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. 2021 Jun;10(11):3489-3498.
doi: 10.1002/cam4.3764. Epub 2021 May 10.

Breast cancer in Zimbabwe: patterns of care and correlates of adherence in a national referral hospital radiotherapy center cohort from 2014 to 2018

Shekinah Nefreteri Cluff Elmore  1   2   3 , Melinda Mushonga  4 , Hari Subramaniam Iyer  5 , Caroline Kanda  4 , Shirley Chibonda  4 , Fallon Chipidza  1   2   6 , Rudo Makunike Mutasa  7 , David Muchuweti  8 , Edwin G Muguti  8 , Aspect Maunganidze  8 , Ntokozo Ndlovu  4   9 , Jennifer Ruth Bellon  6 , Anna Mary Nyakabau  4   7   10
Affiliations

Breast cancer in Zimbabwe: patterns of care and correlates of adherence in a national referral hospital radiotherapy center cohort from 2014 to 2018

Shekinah Nefreteri Cluff Elmore et al. Cancer Med. 2021 Jun.

Abstract

Background: Breast cancer is the second most common cancer among women in Zimbabwe. Patients face socioeconomic barriers to accessing oncology care, including radiotherapy. We sought to understand patterns of care and adherence for women with breast cancer in sub-Saharan Africa (SSA) with radiotherapy access.

Methods: A retrospective cohort was created for women with breast cancer evaluated at the Parirenyatwa Hospital Radiotherapy and Oncology Center (RTC) from 2014 to 2018. Clinical data were collected to define patterns of care. Non-adherence was modeled as a binary outcome with different criteria for patients with localized versus metastatic disease.

Results: In total, 351 women presented with breast cancer with median age 51 at diagnosis (IQR: 43-61). Receptor status was missing for 71% (248). 199 (57%) had non-metastatic disease, and 152 (43%) had metastases. Of women with localized disease, 34% received post-mastectomy radiation. Of women with metastatic disease, 9.7% received radiotherapy. Metastatic disease and missing HIV status were associated with increased odds of study-defined non-adherence (aOR: 1.85, 95% CI: 1.05, 3.28; aOR: 2.13, 95% CI: 1.11, 4.05), while availability of ER/PR status was associated with lower odds of non-adherence (aOR: 0.18, 95% CI: 0.09, 0.36).

Conclusions: Radiotherapy is likely underutilized for women with breast cancer, even in a setting with public sector availability. Exploring patient-level factors that influence adherence to care may provide clinicians with better tools to support adherence and improve survival. Greater investment is needed in multidisciplinary, multimodality care for breast cancer in SSA.

Keywords: Breast cancer; adherence to care; global health; multidisciplinary team; radiation oncology; radiotherapy; resource-limited setting.

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Conflict of interest statement

The authors report no conflicts of interest related to this work.

Figures

FIGURE 1
FIGURE 1
Map of Zimbabwe with cohort geography.
FIGURE 2
FIGURE 2
Patterns of Care 2014–2018.
FIGURE 3
FIGURE 3
Treatment received by breast cancer study participants before and after 2017 (N = 290).
See this image and copyright information in PMC

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