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Table.  Results of Survey Regarding African Clinicians’ Assessment of Needs From International Partnerships
Results of Survey Regarding African Clinicians’ Assessment of Needs From International Partnerships
1.
Brinton  LA, Figueroa  JD, Awuah  B,  et al.  Breast cancer in Sub-Saharan Africa: opportunities for prevention.  Breast Cancer Res Treat. 2014;144(3):467-478. doi:10.1007/s10549-014-2868-zPubMedGoogle ScholarCrossref
2.
DeSantis  CE, Bray  F, Ferlay  J, Lortet-Tieulent  J, Anderson  BO, Jemal  A.  International variation in female breast cancer incidence and mortality rates.  Cancer Epidemiol Biomarkers Prev. 2015;24(10):1495-1506. doi:10.1158/1055-9965.EPI-15-0535PubMedGoogle ScholarCrossref
3.
Azubuike  SO, Muirhead  C, Hayes  L, McNally  R.  Rising global burden of breast cancer: the case of sub-Saharan Africa (with emphasis on Nigeria) and implications for regional development: a review.  World J Surg Oncol. 2018;16(1):63. doi:10.1186/s12957-018-1345-2PubMedGoogle ScholarCrossref
4.
Fitzmaurice  C, Akinyemiju  TF, Al Lami  FH,  et al; Global Burden of Disease Cancer Collaboration.  Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2016: a systematic analysis for the Global Burden of Disease study  [published online June 2, 2018].  JAMA Oncol. 2018. doi:10.1001/jamaoncol.2018.2706PubMedGoogle Scholar
5.
Jiagge  E, Oppong  JK, Bensenhaver  J,  et al.  Breast cancer and African ancestry: lessons learned at the 10-year anniversary of the Ghana-Michigan Research Partnership and International Breast Registry.  J Glob Oncol. 2016;2(5):302-310. doi:10.1200/JGO.2015.002881PubMedGoogle ScholarCrossref
6.
US Central Intelligence Agency. The world factbook. https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html. Published 2017. Accessed April 30, 2017.
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    Research Letter
    November 7, 2018

    African Clinicians’ Prioritization of Needs in International Breast Cancer Partnerships

    Author Affiliations
    • 1International Center for the Study of Breast Cancer Subtypes, formerly of Henry Ford Cancer Institute, Henry Ford Health System, Detroit, Michigan, now at Weill Cornell Medicine-New York Presbyterian Hospital Network, New York
    • 2Department of Surgery, Henry Ford Health System, Detroit, Michigan
    • 3Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana
    • 4Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
    • 5Now with Department of Surgery, Weill Cornell Medicine-New York Presbyterian Hospital Network, New York
    JAMA Surg. 2019;154(2):182-184. doi:10.1001/jamasurg.2018.4208

    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.

    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.2-4 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.

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    Article Information

    Corresponding Author: Lisa A. Newman, MD, MPH, International Center for the Study of Breast Cancer Subtypes, Department of Surgery, Weill Cornell Medicine–New York Presbyterian Hospital Network, 525 E 68th St, New York, NY 10065 (lan4002@med.cornell.edu).

    Published Online: November 7, 2018. doi:10.1001/jamasurg.2018.4208

    Author Contributions: Dr Newman had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: Gyan, Kyei, Newman.

    Acquisition, analysis, or interpretation of data: Susick, Chen, Davis, Salem, Newman.

    Drafting of the manuscript: Gyan, Chen, Davis, Newman.

    Critical revision of the manuscript for important intellectual content: Gyan, Kyei, Susick, Davis, Salem, Newman.

    Statistical analysis: Chen, Davis, Newman.

    Obtained funding: Gyan, Newman.

    Administrative, technical, or material support: Gyan, Kyei, Susick, Davis, Salem, Newman.

    Supervision: Gyan, Davis, Newman.

    Conflict of Interest Disclosures: None reported.

    Funding/Support: This work was supported by the Department of Surgery and the Henry Ford Cancer Institute, Henry Ford Health System and a Komen Scholars leadership grant from the Susan G. Komen Breast Cancer Foundation (Dr Newman).

    Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

    References
    1.
    Brinton  LA, Figueroa  JD, Awuah  B,  et al.  Breast cancer in Sub-Saharan Africa: opportunities for prevention.  Breast Cancer Res Treat. 2014;144(3):467-478. doi:10.1007/s10549-014-2868-zPubMedGoogle ScholarCrossref
    2.
    DeSantis  CE, Bray  F, Ferlay  J, Lortet-Tieulent  J, Anderson  BO, Jemal  A.  International variation in female breast cancer incidence and mortality rates.  Cancer Epidemiol Biomarkers Prev. 2015;24(10):1495-1506. doi:10.1158/1055-9965.EPI-15-0535PubMedGoogle ScholarCrossref
    3.
    Azubuike  SO, Muirhead  C, Hayes  L, McNally  R.  Rising global burden of breast cancer: the case of sub-Saharan Africa (with emphasis on Nigeria) and implications for regional development: a review.  World J Surg Oncol. 2018;16(1):63. doi:10.1186/s12957-018-1345-2PubMedGoogle ScholarCrossref
    4.
    Fitzmaurice  C, Akinyemiju  TF, Al Lami  FH,  et al; Global Burden of Disease Cancer Collaboration.  Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 29 cancer groups, 1990 to 2016: a systematic analysis for the Global Burden of Disease study  [published online June 2, 2018].  JAMA Oncol. 2018. doi:10.1001/jamaoncol.2018.2706PubMedGoogle Scholar
    5.
    Jiagge  E, Oppong  JK, Bensenhaver  J,  et al.  Breast cancer and African ancestry: lessons learned at the 10-year anniversary of the Ghana-Michigan Research Partnership and International Breast Registry.  J Glob Oncol. 2016;2(5):302-310. doi:10.1200/JGO.2015.002881PubMedGoogle ScholarCrossref
    6.
    US Central Intelligence Agency. The world factbook. https://www.cia.gov/library/publications/the-world-factbook/rankorder/2102rank.html. Published 2017. Accessed April 30, 2017.
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