Predictors of Timely Access of Oncology Services and Advanced-Stage Cancer in an HIV-Endemic Setting
Open/View files
Date
2016
Author(s)
Brown, Carolyn A.
Suneja, Gita
Tapela, Neo
Mapes, Abigail
Pusoentsi, Malebogo
Mmalane, Mompati
Hodgeman, Ryan
Boyer, Matthew
Musimar, Zola
Ramogola-Masire, Doreen
Grover, Surbhi
Nsingo-Bvochora, Memory
Kayembe, Mukendi
Publisher
AlphaMed Press
The Harvard community has made this article openly available. Please share how this access benefits you.
Citation
Brown, C. A., G. Suneja, N. Tapela, A. Mapes, M. Pusoentsi, M. Mmalane, R. Hodgeman, et al. 2016. “Predictors of Timely Access of Oncology Services and Advanced-Stage Cancer in an HIV-Endemic Setting.” The Oncologist 21 (6): 731-738. doi:10.1634/theoncologist.2015-0387. http://dx.doi.org/10.1634/theoncologist.2015-0387.
Abstract
Background. Three-quarters of cancer deaths occur in resource-limited countries, and delayed presentation contributes to poor outcome. In Botswana, where more than half of cancers arise in HIV-infected individuals, we sought to explore predictors of timely oncology care and evaluate the hypothesis that engagement in longitudinal HIV care improves access. Methods. Consenting patients presenting for oncology care from October 2010 to September 2014 were interviewed and their records were reviewed. Cox and logistic models were used to examine the effect of HIV and other predictors on time to oncology care and presentation with advanced cancer (stage III or IV). Results. Of the 1,146 patients analyzed, 584 (51%) had HIV and 615 (54%) had advanced cancer. The initial clinic visit occurred a mean of 144 days (median 29, interquartile range 0–185) after symptom onset, but subsequent mean time to oncology care was 406 days (median 160, interquartile range 59–653). HIV status was not significantly associated with time to oncology care (adjusted hazard ratio [aHR] 0.91, 95% confidence interval [CI] 0.79–1.06). However, patients who reported using traditional medicine/healers engaged in oncology care significantly faster (aHR 1.23, 95% CI 1.09–1.40) and those with advanced cancer entered care earlier (aHR 1.48, 95% CI 1.30–1.70). Factors significantly associated with advanced cancer included income <$50 per month (adjusted odds ratio [aOR] 1.35, 95% CI 1.05–1.75), male sex (aOR 1.45, 95% CI 1.12–1.87), and pain as the presenting symptom (aOR 1.39, 95% CI 1.03–1.88). Conclusion. Longitudinal HIV care did not reduce the substantial delay to cancer treatment. Research focused on reducing health system delay through coordination and navigation is needed. Implications for Practice: The majority (54%) of patients in this large cohort from Botswana presented with advanced-stage cancer despite universal access to free health care. Median time from first symptom to specialized oncology care was 13 months. For HIV-infected patients (51% of total), regular longitudinal contact with the health system, through quarterly doctor visits for HIV management, was not successful in providing faster linkages into oncology care. However, patients who used traditional medicine/healers engaged in cancer care faster, indicating potential for leveraging traditional healers as partners in early cancer detection. New strategies are urgently needed to facilitate diagnosis and timely treatment of cancer in low- and middle-income countries.
Other Available Sources
Terms of Use
This article is made available under the terms and conditions applicable to Other Posted Material (LAA), as set forth at Terms of Service
Collection
Mapped collections