Members of the University community are hereby invited to an Inter-College Lecture to be delivered by Dr. Florence Dedey from the Department of Surgery, School of Medicine and Dentistry, College of Health Sciences as follows:
Topic: Identifying the Root Cause of Delays in Breast Cancer Treatment in a Teaching Hospital in Ghana.
Date: 18th April, 2019
Time: 4.30 p.m.
Venue: R.S Amegashie Auditorium – University of Ghana Business School
Chairman: Rev. Prof. Patrick F. Ayeh-Kumi (Provost, College of Health Sciences)
All are cordially invited
ABSTRACT
This presentation will discuss the causes of delay in treating patients with breast cancer in the Korle Bu Teaching Hospital (KBTH), and some measures that have been taken to minimise the delays. Breast cancer is the commonest female cancer in the world with increasing incidence in low and middle income countries. In Ghana, relatively younger women are affected with the peak age between 40 – 49 years. Early detection and effective treatment of breast cancer results in good outcomes but majority of patients seen in KBTH present with advanced disease. Furthermore, there are also delays in starting treatment after presentation to hospital. These delays in presentation and treatment are associated with several factors including patient, health worker and health system factors.
A hospital-based retrospective study of 205 breast cancer patients starting definitive treatment at Korle Bu Teaching Hospital between May and December 2013 was conducted to evaluate the duration and factors that influence waiting time from first presentation to start of definitive treatment of breast cancer. The patient, health system, and health worker factors associated with median waiting time were examined. A follow up qualitative study involving four focus group discussions (FGDs) with 20 breast cancer patients were conducted and the transcripts were analysed thematically.
The results show the mean age of the patients was 51.1 ± 11.8 years and median waiting time to start of treatment was 5 weeks. The determinants of waiting time were level of education, age, income, marital status, ethnicity, disease stage, health insurance status, study sites, time interval between when biopsy was requested and when results were received and receipt of adequate information from health workers. The qualitative study provided insights on the multi-level causes of delay in treatment. Patient factors included misinterpretation of symptoms, fear, financial constraints, seeking alternative treatment, and spiritual causal theories of breast cancer. The health care providers’ factors were poor attitudes of health workers and perceived corruption in health service provision. The health systems’ factors were delays in providing pathology results, regular breakdown of machines, and the fragmentation of cancer treatment procedures.
The findings indicate that reducing delays in breast cancer treatment will require multi-level interventions including: health systems strengthening with particular focus on improving health professionals’ attitudes and diagnostic and treatment timelines, shortening time to obtain biopsy reports, psychosocial counselling, education of patients and providers on timely treatment to improve prognosis and public education on breast cancer.
As a follow up to the findings of the studies a multipronged approach to public education has been adopted by the Breast Unit of KBTH. In 2016, the ‘Changing Young Minds’ project was started with its main objective being to educate young girls in the secondary schools about breast cancer. Taking advantage of October being breast cancer awareness month, a massive campaign was launched in Accra and its’ environs in October 2017 and 2018 and more than 5000 women were taught breast self examination and clinically examined each year. Public education on breast cancer was also carried out using various media platforms.
PROFILE
Dr Florence Dedey graduated with BSc (Medical Sciences) and MBChB from the University of Ghana Medical School in 1997 and 2001 respectively. She then had her post graduate training in general surgery with the West African College of Surgeons, obtaining the Fellowship of the College (FWACS) in 2009. She joined the University of Ghana Medical School as a lecturer in 2010 and is currently a senior lecturer with the School of Medicine and Dentistry. She has been working in the Korle Bu Teaching Hospital since 2002 and was appointed a consultant general surgeon in 2009. She was subsequently appointed the Head of the Breast Unit in the Department of Surgery, Korle Bu Teaching Hospital in 2015. She is a very active member of the Breast Multidisciplinary Team in the hospital and is also affiliated to the Palliative Care Team of the hospital.
She has attended several conferences and workshops, and has been a facilitator at some of these, mainly on topics related to Breast Cancer and Palliative Care. Her areas of interest are in breast cancer management, specifically improving outcomes of breast cancer patients in Ghana as well as palliative care in cancer patients. She won an international guest scholarship of the American College of Surgeons in 2016 and visited two hospitals in the United States of America to observe breast cancer management.
She is married with 3 children.
