Abstract
This study analyzes a survey conducted at a gathering of clinicians who specialize in breast cancer in sub-Saharan Africa to better understand what they need from international collaborators.
The worldwide burden of breast cancer is rising, with disproportionate increases in the low- and middle-income countries of sub-Saharan Africa.1 Breast cancer case fatality rates are notably higher for these regions2 because of advanced stage distribution associated with inadequate health care access and sparse oncology resources.3,4 These issues have inspired United States–based oncologists to develop global outreach programs for multidisciplinary breast cancer research and education/training. Surgical partnerships are particularly important, because surgical care is the mainstay of breast cancer treatment in low- and middle-income countries. The goals of these international collaborations are commendable and are more likely to be realized if they meet needs defined by African clinicians and other relevant stakeholders, such as the patient and advocacy community and governing bodies.
Methods
The International Center for the Study of Breast Cancer Subtypes (ICS BCS)5 convened its first multidisciplinary breast cancer symposium in partnership with the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana, in August 2017; both ICS BCS and KATH promoted attendance through flyers and direct communications. Attendees were asked to complete a single-page survey (jointly drafted by the ICS BCS and KATH staff) to provide information regarding their profession and an assessment of the needs that they believed could be addressed by international partners from more affluent countries. Respondents were asked to prioritize needs among the following options: (1) direct financial/monetary support, (2) medical or hospital supplies, (3) opportunities to visit or train in the United States, (4) training or educational programs conducted in Africa, (5) academic recognition as a coauthor on publications in medical journals, and (6) academic recognition as a coinvestigator on grant applications.
As an anonymous survey study, this project was exempt from review by the Henry Ford Health System institutional review board. These anonymous surveys were only completed by those who were willing to do so, and submitting the survey constituted consent.
Responses were evaluated with χ2 analyses. Data analyses were computed in the R environment with standard packages (version 3.4.0; R Foundation for Statistical Computing).
Results
Of 170 African attendees, most (128 [75.3%]) were from Ghana (the hosting country), followed by Nigeria (18 [10.5%]) and Ethiopia, Uganda, Burkina Faso, and Sudan (12 [7%]). Seventy-seven attendees (45.3%) were physicians; 65 (38.2%) were nurses. One hundred forty-six attendees (85.9%) participated in the survey. The Table summarizes 146 survey responses, stratified by profession.
Table. Results of Survey Regarding African Clinicians’ Assessment of Needs From International Partnerships.
| Answer Choice | Participants, No./Total No. (%) | P Valuea | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Physicians | Nurses | Medical Assistants | Administrator | Laboratory Technician | Other | Not Reported | Total | ||
| Total conference attendees | 77/170 (45.3) | 65/170 (38.2) | 8 (4.7) | 3 (1.8) | 4/170 (2.4) | 11/170 (6.5) | 2/170 (1) | 170/170 (100) | NA |
| First Choice | |||||||||
| Total respondents | 70/77 (91) | 53/65 (82) | 6/8 (75) | 2/3 (67) | 3/4 (75) | 10/11 (91) | 2/2 (100) | 146/170 (85.9) | .08 |
| Direct financial/monetary support | 8/70 (11) | 10/53 (19) | 0 | 0 | 0 | 2/10 (20) | 1/2 (50) | 21/146 (14.4) | |
| Medical/hospital supplies | 13/70 (19) | 10/53 (19) | 2/6 (33) | 2/2 (100) | 2/3 (67) | 0 | 1/2 (50) | 30/146 (20.5) | |
| Opportunities to visit/train in United States | 18/70 (26) | 22/53 (42) | 2/6 (33) | 0 | 0 | 2/10 (20) | 0 | 44/146 (30.1) | |
| Training/educational programs conducted in Africa | 28/70 (40) | 11/53 (21) | 2/6 (33) | 0 | 1/3 (33) | 4/10 (40) | 0 | 46/146 (31.5) | |
| Coauthor on publications in medical journals | 2/70 (3) | 0 | 0 | 0 | 0 | 1/10 (10) | 0 | 3/146 (2.1) | |
| Coinvestigator status on grant applications | 1/70 (1) | 0 | 0 | 0 | 0 | 1/10 (10) | 0 | 2/146 (1.4) | |
| Second Choice | |||||||||
| Total respondents | 66/70 (94) | 52/65 (80) | 6/8 (75) | 2/3 (67) | 3/4 (75) | 10/11 (91) | 2/2 (100) | 141/170 (82.9) | .02 |
| Direct financial/monetary support | 9/66 (14) | 7/52 (13.5) | 0 | 1/2 (50) | 0 | 2/10 (20) | 0 | 19/141 (13.5) | |
| Medical/hospital supplies | 18/66 (27) | 24/52 (46) | 4/6 (66.7) | 0 | 1/3 (33.3) | 5/10 (50) | 1/2 (50) | 53/141 (37.6) | |
| Opportunities to visit/train in United States | 17/66 (26) | 8/52 (15) | 2/6 (33.3) | 1/2 (50) | 2/3 (66.7) | 1/10 (10) | 1/2 (50) | 32/141 (22.7) | |
| Training/educational programs conducted in Africa | 12/66 (18) | 13/52 (25) | 0 | 0 | 0 | 1/10 (10) | 0 | 26/141 (18.4) | |
| Coauthor on publications in medical journals | 7/66 (11) | 0 | 0 | 0 | 0 | 0 | 0 | 7/141 (5.0) | |
| Coinvestigator status on grant applications | 3/66 (5) | 0 | 0 | 0 | 0 | 1/10 (10) | 4/141 (2.8) | ||
| Third Choice | |||||||||
| Total respondents | 65/77 (84) | 52/65 (80) | 6/8 (75) | 2/3 (67) | 3/4 (75) | 10/11 (91) | 2/2 (100) | 140/170 (82.4) | .002 |
| Direct financial/monetary support | 4/65 (6) | 7/52 (14) | 0 | 0 | 0 | 4/10 (40) | 0 | 15/140 (10.7) | |
| Medical/hospital supplies | 12/65 (19) | 14/52 (27) | 0 | 0 | 0 | 1/10 (10) | 0 | 27/140 (19.3) | |
| Opportunities to visit/train in United States | 15/65 (23) | 12/52 (23) | 2/6 (33) | 1/2 (50) | 1/3 (33.3) | 2/10 (20) | 0 | 33/140 (23.6) | |
| Training/educational programs conducted in Africa | 17/65 (26) | 19/52 (37) | 4/6 (67) | 1/2 (50) | 2/3 (67) | 1/10 (10) | 2/2 (100) | 46/140 (32.9) | |
| Coauthor on publications in medical journals | 11/65 (17) | 0 | 0 | 0 | 0 | 2/10 (20) | 0 | 13/140 (9.3) | |
| Coinvestigator status on grant applications | 6/65 (9) | 0 | 0 | 0 | 0 | 0 | 0 | 6/140 (4.3) | |
Abbreviation: NA, not applicable.
P value from χ2 test of comparing the responses from physician and nurse only.
Physicians and nurses ranked educational/training programs as their highest-priority need, but physicians ranked training programs conducted in Africa higher than programs involving training in the United States (28 [40%] vs 18 [25.7%], respectively), while the reverse was seen for nurses (11 [20.8%] vs 22 [41.5%], respectively). Medical/hospital supplies and direct financial/monetary support were ranked as the highest priority by 30 [20.5%] and 21 [14.4%] respondents, respectively. Dominance of Ghanaian participants precluded meaningful comparisons of responses by practice location.
Discussion
The health care needs of sub-Saharan African low- and middle-income countries are numerous; these deficiencies are especially prominent in cancer care, where multidisciplinary specialists, pathology supplies, and medications (for treatment as well as supportive care) are scarce. Overall life expectancy of African individuals is 2 to 3 decades shorter than that of US individuals and European individuals6; as longevity increases with improvements in general medical resources, and as Western lifestyles and diets are adopted in Africa, breast cancer burden rises.2,3,4 International initiatives featuring investment of resources into cancer services in Africa are therefore important but should be aligned with needs defined by local clinicians and other relevant stakeholders, such as the patient and advocacy communities and local and national governing bodies.
This study demonstrated that African physicians and nurses prioritize provision of educational/training programs and medical/hospital supplies over direct monetary contributions. These are likely seen as capacity building. It is also possible that clinicians in African medical facilities experience difficulties with directly accessing or purchasing commercial products and coordinating delivery to local facilities; this barrier may contribute to the preference for donation of supplies over direct monetary contributions. This study reflects preferences of clinicians with strong interests in breast cancer and with resources that allowed them the opportunity to attend a breast cancer conference. These results cannot necessarily be generalized to clinicians in other areas of medicine or with more constrained finances.
References
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