Christian Felix Reibold1, Wakuma Tariku2, Pia Eber-Schulz1, Sefonias Getachew3, Adamu Addisie3, Susanne Unverzagt4, Andreas Wienke4, Steffen Hauptmann5, Claudia Wickenhauser6, Martina Vetter1, Ahmedin Jemal7, Christoph Thomssen1, Eva Johanna Kantelhardt1. 1. Department of Gynecology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany. 2. Ethiopian Evangelical Church of Mekane Yesus EECMY Aira Hospital, Aira, Ethiopia. 3. School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia. 4. Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany. 5. Department of Pathology, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands. 6. Department of Pathology, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany. 7. American Cancer Society, Atlanta, Georgia, USA.
Abstract
INTRODUCTION: Endocrine therapy for breast cancer (BC) patients is highly underutilized in rural Ethiopia and other African countries. OBJECTIVE: This study aims to assess the feasibility of and adherence to tamoxifen therapy in rural Ethiopia. METHODS: We ascertained the hormone receptor (HR) status in 101 women diagnosed with BC from January 2010 to December 2015 and who had surgery in Aira Hospital, in rural Ethiopia. From 2013, tamoxifen was offered to patients with HR-positive (HR+) tumors. Prescription refill records and a structured questionnaire were used to assess receipt of and adherence to tamoxifen. RESULTS: Of the 101 BC patients tested for HR status during the study period, 66 (65%) patients were HR+ and were eligible for tamoxifen treatment. However, 15 of the HR+ patients died before tamoxifen became available in 2013. Of the remaining 51 HR+ patients, 26 (51%) initiated tamoxifen but only 9 of them (35%) adhered to therapy (medication possession rate ≥80%, median observation 16.2 months). After 1 year, 52% of the patients were still adherent, and 9 patients had discontinued therapy. The reasons for non-initiation of tamoxifen included patient factors (n = 5), including financial hardship or lack of transportation, and health care provider factors (n = 12). CONCLUSIONS: Endocrine therapy for BC patients seems feasible in rural Western Ethiopia, although non-adherence due to financial hardship and a less developed health care infrastructure remains a major challenge. We postulate that the implementation of breast nurses could reduce patient and health system barriers and improve initiation of and adherence to endocrine treatment.
INTRODUCTION: Endocrine therapy for breast cancer (BC) patients is highly underutilized in rural Ethiopia and other African countries. OBJECTIVE: This study aims to assess the feasibility of and adherence to tamoxifen therapy in rural Ethiopia. METHODS: We ascertained the hormone receptor (HR) status in 101 women diagnosed with BC from January 2010 to December 2015 and who had surgery in Aira Hospital, in rural Ethiopia. From 2013, tamoxifen was offered to patients with HR-positive (HR+) tumors. Prescription refill records and a structured questionnaire were used to assess receipt of and adherence to tamoxifen. RESULTS: Of the 101 BC patients tested for HR status during the study period, 66 (65%) patients were HR+ and were eligible for tamoxifen treatment. However, 15 of the HR+ patients died before tamoxifen became available in 2013. Of the remaining 51 HR+ patients, 26 (51%) initiated tamoxifen but only 9 of them (35%) adhered to therapy (medication possession rate ≥80%, median observation 16.2 months). After 1 year, 52% of the patients were still adherent, and 9 patients had discontinued therapy. The reasons for non-initiation of tamoxifen included patient factors (n = 5), including financial hardship or lack of transportation, and health care provider factors (n = 12). CONCLUSIONS: Endocrine therapy for BC patients seems feasible in rural Western Ethiopia, although non-adherence due to financial hardship and a less developed health care infrastructure remains a major challenge. We postulate that the implementation of breast nurses could reduce patient and health system barriers and improve initiation of and adherence to endocrine treatment.
Authors: Pia Eber-Schulz; Wakuma Tariku; Christian Reibold; Adamu Addissie; Claudia Wickenhauser; Christine Fathke; Steffen Hauptmann; Ahmedin Jemal; Christoph Thomssen; Eva Johanna Kantelhardt Journal: Breast Cancer Res Treat Date: 2018-02-26 Impact factor: 4.872
Authors: William J Gradishar; Benjamin O Anderson; Ron Balassanian; Sarah L Blair; Harold J Burstein; Amy Cyr; Anthony D Elias; William B Farrar; Andres Forero; Sharon H Giordano; Matthew P Goetz; Lori J Goldstein; Steven J Isakoff; Janice Lyons; P Kelly Marcom; Ingrid A Mayer; Beryl McCormick; Meena S Moran; Ruth M O'Regan; Sameer A Patel; Lori J Pierce; Elizabeth C Reed; Kilian E Salerno; Lee S Schwartzberg; Amy Sitapati; Karen Lisa Smith; Mary Lou Smith; Hatem Soliman; George Somlo; Melinda L Telli; John H Ward; Rashmi Kumar; Dorothy A Shead Journal: J Natl Compr Canc Netw Date: 2018-03 Impact factor: 11.908
Authors: Claudia Allemani; Hannah K Weir; Helena Carreira; Rhea Harewood; Devon Spika; Xiao-Si Wang; Finian Bannon; Jane V Ahn; Christopher J Johnson; Audrey Bonaventure; Rafael Marcos-Gragera; Charles Stiller; Gulnar Azevedo e Silva; Wan-Qing Chen; Olufemi J Ogunbiyi; Bernard Rachet; Matthew J Soeberg; Hui You; Tomohiro Matsuda; Magdalena Bielska-Lasota; Hans Storm; Thomas C Tucker; Michel P Coleman Journal: Lancet Date: 2014-11-26 Impact factor: 79.321
Authors: T Peter Kingham; Olusegun I Alatise; Verna Vanderpuye; Corey Casper; Francis A Abantanga; Thaim B Kamara; Olufunmilayo I Olopade; Muhammad Habeebu; Fatimah B Abdulkareem; Lynette Denny Journal: Lancet Oncol Date: 2013-04 Impact factor: 41.316
Authors: Adekunle Adesina; David Chumba; Ann M Nelson; Jackson Orem; Drucilla J Roberts; Henry Wabinga; Michael Wilson; Timothy R Rebbeck Journal: Lancet Oncol Date: 2013-04 Impact factor: 41.316
Authors: Eva Johanna Kantelhardt; Assefa Mathewos; Abreha Aynalem; Tigeneh Wondemagegnehu; Ahmedin Jemal; Martina Vetter; Erdme Knauf; Anne Reeler; Solomon Bogale; Christoph Thomssen; Andreas Stang; Tufa Gemechu; Pietro Trocchi; Bekuretsion Yonas Journal: BMC Cancer Date: 2014-11-29 Impact factor: 4.430