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

• Published in: Cancer medicine (Malden, MA) Vol. 10; no. 11; pp. 3489 - 3498
• Main Authors: Elmore, Shekinah Nefreteri Cluff, Mushonga, Melinda, Iyer, Hari Subramaniam, Kanda, Caroline, Chibonda, Shirley, Chipidza, Fallon, Makunike Mutasa, Rudo, Muchuweti, David, Muguti, Edwin G., Maunganidze, Aspect, Ndlovu, Ntokozo, Bellon, Jennifer Ruth, Nyakabau, Anna Mary
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.06.2021; John Wiley and Sons Inc; Wiley
• Subjects: adherence to care; Adult; Age; Birth control; Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - pathology; Breast Neoplasms - radiotherapy; Breast Neoplasms - surgery; Cancer Care Facilities; Cancer therapies; Clinical Cancer Research; Demographics; Ethnicity; Family medical history; Female; Geography; global health; Health care access; Health insurance; Health Services Accessibility; Health Services Misuse - statistics & numerical data; Histology; HIV; Hospitals; Human immunodeficiency virus; Humans; Insurance coverage; Mastectomy - statistics & numerical data; Metastases; Metastasis; Middle Aged; multidisciplinary team; Neoadjuvant Therapy - statistics & numerical data; Oncology; Open data; Original Research; Patient Compliance - statistics & numerical data; Patients; radiation oncology; Radiation therapy; radiotherapy; resource‐limited setting; Retrospective Studies; Risk Factors; Womens health; Zimbabwe; Zimbabwe; United States > US; global health; resource-limited setting; multidisciplinary team; radiotherapy; radiation oncology; Breast cancer; adherence to care
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.3764

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.