Challenges of gynaecological cancer care in Nigeria – a review article

Authors

  • Dr. T.A.O. Oluwasola

Abstract

Background: Gynaecological cancers and their management in the tropics constitute a big challenge to the gynaecological oncologist considering the overwhelming economic burden of care on patients and their relatives. These challenges are numerous and present at different levels vis-a-vis of prevention, diagnosis, treatment of the disease and patients’ follow up. The main thrust of this review was to illustrate the challenges affecting gynaecological cancer care in Nigeria and proffer potential opportunities for their early identification while making recommendations that may be beneficial in ameliorating their effects and impacts.

Methodology: Electronic search of local and international literatures was conducted in major databases including PubMed, Web of Science, Sciencedirect, EMBASE, SpringerLink, Scopus, JSTOR,
JaypeeDigital, and Google Scholar using appropriate MESH terms either individually or in combination. All relevant peer–reviewed articles and publications were identified, retrieved and reviewed.

Results: Challenges of management of gynaecological cancers are enormous and diverse. They vary at different levels of care and included poverty, lack of access to health care, inadequate or absence of basic infrastructure for cancer care and lack of political will. Delay at different levels of care leading to late presentation remains a leading factor that negatively contributes to survival.

Conclusion: Gynaecological cancer care in the tropics is a big challenge to health care providers. Efforts should be intensified in prompt identification of these challenges and offering solutions that will help in improving the health of our women.

Keywords: burden, care, challenges, gynaecologic cancer, Nigeria

Résumé
Contexte: Les cancers gynécologiques et leur prise en charge dans les tropiques constituent un grand défi pour l’oncologue gynécologique compte tenu du fardeau économique accablant des soins pour les patients et leurs proches. Ces défis sont nombreux et présents à différents niveaux vis-àvis de la prévention, le diagnostic, le traitement de la maladie et la suivie des patientes. L’objectif principal de cette revue était d’illustrer les défis qui affectent les soins gynécologiques contre le cancer au Nigeria et de proposer des opportunités potentielles pour leur identification précoce tout en faisant des recommandations qui pourraient être bénéfiques pour améliorer leurs effets et leurs impacts.

Méthodologie : La recherche électronique des littératures locales et internationales a été menée dans des bases de données majeures telles que PubMed, Web of Science, Sciencedirect , EMBASE, SpringerLink , Scopus, JSTOR, JaypeeDigital et Google Scholar en utilisant les termes MESH appropriés individuellement ou en combinaison. Tous les articles et publications pertinents évalués par des pairs ont été identifiés, récupérés et examinés.

Résultats: Les défis de la prise en charge des cancers gynécologiques sont énormes et diversifiés. Ils varient selon les différents niveaux de soins et comprennent la pauvreté, le manque d’accès aux soins de santé, l’insuffisance ou l’absence d’infrastructures de base pour les soins contre le cancer et le manque de volonté politique. Retard à différents niveaux de soins menant à la présentation tardive reste un facteur majeur qui contribue négativement à la survie.

Conclusion: Les soins gynécologiques contre le cancer dans les tropiques représentent un défi important pour les fournisseurs de soins de santé. Les efforts devraient être intensifiés pour identifier rapidement ces défis et offrir des solutions qui aideront à améliorer la santé de nos femmes.

Mots clés: fardeau, soins, défis, cancer gynécologique, Nigéria

Correspondence: Dr. T.A.O. Oluwasola, Department of Obstetrics and Gynaecology, College of Medicine, University of Ibadan, Ibadan, Nigeria. E-mail: sesanoluwasola@yahoo.com.

References

Iyoke CA, Ugwu GO, Ezugwu EC, et al. . Challenges associated with the management of gynaecological cancers in a tertiary hospital in South East Nigeria. Int J Womens Health. 2014;6(1):123–130.

Aniebue UU and Onyeka TC. Ethical, Socioeconomic, and Cultural Considerations in Gynaecologic Cancer Care in Developing Countries. Int J Palliat Care. 2014;2014(Article ID 141627):6 pages.

Oguntayo AO, Zayyan M, Akpar M, et al. The burden of gynaecological cancer management in Northern Nigeria. Open J Obs Gynaecol. 2013;3:634–638.

Randall TC and Ghebre R. Challenges in Prevention and Care Delivery for Women with Cervical Cancer in Sub-Saharan Africa. Front Oncol. 2016;6:160.

Agboeze J, Ezeonu PO, Onoh RC, et al. Frequency and pattern of gynaecological cancers in federal teaching hospital, Abakaliki, Nigeria. J Basic Clin Reprod Sci. 2015; 4(2): 54–57.

Odukogbe A, Adebamowo C, Ola B, Olayemi O and Oladokun A. Ovarian cancer in Ibadan: characteristics and management. J Obstet Gynaecol. 2004;24(3):294–297.

Oguntayo AO, Zayyan MS, Adewuyi SA, et al. The pattern of carcinoma of the vulva in Zaria, Northern Nigeria. Niger J Basic Clin Sci. 2016;13(1):46.

Okeke TC, Onah N, Ikeako LC and Ezenyeaku CCT. The frequency and pattern of female genital tract malignancies at the University of Nigeria Teaching Hospital, Enugu, Nigeria. Ann Med Health Sci Res. 2013;3(3):345–348.

Okolo CA, Odubanjo MO, Awolude OA and Akang EEU. A Review of Vulvar and Vaginal Cancers in Ibadan , Nigeria. North Am J Med Sci. 2013;6(2):76–81.

Yakasai IA, Ugwa E and Otubu J. Gynaecological malignancies in Amino Kano teaching hospital, Kano. A 3 year review. Niger J Clin Pr. 2013;16(1):63–66.

Adefuye PO, Adefuye BO and Oluwole AA. Female genital tract cancers in Sagamu, Southwest, Nigeria. East Afr Med J. 2014;91(11):398–406.

Ikechebelu JI, Onyiaorah IV, Ugboaja JO, Anyiam DCD and Eleje GU. Clinicopathological analysis of cervical cancer seen in a tertiary health facility in Nnewi, South-east Nigeria. J Obstet Gynaecol. 2010;30(3):200–301.

Ugwu EO, Iferikigwe ES, Okeke TC, et al. . Pattern of gynaecological cancers in University of Nigeria Teaching Hospital, Enugu, South Eastern Nigeria. Niger J Med. 2011; 20(2):266–269.

Bassey EA, Ekpo MD and Abasiatai A. Female genital tract malignancies in Uyo, South-South Nigeria. Niger Postgrad Med J. 2007;14(2):134–136.

Ibrahim HM and Ijaiya MA. Pattern of gynaecological malignancies at the University of Ilorin Teaching Hospital , Ilorin , Nigeria. J Obstet Gynaecol. 2013;33(2):194–196.

Nwosu SO and Anya SE. Malignancies of the female genital tract at the University of Port Harcourt Teaching Hospital: a ten year review — 1990-1999. Niger Postgrad Med J. 2004;11(2):107–109.

Nnadi D, Singh S, Ahmed Y, Siddique S and Bilal S. Histo pathological Features of Genital Tract Malignancies as seen in a Tertiary Health Centre in North Western Nigeria/ : A 10 year Review. Ann Med Health Sci Res. 2014;4(3):213–217.

Ibrahim SA, Natalia A, Abubakar IS and Garba ID. Pattern of gynaecological admissions in Aminu Kano teaching hospital: A three year review. Trop J Obstet Gynaecol. 2011;28(2):145–150.

Udigwe GO, Umeononihu OS and Mbachu II. A review of the prevalence and pattern of presentation of gynaecological cancers in a tertiary hospital in Nnewi, South-East Nigeria. Orient J Med. 2011;23(1/4):12–16.

Galadanci HS, Mohammed AZ, Uzoho CC, Jido TA and Ochicha O. Gynaecological malignancies seen in a tertiary health facility in Kano, Northern Nigeria. Trop J Obstet Gynaecol. 2003;20(2):105–108.

Kyari O, Nggada H and Mairiga A. Malignant tumours of female genital tract in North Eastern Nigeria. East Afr Med J. 2004;81(3):142–145.

Mandong BM and Ujah IAO. A Ten - Year Review of Gynaecological Malignancies in Jos University Teaching Hospital, Jos, Nigeria (1990-1999). Sahel Med J. 2003;6(2):49–52.

Mohammed A, Ahmed SA, Oluwole OP and Avidime S. Malignant Tumours of the female genital tract in Zaria, Nigeria. Ann Afr Med. 2006;5(2):93–96.

Ozumba BC, Nzegwu MA and Anyikam A. Histological Patterns of Gynaecological Lesions in Enugu, Nigeria. A Five-Year Review from. Adv Biores. 2011;2(132):132–136.

Olu-Eddo AN, Ekanem VJ, Umannah I and Onakevhor J. A 20-year histopathological study of cancer of the cervix in Nigerians. Nig Q J Hosp Med. 2011; 21(2):149–153.

Yakasai I, Abubakar I and Eze Y. Gestational Trophoblastic Diseases in a Teaching Hospital in Northern Nigeria. Am J Biosci. 2015;3(1):7–10.

Mbamara SU, Obiechina NJA, Eleje GU, Akabuike CJ and Umeononihu OS. Gestational trophoblastic disease in a tertiary hospital in Nnewi, Southeast Nigeria. Niger Med J. 2009;50(4):87–89.

Anakwenze CP, Ntekim A, Trock B, Uwadiae IB and Page BR. Barriers to radiotherapy access at the University College Hospital in Ibadan, Nigeria. Clin Transl Radiat Oncol. 2017;5:1–5.

Abubakar MS, Musa AM, Ahmed A and Hussaini IM. The perception and practice of traditional medicine in the treatment of cancers and inflammations by the Hausa and Fulani tribes of Northern Nigeria. J Ethnopharmacol. 2007;111:625–629.

Adamou N and Umar UA. Delayed Presentation of Patients with Gynaecological Malignancies in Kano , North-Western Nigeria. Open J Obs Gynaecol. 2015;5:333–340.

McCormack VA and Schuz J. Africa’s growing cancer burden: Environmental and occupational contributions. Cancer Epidemiol. 2012;36:1–7.

Dim CC, Ekwe E, Madubuko T, Dim NR and Ezegwui HU. Improved awareness of Pap smear may not affect its use in Nigeria/ : a case study of female medical practitioners in Enugu , Southeastern Nigeria. Trans R Soc Trop Med Hyg. 2009;103: 852–854.

Dodo AM. Sociocultural barriers to breast and cervical cancer screening in Northern Nigeria. Eur J Surg Oncol 2016;42(11): S242.

Ndikom MC and Ofi AB. Awareness, perception and factors affecting utilization of cervical cancer screening services among women in Ibadan, Nigeria: a qualitative study. Reprod Health. 2012; 9:1.

Ezechi OC, Petterson KO, Gabajabiamila TA, et al. Predictors of default from follow-up care in a cervical cancer screening program using direct visual inspection in South-Western Nigeria. BMC Health Serv Res. 2014;14 (1):143.

Chigbu CO, and Aniebue UU. Why Southeastern Nigerian women who are aware of cervical cancer screening do not go for cervical cancer screening. Int J Gynaecol Cancer. 2011;21 (7): 1282–1286.

Supoken A, Chaisrisawatsuk T and Chumworathayi B. Proportion of Gynaecologic Cancer Patients Using Complementary and Alternative Medicine. Asian Pacific J Cancer Prev. 2009;10 (5): 779–782.

Chigbu CO and Aniebue UU. Non-uptake of colposcopy in a resource-poor setting. Int J Gynaecol Obstet. Int J Gynaecol Obstet; 2011;113 (2): 100–102.

Ndukwe EO, Agwu UM, Obuna JA, et al. Challenges of Establishing and Running Cancer Screening in a Tertiary Health Institution in a Low Resource Setting in South East Nigeria. Androl Gynaecol Curr Res. 2015; 4:1.

Basile S, Angioli R, Manci N, et al. Gynaecological cancers in developing countries: The challenge of chemotherapy in low-resources setting. Int J Gynaecol Cancer. 2006;16(4): 1491–1497.

Ezeome ER and Anarado AN. Use of complementary and alternative medicine by cancer patients at the University of Nigeria Teaching Hospital, Enugu, Nigeria. BMC Complement Altern Med. 2007; 7: 28.

Iyoke CA and Ugwu GO. Burden of gynaecological cancers in developing countries. World J Obstet Gynaecol. 2013;2 (1): 1–7.

Wainer J, Willis E, Dwyer J, King D and Owada K. The treatment experiences of Australian women with gynaecological cancers and how they can be improved: A qualitative study. Reprod Health Matters. 2012;20 (40): 38–48.

Grover S, Longo J, Einck J, et al. The Unique issues with Brachytherapy in Low- and Middle-Income Countries. Semin Radiat Oncol. 2017; 27 (2): 136–142.

Morhason-Bello IO, Odedina F, Rebbeck TR, et al. Challenges and opportunities in cancer control in Africa: A perspective from the African Organisation for Research and Training in Cancer. Lancet Oncol. 2013;14(4):e142–151.

Njaka SA. Systemic review of incidence of cancer and challenges to its treatment in Nigeria. J Cancer Sci Ther. 2016;8 (12):286–288.

Adepoju EG, Ilori T, Olowookere SA and Idowu A. Targeting women with free cervical cancer screening: challenges and lessons learnt from Osun State, Southwest Nigeria. Pan Afr Med J. 2016;24: 319–322.

Price AJ, Ndom P, Atenguena E et al. Cancer care challenges in developing countries. Cancer. 2012;118(14): 3627–3635.

Kozachik SL, Given CW, Given BA, et al. Improving depressive symptoms among caregivers of patients with cancer: results of a randomized clinical trial. Oncol Nurs Forum. 2001;28(7):1149–1157.

Kim Y and Given BA. Quality of life of family caregivers of cancer survivors: Across the trajectory of the illness. Cancer Suppl. 2008;112(11):2556–2568.

Ward E, Halpern M, Schrag N, et al. Association of insurance with cancer care utilization and outcomes. CA Cancer J Clin. 2008;58(1): 9–31.

Marlow NM, Pavluck AL, Bian J, Ward EM and Halpern MT. The Relationship between Insurance Coverage and Cancer Care: A Literature Synthesis. RTI Press publication No. RR-0005-0905; 2009 May. Research Triangle Park, NC: RTI International. Cited 28 July, 2017 from http://www.rti.org/rtipress

Farmer P, Frenk J, Knaul FM, et al. Expansion of cancer care and control in countries of low and middle income: A call to action. Lancet. 2010;376 (9747):1186–1193.

Patel MI, Periyakoil VS, Blayney DW, et al. edesigning Cancer Care Delivery: Views From Patients and Caregivers. J Oncol Pract. 2017;13(4):e291–e302.

Guadagnolo BA, Petereit DG and Coleman CN. Cancer Care Access and Outcomes for American Indian Populations in the United States: Challenges and Models for Progress. Semin Radiat Oncol. 2017;27(2): 143–149.

Varughese J and Richman S. Cancer care inequity for women in resource-poor countries. Rev Obstet Gynaecol. 2010;3(3): 122–132.

Eguzo K, Camazine B. Cancer care in resource-limited settings: A call for action. J Cancer Sci Ther. 2012;4(8): 223–226.

Ogunbode OO and Ayinde OA. Awareness of cervical cancer and screening in a Nigerian female market population. Ann Afr Med. 2005;4 (4): 160–163.

Okunade KS, Okunola H, Okunowo AA and Anorlu RI. A five year review of ovarian cancer at a tertiary institution in Lagos, South-West, Nigeria. Niger J Gen Pract 2016;14 (2): 23–27.

Enakpene CA, Omigbodun AO, Goecke TW, Odukogbe AT and Beckmann MW. Preoperative evaluation and triage of women with suspicious adnexal masses using risk of malignancy index. J Obstet Gynaecol Res. 2009;35 (1): 131–138.

Abdel-wahab M, Bourque J, Pynda Y, et al. Status of radiotherapy resources in Africa/ : an International Atomic Energy Agency Analysis. Lancet Oncol 2013; 14(4) : e168–175.

Balogun O, Rodin D, Ngwa W, Grover S and Longo J. Challenges and Prospects for Providing Radiation Oncology Services in Africa. Semin Radiat Oncol. 2017;27 (2): 184–148.

Ntekim A. Cervical Cancer in Sub Sahara Africa. In: Rajaminckam R, editor. Topics on Cervical Cancer with an advocacy for prevention. In Tech; 2012. p. 51–74. Available from: www.intechopen.com

Graham J and Mishra A. Global challenges of implementing human papillomavirus vaccines. Int J Equity Health. 2011; 10:27.

Pervaiz R and Faisal F. Cancer incidence and mortality are associated with human development index and health setups in Africa. J Egypt Natl Canc Inst. 2017;29: 3–6. http://dx.doi.org/10.1016/j.jnci.2017.05.003

Ginsburg O, Badwe R, Boyle P, et al. Changing global policy to deliver safe, equitable, and affordable care for women’s cancers. Lancet 2016;6736(16): 31–40.

Kibel SM and Cain JM. Palliative care in gynaecological cancer. Int J Gynaecol Obstet 2015;131: S167–71.

Sheppard VB, Hurtado-de-mendoza A, Song M, Hirpa F and Nwabukwu I. The role of knowledge, language , and insurance in endorsement of cancer screening in women of African origin. Prev Med Reports 2015;2: 517–523.

Brock DW. Ethical and value issues in insurance coverage for cancer treatment. The Oncologist 2010;15 Suppl 1: 36–42.

Freeman E, Semeere A, Wenger M, et al. Pitfalls of practicing cancer epidemiology in resource-limited settings: the case of survival and loss to follow-up after a diagnosis of Kaposi’s sarcoma in five countries across sub-Saharan Africa. BMC Cancer; 2016; 16:65.

Khozaim K, Orang’o E, Christoffersen-Deb A, et al. Successes and challenges of establishing a cervical cancer screening and treatment program in western Kenya. Int J Gynecol Obstet. 2014; 124(1):12–18.

Carpenter KM and Andersen BL. Psychological and Sexual Aspects of Gynaecologic Cancer. Glob Libr Women’s Med. 2009;2228: 1–27.

Maguire R, Kotronoulas G, Simpson M and Paterson C. A systematic review of the supportive care needs of women living with and beyond cervical cancer. Gynaecol Oncol 2015;136(3): 478–490.

Muliira RS, Salas AS and O’Brien B. Quality of Life among Female Cancer Survivors in Africa: An Integrative Literature Review. Asia-Pacific J Oncol Nurs. 2017;4(1): 6–17.

Nakaya N. Effect of Psychosocial Factors on Cancer Risk and Survival. J Epidemiol. 2014; 24 (1): 1–6.

Manne SL, Virtue SM, Ozga M, et al. A comparison of two psychological interventions for newly-diagnosed gynaecological cancer patients. Gynaqecol Oncol. 2017;144 (2): 354–362.

Fu WW, Popovic M, Agarwal A, et al. The impact of psychosocial intervention on survival in cancer: a meta-analysis. Ann Palliat Med. 2016; 5(2): 93–106.

Omolara KA. Feasible cancer control strategies for Nigeria: Mini-review. Am J Trop Med Public Heal. 2011; 1(1):1: 1-10.

O’Hara RE, Hull JG, Lyons KD, et al. Impact on Caregiver Burden of a Patient-Focused Palliative Care Intervention for Patients with Advanced Cancer. Palliat Support Care. 2010; 8(4): 395–404.

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2020-08-27

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Short Review