Challenges of Distance to Access of Radiotherapy Management of Breast Cancer in Nigeria

Abstract

Background: The shortage of radiotherapy services in Nigeria has led to tremendous suffering for breast cancer patients across the country. The aim of this study is to explore the effect of distance on the care of breast cancer patients in Nigeria.
Materials and Methods: This was a retrospective study of breast cancer patients from 1st January 2003 to 31st December 2012 in University College Hospital (UCH), Ibadan. Data obtained included biodata, disease features and follow-up information using a structured questionnaire. Univariate, bivariate and multivariate statistics was used to analyse the data. Results: We studied 504 breast cancer patients. The mean age of the patients was 47.7 (±10.6) years, late presentation with symptoms beyond 3 months was seen in 88.1% while advanced stage disease was seen in 58.7% of patients. Patients that lived at distances within 50 km and beyond 50 km from UCH, Ibadan were 74 (14.7%) and 430 (85.3%) respectively. Majority of the patients 87.3% completed treatment, however, 94.8% of patients treated during the period discontinued follow-up care at the end of the study. The reasons for discontinuation were “death”, “financial constraints” and “referred back to distant primary surgeon after treatment” accounting for 90 (18.8%), 230 (48.1%) and 158 (33.1%) respectively. The factors affected by distance were socioeconomic status [OR=2.9; 95% CI=1.42-6.01], bilateral breast cancer disease [OR=14.22; 95% CI = 7.32 – 27.620], left breast disease (OR=11.45; 95% CI = 5.89 – 22.62) and reasons for discontinuing follow-up care: financial constraints [OR=2.0; 95% CI =0.9 – 3.2], and referred back to primary breast surgeon [OR=3.0; 95% CI =1.3 – 6.0]. Conclusion: Long distance and shortage of functioning radiotherapy centres in Nigeria are critical challenges for breast cancer treatment, leading patients to late presentation with advanced disease and poor compliance with follow-up care. Therefore, more centres should be built in each state to minimise these challenges.