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. 2024 Aug 27:18:1747.
doi: 10.3332/ecancer.2024.1747. eCollection 2024.

Treatment delays for cancer patients in Sub-Saharan Africa: South Africa as a microcosm

Abba Mallum  1   2   3 , Saloni Patel  2   3 , Elizabeth Olatunji  2   3 , Godwin Nnko  4   5 , Adewumi Alabi  6 , John Akudugu  7 , Rugengamanzi Eulade  4   8 , Adedayo Joseph  6 , Mamsau Ngoma  5 , Twalib Athumani Ngoma  4   5 , Afekhai Taiwo  6 , Maureen Bilinga Tendwa  9 , Mariza Vorster  1   10 , Wilfred Ngwa  2   10
Affiliations

Treatment delays for cancer patients in Sub-Saharan Africa: South Africa as a microcosm

Abba Mallum et al. Ecancermedicalscience. .

Abstract

Purpose: Delays in initiating cancer treatment time to treatment initiation (TTI) can negatively impact patient outcomes. This study aimed to quantify the association between TTI and survival in breast, cervical and prostate cancer patients at Inkosi Albert Luthuli Central Hospital (IALCH) in KwaZulu-Natal, South Africa, as a microcosm of Sub-Saharan Africa (SSA).

Methods: We analyzed electronic medical records of patients diagnosed with breast, cervical or prostate cancer at IALCH between 2010 and 2020. Median TTI was calculated for different treatment modalities. To assess the link between treatment delay and mortality, we employed a Cox proportional hazards model to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), treating breast cancer and patients over 40 as competing events. Additionally, Kruskal-Wallis one-way analysis and linear regression were used to compare TTI across racial groups.

Results: The study included patients with breast (44%), cervical (44%) and prostate cancer (12%). Mean age at diagnosis was 62.6, 56.6 and 73.0 years, respectively. Breast cancer patients experienced the longest delays for mastectomy (median 18.4 weeks), followed by prostate cancer patients waiting for radiotherapy (median 16.6 weeks). Significantly longer TTI for radiotherapy was observed in patients younger than 40 with cervical (HR = 2.30, 95% CI: 2.16-2.44, p < 0.001) or prostate cancer (HR = 1.42, 95% CI: 1.03-1.95, p = 0.033) compared to older breast cancer patients. Similar trends were seen for younger patients with cervical cancer receiving chemotherapy. Notably, all racial groups exhibited substantial delays in initiating treatment for all three cancers (breast p < 0.001, prostate p = 0.004 and cervical cancer p < 0.001).

Conclusion: This study identified significant delays in treatment initiation (TTI) for breast, prostate and cervical cancer patients at Inkosi Albert Luthuli Central Hospital (IALCH) in South Africa. These delays were concerning, particularly for younger patients and individuals across all racial backgrounds. Delays in treatment initiation have been linked to increased mortality risk in other studies, highlighting the urgency of addressing this issue. Furthermore, this study serves as a valuable model for future research throughout SSA to collectively address the challenges of treatment delays and improve cancer care for the region.

Keywords: Sub-Saharan Africa (SSA); breast cancer; cervical cancer; prostate cancer; time to treatment initiation and treatment delay.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1.
Figure 1.. TTI for breast cancer patients at IALCH.
Figure 2.
Figure 2.. TTI for prostate cancer patients at IALCH.
Figure 3.
Figure 3.. TTI for cervical cancer patients at IALCH.
Figure 4.
Figure 4.. A graphical representation of TTI by race (IALCH) for breast, prostate and cervical cancer.
Figure 5.
Figure 5.. A graphical representation comparing TTI by race (IALCH) and a forest plot visualizing the HR for delays in treatment initiation from the first visit to the first date of (a): Radiotherapy, (b): Chemotherapy, (c): Surgery and (d): Surgery to the first day of radiotherapy. This comparison includes various subgroups using prostate and cervical cancer as references, compared to breast cancer.
See this image and copyright information in PMC

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