Assessing the continuum of care in sub-Saharan African hospitals performing surgery for breast cancer

Abstract While breast cancer incidence rates in SSA are among the lowest worldwide, mortality rates remain among the highest, reflecting particularly poor survival. Only a few studies in SSA have investigated the capabilities of treatment services to adequately provide a continuum of care for breast cancer. Our aim was to assess the availability of diagnostic facilities and adjuvant therapies in hospitals performing breast cancer surgery in SSA. We performed a secondary analysis of GlobalSurg3 study data collected in the SSA region. A total of 47 hospitals from 15 SSA countries and 43 cities were included between April 1, 2018, and Jan 31, 2019. One-third of hospitals covered a population greater than two million (n=17; 36.2%). Ultrasound was available in all hospitals; however, it was not consistently functional in 11 hospitals (23.4%). Only half of theparticipating hospitals (n=26, 55.3%) had access to a full-time pathologist, while the multidisciplinary team (MDT) approach was not found in 42.4% of hospitals. Equipment for radiotherapy was only available in nine hospitals (19.1%). Only half of the hospitals (n=25, 53.1%) had chemotherapy drugs available on site. In nine hospitals (19.1%), patients had to travel more than 50 kilometers to access chemotherapy drugs. In conclusion, the outcome of breast cancer patients in SSA cannot be improved without significant investments in pathology, surgical and oncological treatment pathways to provide timely diagnostic and effective treatment.