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Breast and Cervical Cancer Patients' Experience in Addis Ababa City, Ethiopia

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Breast and Cervical Cancer Patients' Experience in Addis Ababa City, Ethiopia BMJ Open: first published as 10.1136/bmjopen-2018-027034 on 9 April 2019. Downloaded from BMJ Open is committed to open peer review. As part of this commitment we make the peer review history of every article we publish publicly available. When an article is published we post the peer reviewers’ comments and the authors’ responses online. We also post the versions of the paper that were used during peer review. These are the versions that the peer review comments apply to. The versions of the paper that follow are the versions that were submitted during the peer review process. They are not the versions of record or the final published versions. They should not be cited or distributed as the published version of this manuscript. BMJ Open is an open access journal and the full, final, typeset and author-corrected version of record of the manuscript is available on our site with no access controls, subscription charges or pay-per-view fees (http://bmjopen.bmj.com). If you have any questions on BMJ Open’s open peer review process please email [email protected] http://bmjopen.bmj.com/ on September 25, 2021 by guest. Protected copyright. BMJ Open BMJ Open: first published as 10.1136/bmjopen-2018-027034 on 9 April 2019. Downloaded from Breast and cervical cancer patients’ experience in Addis Ababa city, Ethiopia: A follow-up study protocol Journal: BMJ Open ManuscriptFor ID peerbmjopen-2018-027034 review only Article Type: Protocol Date Submitted by the 02-Oct-2018 Author: Complete List of Authors: Gebremariam, Alem; Adigrat University, Public Health Addissie, Adamu; Addis Ababa University School of Public Health, Preventive Medicine Worku, Alemayehu; Addis Ababa University, School of Public Health Hirpa, Selamawit; Addis Ababa University School of Public Health Assefa, Mathewos ; Addis Ababa University School of Medicine, Oncology Pace, Lydia; Brigham and Women's Hospital, Boston, Massachusetts Kantelhardt, Eva; Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, Halle, Germany Jemal, Ahmedin; American Cancer Society, Surveillance and Health Services Research Breast Neoplasm, Uterine Cervical Neoplasm, Reported Outcome Keywords: http://bmjopen.bmj.com/ Measures on September 25, 2021 by guest. Protected copyright. For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 1 of 19 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2018-027034 on 9 April 2019. Downloaded from 1 2 3 4 Breast and cervical cancer patients’ experience in Addis 5 6 7 Ababa city, Ethiopia: A follow-up study protocol 8 9 10 1,2 2 2 2 11 Alem Gebremariam *, Adamu Addissie , Alemayehu Worku Yalew , Selamawit Hirpa 12 3 4 5 6 13 Mathewos Assefa , Lydia E. Pace , Eva Johanna Kantelhardt , Ahmedin Jemal 14 15 1Department of Public Health, College of Medicine and Health Sciences, Adigrat University 16 For peer review only 17 18 Adigrat, Ethiopia 19 20 2School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, 21 22 Ethiopia 23 24 3 25 Department of Radiotherapy Center, School of Medicine, Addis Ababa University, Addis 26 27 Ababa, Ethiopia 28 29 4Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, 30 31 Boston, Massachusetts, USA 32 http://bmjopen.bmj.com/ 33 5 34 Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University, 35 36 Halle, Germany 37 38 6Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia, United 39 40 on September 25, 2021 by guest. Protected copyright. 41 States of America 42 43 44 * Corresponding Author 45 46 Abstract 47 48 49 50 Introduction: Cancer is an emerging public health problem in Ethiopia, with breast and cervical 51 52 cancers accounting for over half of all newly diagnosed cancers in women. Based on limited 53 54 published data, the majority of breast and cervical cancer patients are diagnosed at late stage of 55 56 57 58 1 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 2 of 19 BMJ Open: first published as 10.1136/bmjopen-2018-027034 on 9 April 2019. Downloaded from 1 2 3 the disease and most patients do not receive care consistent with global standards. However, little 4 5 6 is known about the health seeking behaviors, barriers to early detection and treatment, patient 7 8 reported outcomes, financial burden, and survival of breast and cervical cancer patients in the 9 10 country. Therefore, this study aims to document the experience of breast and cervical cancer 11 12 patients from recognition of symptoms to diagnosis, treatment, and survivorship/mortality in 13 14 15 Addis Ababa city, Ethiopia. 16 For peer review only 17 Methods and analysis: All consenting breast and cervical cancer patients diagnosed from 18 19 January 1, 2017 to June 30, 2018 who are residents of Addis Ababa City will be included in the 20 21 22 study and will be followed prospectively for two years. Pretested questionnaires will be 23 24 administered to patients by trained interviewers face-to-face or over the phone to collect 25 26 information about medical consultations after recognition of symptoms, health seeking 27 28 29 behaviors, treatment received, barriers to early detection and treatment, survivorship care, and 30 31 vital status. Information on treatments and clinical characteristics will be extracted from medical 32 http://bmjopen.bmj.com/ 33 records. Multivariable analysis will be employed to determine the contributions of independent 34 35 variables on the outcomes of interest. Hazard ratios with their corresponding 95% confidence 36 37 38 intervals will be calculated for time to event outcomes. Qualitative data will be analyzed using 39 40 thematic analysis. on September 25, 2021 by guest. Protected copyright. 41 42 Ethics and dissemination: This protocol is ethically approved by Addis Ababa University, 43 44 45 College of Health Science Institutional Review Board. Verbal informed consent will be obtained 46 47 from study participants prior to their enrollment. Results from this project will be disseminated 48 49 in international peer-reviewed journals and presented in relevant conferences. 50 51 52 53 54 55 56 57 58 2 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 3 of 19 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2018-027034 on 9 April 2019. Downloaded from 1 2 3 Keywords : Breast Neoplasm, Uterine Cervical Neoplasm, Patient Reported Outcome Measures, 4 5 6 Addis Ababa, Ethiopia 7 8 9 Strengths and limitations of this study 10 11 12 13 • To the best of our knowledge, this study is the first population based prospective follow- 14 15 up study in Ethiopia to determine the experience of breast and cervical cancer patients 16 For peer review only 17 18 from the first symptom recognition through the course of survivorship care using rigorous 19 20 mixed methods. 21 22 • Being prospective follow-up study design, allows us to test the temporal relationship 23 24 25 between patient and or provider delay and survival of breast and cervical cancer patients. 26 27 • Our study will try to capture all of the incident cases of the city so that generalization 28 29 about breast and cervical cancer patients in the city will be possible latter. 30 31 32 • The study will identify gaps and barriers to receipt of cancer care in Addis Ababa from a http://bmjopen.bmj.com/ 33 34 patient perspective, which will inform public health policies and clinical guidelines for 35 36 early detection and improving the quality of cancer care in Addis Ababa and other parts 37 38 39 of the country. 40 on September 25, 2021 by guest. Protected copyright. 41 • It will also provide patient narratives and quantitative evidence to support efforts to 42 43 increase public awareness and advocate for increased resources to reduce suffering and 44 45 death from cancer in Ethiopia. 46 47 48 49 50 51 52 53 54 55 56 57 58 3 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 4 of 19 BMJ Open: first published as 10.1136/bmjopen-2018-027034 on 9 April 2019. Downloaded from 1 2 3 Introduction 4 5 6 Breast and cervical cancers are the most commonly diagnosed cancers and the leading causes of 7 8 cancer death among women in Ethiopia and in other parts of sub-Saharan Africa [1-3], 9 10 11 accounting for about half of all cancer cases and deaths [4]. These cancers have significant 12 13 public health and societal implications not only because they represent more than half of all 14 15 cancer cases in women but also because they most frequently occur in young or middle age [5, 6] 16 For peer review only 17 18 when patients are in the workforce, raising children, and supporting other family members. 19 20 21 The morbidity and mortality associated with breast and cervical cancer can be mitigated through 22 23 early detection and receipt of evidence-based, high quality care [7]. However, based on limited 24 25 data, a substantial proportion of breast and cervical cancer patients in Ethiopia present with 26 27 28 advanced-stage disease. For instance, about 71% of the breast cancer cases [6] and 84% cervical 29 30 cancer cases [5] in Ethiopia were diagnosed at advanced stage largely because of patient delays 31 32 in seeking medical care after recognition of symptoms and provider/health systems delay in http://bmjopen.bmj.com/ 33 34 35 referral of patients to cancer treatment centers [8, 9]. Further, most breast and cervical cancer 36 37 patients in the country do not receive treatments consistent with the global standard of care [3].
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