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. 2020 Sep;25(9):e1372-e1381.
doi: 10.1634/theoncologist.2019-0951. Epub 2020 Jul 13.

Patient Characteristics and Outcomes of Nonmetastatic Breast Cancer in Haiti: Results from a Retrospective Cohort

Temidayo Fadelu  1 , Ruth Damuse  2   3 , Joarly Lormil  2   3 , Elizabeth Pecan  4 , Cyrille Dubuisson  2   3 , Viergela Pierre  2   3 , Timothy Rebbeck #  1   5 , Lawrence N Shulman #  6
Affiliations

Patient Characteristics and Outcomes of Nonmetastatic Breast Cancer in Haiti: Results from a Retrospective Cohort

Temidayo Fadelu et al. Oncologist. 2020 Sep.

Abstract

Background: There are few studies on breast cancer outcomes in the Caribbean region. This study identified a retrospective cohort of female patients with nonmetastatic breast cancer in Haiti and conducted survival analyses to identify prognostic factors that may affect patient outcomes.

Methods: The cohort included 341 patients presenting between June 2012 and December 2016. The primary endpoint was event-free survival (EFS), defined as time to disease progression, recurrence, or death. Descriptive summaries of patient characteristics and treatments were reported. Survival curves were plotted using Kaplan-Meier estimation. Multivariate survival analyses were performed using Cox proportional hazards regression.

Results: Median age at diagnosis was 49 years, with 64.2% being premenopausal. Most patients (55.1%) were staged as locally advanced. One hundred and sixty patients received neoadjuvant therapy: 33.3% of patients with early stage disease and 61.2% of those with locally advanced stage disease. Curative-intent surgery was performed in 278 (81.5%) patients, and 225 patients received adjuvant therapy. Adjuvant endocrine therapy was used in 82.0% of patients with estrogen receptor-positive disease. During the follow-up period, 28 patients died, 77 had disease recurrence, and 10 had progressive disease. EFS rates at 2 years and 3 years were 80.9% and 63.4%, respectively. After controlling for multiple confounders, the locally advanced stage group had a statistically significant adjusted hazard ratio for EFS of 3.27 compared with early stage.

Conclusion: Patients with nonmetastatic breast cancer in Haiti have more advanced disease, poorer prognostic factors, and worse outcomes compared with patients in high-income countries. Despite several limitations, curative treatment is possible in Haiti.

Implications for practice: Patients with breast cancer in Haiti have poor outcomes. Prior studies show that most Haitian patients are diagnosed at later stages. However, there are no rigorous studies describing how late-stage diagnosis and other prognostic factors affect outcomes in this population. This study presents a detailed analysis of survival outcomes and assessment of prognostic factors in patients with nonmetastatic breast cancer treated in Haiti. In addition to late-stage diagnosis, other unfavorable prognostic factors identified were young age and estrogen receptor-negative disease. The study also highlights that the availability of basic breast cancer treatment in Haiti can lead to promising early patient outcomes.

Keywords: Breast cancer outcomes; Cancer in low-resource settings; Caribbean region; Global oncology; Haiti.

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Conflict of interest statement

Disclosures of potential conflicts of interest may be found at the end of this article.

Figures

Figure 1
Figure 1
Cohort derivation.
Figure 2
Figure 2
Event‐free survival curves by stage. Abbreviations: CI, confidence interval; NE, unreached and unable to estimate.
Figure 3
Figure 3
Event‐free survival curves by ER status. Abbreviations: CI, confidence interval; ER, estrogen receptor; NE, unreached and unable to estimate.
See this image and copyright information in PMC

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