Top

World Journal of Surgery

Published in:

01-05-2021 | Breast Cancer | Surgery in Low and Middle Income Countries

The Value of Navigators in Breast Cancer Management in a South African Hospital

Authors: S. R. Čačala, H. Farrow, S. Makhanya, D. G. Couch, M. Joffe, L. Stopforth

Published in: World Journal of Surgery | Issue 5/2021

Abstract

Background

Specialist breast cancer nurses (BCNs) have improved the psychological care and follow-up rates of breast cancer (BC) patients. This study sought to determine if breast cancer research workers (BCRWs) as de facto BCNs impacted patients’ adherence to treatment by comparing groups with and without these patient navigators; hence assessing our need for BCNs.

Methods

Two groups BC patients booked for primary chemotherapy compared. Study group 1 (SG1): no BCRWs/BCNs. Study group 2 (SG2): BCRWs involvement. Assessment of numbers completing primary chemotherapy, undergoing surgery post-neoadjuvant chemotherapy and BCRWs interventions.

Results

SG1: n = 281, 25–89y, mean 52.7y, Stage 4: 35.6%, Stage 3: 64.4%. SG2: n = 154, 21–85y, mean 52.6y, Stage 4: 47.4%, Stage 3: 43.3%, Stage 2: 9%. Primary chemotherapy not completed SG1: 40.2% (113) versus SG2: 13.5% (21); p < 0.00001. SG1: 88% not completing were lost to follow-up. Excluding peri-chemotherapy deaths and discontinuation: SG1: 37.1% did not complete chemotherapy versus SG2: 2.6%, p < 0.00001. SG2: BCRWs: 107 interventions for 58 (37.7%) patients. Therapeutic breast surgery SG1: 103/181 (56.9%) versus SG2: 66/81 (81.5%); p < 0.0001. SG1: main reasons for not having surgery: lost to follow-up during (n = 58) or after (n = 9) chemotherapy. Follow-up SG2: 12–43 months, mortality: 52% (80/154), no lost to follow-ups. SG1: No mortality data.

Conclusions

In our setting, BC patients often do not attend or complete treatments. In this study, BCRWs as de-facto BCNs were beneficial for BC patient care, improving chemotherapy compliance and therapeutic surgical interventions. This highlights the need for BCNs for the management of BC patients in South Africa.

Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018 GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68(6):394–424. https://doi.org/10.3322/caac.21492CrossRefPubMed

Berry DA, Cronin KA, Plevritis SK, Fryback DG, Clarke L, Zelen M et al (2005) Effect of screening and adjuvant therapy on mortality from breast cancer. NEJM 353(17):1784–1792. https://doi.org/10.1056/NEJMoa050518CrossRefPubMed

Freeman HA (2004) Model patient navigator program. Oncol Issues 19:44–46CrossRef

Freeman P (2006) Patient navigation: a community based strategy to reduce cancer disparities. J Urban Health 83(2):139–141. https://doi.org/10.1007/s11524-006-9030-0)CrossRefPubMedPubMedCentral

Raich PC, Whitley EM, Thorland W, Valverde P, Fairclough D (2012) Patient navigation improves cancer diagnostic resolution: an individually randomized clinical trial in an underserved population. Cancer Epidemiol Biomark Prev 21(10):1629–1638. https://doi.org/10.1158/1055-9965CrossRef

Riogi B, Wasike R, Saidi H (2017) Effect of a breast navigation programme in a teaching hospital in Africa. South Afr J Oncol. https://doi.org/10.4102/sajo.v1i0.30CrossRef

Wells KJ, Battaglia TA, Dudley DJ, Garcia R, Greene A, Calhoun E et al (2008) Patient navigation: state of the art or is it science? Cancer 113(8):1999–2010. https://doi.org/10.1002/cncr.23815 (PMID: 18780320)CrossRefPubMed

Cruickshank S, Kennedy C, Lockhart K, Dosser I, Dallas L (2008) Specialist breast care nurses for supportive care of women with breast cancer. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD005634.pub2CrossRefPubMed

Dalton M, Holzman E, Erwin E, Michelen S, Rositch A, Kumar S, Vanderpuy V, Yeates K, Liebermann E, Ginsburg O (2019) Patient navigation services for cancer care in low-and middle-income countries: a scoping review. PLos One. https://doi.org/10.1371/journal.pone.0223537CrossRefPubMedPubMedCentral

10.

Ritz LJ, Nissen MJ, Swenson KK, Farrell JB, Sperduto PW, Sladek ML (2000) Effects of advanced nursing care on quality of life and cost outcomes of women diagnosed with breast cancer. Oncol Nurs Forum 27(6):923–932PubMed

11.

Biganzoli L, Marotti L, Hart CD, Cataliotti L, Cutuli B, Kühn T et al (2017) Quality indicators in breast cancer care: an update from the EUSOMA working group. EJCA. 86:59–81. https://doi.org/10.1016/J.EJCA.2017.08.017CrossRef

12.

Clegg-Lamptey J, Dakubo J, Attobra Y (2009) Psychosocial aspects of breast cancer treatment in Accra, Ghana. East Afr Med J 86(7):348–352PubMed

13.

McArdle JM, George WD, McArdle CS, Smith DC, Moodie AR, Hughson AV (1996) Psychological support for patients undergoing breast cancer surgery: a randomised study. BMJ 312(7034):813–16. https://doi.org/10.1136/bmj.312.7034.813CrossRefPubMedPubMedCentral

14.

South African National Cancer Registry. Cancer in South Africa (2014). http://www.nicd.ac.za/wpcontent/uploads/2017/03/2014-NCR-tables-1.pdf

15.

Vorobiof DA, Sitas F, Vorobiof G (2001) Breast cancer incidence in South Africa. J Clin Oncol 19:125–127

16.

Rosselli Del Turco M, Ponti A, Bick U, Biganzoli L, Cserni G, Cutuli B (2010) Quality indicators in breast cancer care. EJCA. 46(13):2344–56. https://doi.org/10.1016/J.EJCA.2010.06.119CrossRef

17.

Battaglia TA, Roloff K, Posner MA, Freund KM (2007) Improving follow-up to abnormal breast cancer screening in an urban population. Cancer 109(S2):359–367CrossRefPubMed

18.

Ell K, Vourlekis B, Xie B, Nedjat-Haiem FR, Lee PJ, Muderspach L et al (2009) Cancer treatment adherence among low-income women with breast or gynecologic cancer: a randomized controlled trial of patient navigation. Cancer 115(19):4606–4615. https://doi.org/10.1002/cncr.24500 (PMID: 19551881)CrossRefPubMed

19.

Freund KM, Battaglia TA, Calhoun E, Dudley DJ, Fiscella K, Paskett E et al (2008) National cancer institute patient navigation research program: methods, protocol, and measures. Cancer 113(12):3391–3399. https://doi.org/10.1002/cncr.23960 (PMID: 18951521)CrossRefPubMed

20.

Cacala SR, Gilart J (2017) Factors relating to late presentation of patients with breast cancer in area 2 kwazulu-natal south africa. J Glob Oncol 3(5):497–501. https://doi.org/10.1200/JGO.2016.008060CrossRefPubMedPubMedCentral

21.

Pesec M, Sherertz T (2015) Global health from a cancer care perspective. Future Oncol 11(15):2235–2245. https://doi.org/10.2217/fon.15.142 (PMID: 26235185)CrossRefPubMed

22.

Wadler BM, Judge CM, Prout M, Allen JD, Geller AC (2011) Research article improving breast cancer control via the use of community health workers in South Africa: a critical review. J Oncol. https://doi.org/10.1155/2011/150423CrossRefPubMed

23.

Kamangar K, Dores GM, Anderson WF (2006) Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol 24(14):2137–2150CrossRefPubMed

24.

El Saghi NS, Adebamowo CA, Anderson BO, Carlson RW, Bird PA, Corbex M (2011) Breast cancer management in low resource countries (LRCs): consensus statement from the Breast Health Global Initiative. The Breast 20:S3–S11. https://doi.org/10.1016/J.BREAST.2011.02.006CrossRef

25.

Bradley J, Barone M, Mahé C, Lewis R, Luciani S (2005) Delivering cervical cancer prevention services in low-resource settings. IJGO 89:S21–S29. https://doi.org/10.1016/j.ijgo.2005.01.013CrossRef

Title: The Value of Navigators in Breast Cancer Management in a South African Hospital
Authors: S. R. Čačala
H. Farrow
S. Makhanya
D. G. Couch
M. Joffe
L. Stopforth
Publication date: 01-05-2021
Publisher: Springer International Publishing
Keywords: Breast Cancer
Breast Cancer
Cytostatic Therapy
Published in: World Journal of Surgery / Issue 5/2021
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-020-05931-2

At a glance: The STEP trials

Springer Medicine

The Value of Navigators in Breast Cancer Management in a South African Hospital

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 5/2021

Assessment of Surgical Care Provided in National Health Services Hospitals in Mozambique: The Importance of Subnational Metrics in Global Surgery

Staging Paradox and Discrepancy in Adjuvant Chemotherapy in Patients with T4N0, T1-2N1, and T3N1 Colon Cancer

Robotic Gastrectomy Compared with Laparoscopic Gastrectomy for Clinical Stage I/II Gastric Cancer Patients: A Propensity Score-Matched Analysis

Letter to the Editor: Indications and Outcomes for Non-Trauma Emergency Laparotomy: A Comparison of Rwanda, South Africa, and the USA

Clinicopathological Characteristics and Surgical Outcomes of Primary Cystic Duct Carcinoma: A Multi-institutional Study

Structured and Systematic Team and Procedure Training in Severe Trauma: Going from ‘Zero to Hero’ for a Time-Critical, Low-Volume Emergency Procedure Over Three Time Periods