs) are a class of immunotherapy agents capable of alleviating the immunosuppressive effects exerted by tumorigenic cells. The programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) immune checkpoint is one of the most ubiquitous checkpoints utilized by tumorigenic cells for immune evasion by inducing apoptosis and inhibiting the proliferation and cytokine production of T lymphocytes. Currently, the most frequently used ICIs targeting the PD-1/PD-L1 checkpoint include monoclonal antibodies (mAbs) pembrolizumab and nivolumab that bind to PD-1 on T lymphocytes and inhibit interaction with PD-L1 on tumorigenic cells. However, pembrolizumab and nivolumab are costly, and thus their accessibility is limited in low- and middle-income countries (LMICs). Therefore, it is essential to develop novel biomanufacturing platforms capable of reducing the cost of these two therapies. Molecular farming is one such platform utilizing plants for mAb production, and it has been demonstrated to be a rapid, low-cost, and scalable platform that can be potentially implemented in LMICs to diminish the exorbitant prices, ultimately leading to a significant reduction in cancer-related mortalities within these countries.
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Affiliation(s)
- Michael C Stark
- Department of Physiology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Pretoria 0031, South Africa
| | - Anna M Joubert
- Department of Physiology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Pretoria 0031, South Africa
| | - Michelle H Visagie
- Department of Physiology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Private Bag X323, Pretoria 0031, South Africa
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Mpanza NM, Godman B, Keele MG, Matlala M. Trends in the utilization of medicines sold in the private sector post- registration in South Africa and the implications for similar countries. BMC Public Health 2023; 23:192. [PMID: 36709246 PMCID: PMC9884155 DOI: 10.1186/s12889-023-15021-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/10/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Regulatory authorities register medicines for patients to access them within a reasonable period of time. There is a paucity of available data regarding the extent to which registered medicines reach the public after market authorisation is granted by the South African Health Products Regulatory Authority (SAHPRA). This is important since time spent by SAHPRA assessing medicines that are subsequently not launched onto the South African market means time wasted, which could be spent on assessing new medicines that address an unmet need in the country. Consequently, we initially analysed the time taken for registered medicines to reach patients and the relationship between medicines registered at SAHPRA and those subsequently dispensed in private pharmacies. The extent of registration of multiple sourced versus new patented medicines was also explored. METHODS A retrospective, descriptive and quantitative investigation was conducted for medicines registered between 2014 and 2019. Registered and dispensed medicines were compared to establish accessibility post registration. Data sources included SAHPRA and IQVIA datasets. Microsoft Excel and SAS were used for data storage, analysis, and computation of descriptive statistical analysis. RESULTS Of (N = 2175) registered medicines, only 358 (16.5%; 95% CI 15.0%-18.1%) were dispensed to patients, and out of 1735 medicines registered between 2015 and 2019, only 57 (3.3%; 95% CI 2.5%-4.2%) were dispensed during the study period. Medicines acting on the central nervous system were registered and dispensed the most at 21.0% and 18.0%, respectively, whereas antineoplastic and immunomodulation agents were registered and dispensed only 11% and 5%, respectively. A concern was that only 13.0% of registered medicines were originators, with most either as generics, including branded generics, or pseudo-generics. CONCLUSION Regulatory measures should be implemented to ensure increased medicine access post-registration for new originators, especially for priority disease areas that benefit patients. Mental health diseases and improved access to oncology medicines require special attention and further investigation in South Africa.
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Affiliation(s)
| | - Brian Godman
- grid.459957.30000 0000 8637 3780Present Address: School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa ,grid.11984.350000000121138138Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, G4 0RE UK ,grid.444470.70000 0000 8672 9927Centre of Medical and Bio-Allied Health Sciences Research (CMBHSR), Ajman University, Ajman, United Arab Emirates
| | - Mothobi Godfrey Keele
- grid.459957.30000 0000 8637 3780Present Address: School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa ,grid.11951.3d0000 0004 1937 1135Department of Pharmacy and Pharmacology, University of the Witwatersrand, Johannesburgh, South Africa
| | - Moliehi Matlala
- grid.459957.30000 0000 8637 3780Present Address: School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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Ocran Mattila P, Biritwum RB, Babar ZUD. A comprehensive survey of cancer medicines prices, availability and affordability in Ghana. PLoS One 2023; 18:e0279817. [PMID: 37134123 PMCID: PMC10155977 DOI: 10.1371/journal.pone.0279817] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 12/04/2022] [Indexed: 05/04/2023] Open
Abstract
INTRODUCTION In Ghana, prices for cancer medicines are characterized by high retail markups, forex fluctuations and high variation in prices of medicines. Most patients cannot afford the cancer medicines. There is a problem of unaffordability and limited availability of essential cancer medicines which suggests potential inequity in patient access to cancer medicines. The study objective was to assess the prices, availability, and affordability of cancer medicines in Ghana. Prices of cancer medicines are a major contributor to the cost of treatment for cancer patients and the comparison of these cost was assessed to determine the affordability. METHOD The methods developed and standardized by the World Health Organization (WHO) in collaboration with the Health Action International (HAI), was adapted and used to measure prices, availability, and affordability of cancer medicines in Ghana. The availability of cancer medicines was assessed as percentage of health facilities stocked with listed medicines. The price of cancer medicines (of different brands as well as the same medicine manufactured by different pharmaceutical industries) available in the public hospitals, private hospitals, and private pharmacies was assessed, and the percentage variation in prices was calculated. Medicine prices were compared with the Management Sciences Health's International Reference Prices to obtain a Median Price Ratio (MPR). The affordability of cancer medicines was determined using the treatment cost of a course of therapy for cancer conditions in comparison with the daily wage of the unskilled Lowest-Paid Government Worker. RESULTS Overall availability of cancer medicines was very low. The availability of Lowest Priced Generic (LPG) in public hospitals, private hospitals, and private pharmacies was 46%, 22%, and 74% respectively. The availability of Originator Brand (OB) in public hospitals, private hospitals, and private pharmacies was 14%, 11%, and 23% respectively. The lowest median price [United States Dollars (USD)] for the LPG was 0.25, and the highest median price was 227.98. For the OB, the lowest median price was 0.41 and the highest median price was 1321.60. The lowest and highest adjusted MPRs of OBs and LPGs was 0.01 and 10.15 respectively. Some prices were 20.60 times more expensive. Affordability calculations showed that patients with colorectal and multiple myeloma cancer would need 2554 days wages (5286.40 USD) and 1642 days wages (3399.82 USD) respectively to afford treatment. CONCLUSION The availability of cancer medicines was very low, and less than the WHO target of 80%. There were considerable variations in the prices of different brands of cancer medicines, and affordability remains suboptimal, as most patients cannot afford the cancer medicines. Comprehensive policies, regulations and multifaceted interventions that provides tax incentives, health insurance, and use of generics to improve cancer medicines availability, prices, and affordability, for the masses should be developed and implemented in Ghana.
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Affiliation(s)
| | | | - Zaheer Ud-Din Babar
- Department of Pharmacy, University of Huddersfield, Huddersfield, United Kingdom
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Kizub DA, Naik S, Abogan AA, Pain D, Sammut S, Shulman LN, Martei YM. Access to and Affordability of World Health Organization Essential Medicines for Cancer in Sub-Saharan Africa: Examples from Kenya, Rwanda, and Uganda. Oncologist 2022; 27:958-970. [PMID: 36094141 PMCID: PMC9632308 DOI: 10.1093/oncolo/oyac143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/24/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Cancer mortality is high in sub-Saharan Africa (SSA), partly due to inadequate treatment access. We explored access to and affordability of cancer treatment regimens for the top 10 cancers utilizing examples from Kenya, Uganda, and Rwanda. MATERIALS AND METHODS Population, healthcare financing, minimum wage, and cancer incidence and mortality data were obtained from the WHO, World Bank, public sources, and GLOBOCAN. National Essential Medicines List (NEML) alignment with 2019 WHO EML was assessed as a proportion. Cancer regimen pricing was calculated using public and proprietary sources and methods from prior studies. Affordability through universal healthcare coverage (UHC) was assessed as 1-year cost <3× gross national income per capita; and to patients out-of-pocket (OOP), as 30-day treatment course cost <1 day of minimum wage work. RESULTS A total of 93.4% of the WHO EML cancer medicines were listed on the 2019 Kenya NEML, and 70.5% and 41.1% on Uganda (2016) and Rwanda (2015) NEMLs, respectively. Generic chemotherapies were available and affordable to governments through UHC to treat non-Hodgkin's lymphoma, cervical, breast, prostate, colorectal, ovarian cancers, and select leukemias. Newer targeted agents were not affordable through government UHC purchasing, while some capecitabine-based regimens were not affordable in Uganda and Rwanda. All therapies were not affordable OOP. CONCLUSION All cancer treatment regimens were not affordable OOP and some were not covered by governments. Newer targeted drugs were not affordable to all 3 governments. UHC of cancer drugs and improving targeted therapy affordability to LMIC governments in SSA are key to improving treatment access and health outcomes.
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Affiliation(s)
- Darya A Kizub
- Corresponding author: Darya A. Kizub, UT MD Anderson Cancer Center, Cancer Med—Fellowship Prog, 1515 Holcombe Blvd, Houston, TX 77030-4009, USA. Tel: +1 832 729 1709;
| | | | | | - Debanjan Pain
- Department of Medicine (Hematology-Oncology), University of Pennsylvania, Philadelphia, PA, USA
| | - Stephen Sammut
- Department of Health Care Management, Wharton School, University of Pennsylvania, Philadelphia, PA, USA
| | - Lawrence N Shulman
- Department of Medicine (Hematology-Oncology), University of Pennsylvania, Philadelphia, PA, USA
| | - Yehoda M Martei
- Department of Medicine (Hematology-Oncology), University of Pennsylvania, Philadelphia, PA, USA
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Makene FS, Ngilangwa R, Santos C, Cross C, Ngoma T, Mujinja PGM, Wuyts M, Mackintosh M. Patients’ pathways to cancer care in Tanzania: documenting and addressing social inequalities in reaching a cancer diagnosis. BMC Health Serv Res 2022; 22:189. [PMID: 35151290 PMCID: PMC8841053 DOI: 10.1186/s12913-021-07438-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 12/21/2021] [Indexed: 12/15/2022] Open
Abstract
Background This article investigates the extent and sources of late diagnosis of cancer in Tanzania, demonstrating how delayed diagnosis was patterned by inequities rooted in patients’ socio-economic background and by health system responses. It provides evidence to guide equity-focused policies to accelerate cancer diagnosis. Methods Tanzanian cancer patients (62) were interviewed in 2019. Using a structured questionnaire, respondents were encouraged to recount their pathways from first symptoms to diagnosis, treatment, and in some cases check-ups as survivors. Patients described their recalled sequence of events and actions, including dates, experiences and expenditures at each event. Socio-demographic data were also collected, alongside patients’ perspectives on their experience. Analysis employed descriptive statistics and qualitative thematic analysis. Results Median delay, between first symptoms that were later identified as indicating cancer and a cancer diagnosis, was almost 1 year (358 days). Delays were strongly patterned by socio-economic disadvantage: those with low education, low income and non-professional occupations experienced longer delays before diagnosis. Health system experiences contributed to these socially inequitable delays. Many patients had moved around the health system extensively, mainly through self-referral as symptoms worsened. This “churning” required out-of-pocket payments that imposed a severely regressive burden on these largely low-income patients. Causes of delay identified in patients’ narratives included slow recognition of symptoms by facilities, delays in diagnostic testing, delays while raising funds, and recourse to traditional healing often in response to health system barriers. Patients with higher incomes and holding health insurance that facilitated access to the private sector had moved more rapidly to diagnosis at lower out-of-pocket cost. Conclusions Late diagnosis is a root cause, in Tanzania as in many low- and middle-income countries, of cancer treatment starting at advanced stages, undermining treatment efficacy and survival rates. While Tanzania’s policy of free public sector cancer treatment has made it accessible to patients on low incomes and without insurance, reaching a diagnosis is shown to have been for these respondents slower and more expensive the greater their socio-economic disadvantage. Policy implications are drawn for moving towards greater social justice in access to cancer care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07438-5.
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