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Delayed initiation of adjuvant chemotherapy among women with breast cancer in Addis Ababa, Ethiopia

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Chemotherapy within 90 days following surgery for non-metastatic breast cancer is the standard of care. There are no data, however, on the extent of time to initiation of chemotherapy (TTC) in Africa settings, including Ethiopia.

Methods

A total of 223 women with stage I-III breast cancer treated with surgery and adjuvant chemotherapy during 2017–2019 in Addis Ababa, Ethiopia, were included in the analysis. Based on information from medical records, we calculated TTC from date of surgery and completion of planned chemotherapy, with TTC > 90 days considered delayed and receipt of 85% of planned therapy as complete. Multivariable Poisson regression with robust variance was used to assess whether TTC > 90 days was associated with sociodemographic or clinical factors.

Results

The median TTC was 63 days. Chemotherapy initiation was delayed in 30% (95% CI 24.4–36.6%) of patients, with the risk significantly higher in low-income women. For example, the risk of delay in women with lowest quartile family monthly income group (US$ < 61) was 3.98 (95% CI 1.67–9.46) higher than in those women with highest quartile family income group (US$ > 194). Remarkably, adjuvant chemotherapy was completed in 95% of patients.

Conclusions

A staggering one-in-three women with breast cancer in Addis Ababa, Ethiopia, delay to initiation of adjuvant chemotherapy, with the delay more common in low-income women and yet with remarkably high degree of treatment adherence. These findings underscore the need for public policy to expand health care to low-income population to improve breast cancer care and other health outcomes in the country.

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Data availability

The datasets during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors acknowledge the help of all members of the participating oncology clinics, all data collectors, and study participants for their time and cooperation.

Funding

This work was supported by the Intramural Research Department of the American Cancer Society. The funder has no role in the study design, collection, analysis, and interpretation of the data, writing of the report, and decision to submit the paper for publication.

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Authors and Affiliations

  1. Department of Public Health, College of Medicine and Health Sciences, Adigrat University, Tigray, Adigrat, Ethiopia

    Alem Gebremariam

  2. Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia

    Alem Gebremariam, Adamu Addissie, Alemayehu Worku & Nebiyu Dereje

  3. Radiotherapy Center, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia

    Mathewos Assefa, Aynalem Abreha & Wondemagegnehu Tigeneh

  4. Department of Public Health, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia

    Nebiyu Dereje

  5. Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Lydia E. Pace

  6. Institute for Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle-Wittenberg, Halle, Germany

    Eva Johanna Kantelhardt

  7. Surveillance and Health Services Research, American Cancer Society, Atlanta, GA, USA

    Ahmedin Jemal

Authors
  1. Alem Gebremariam
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  2. Mathewos Assefa
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  7. Wondemagegnehu Tigeneh
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  8. Lydia E. Pace
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  9. Eva Johanna Kantelhardt
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  10. Ahmedin Jemal
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Contributions

AG, AA, AW, MA, and AJ conceptualized the study. AG, MA, and AJ analyzed and wrote the first draft of the manuscript. All authors commented on the designing of the study and reviewed the final draft of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Alem Gebremariam.

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Conflict of interest

The authors declare that they have no conflict of interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional review board of College of Health Science of Addis Ababa University (018/17/SPH) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Gebremariam, A., Assefa, M., Addissie, A. et al. Delayed initiation of adjuvant chemotherapy among women with breast cancer in Addis Ababa, Ethiopia. Breast Cancer Res Treat 187, 877–882 (2021). https://doi.org/10.1007/s10549-021-06131-9

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  • DOI: https://doi.org/10.1007/s10549-021-06131-9

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