Geospatial availability of breast cancer treatment modalities and hypothetical access improvement in Ghana: A nationwide survey

Breast cancer in Ghana is a growing public health problem with increasing incidence and poor outcomes. Lack of access to comprehensive treatment in Ghana may be a contributing factor to its high mortality. The purpose of this study was to evaluate the availability of treatments nationwide and system...

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Bibliographic Details
Published in:	PloS one Vol. 18; no. 9; p. e0291454
Main Authors:	Schoenhals, Sarah, Mali, Meghan E, Sutherland, Edward K, Sorenson, Justin, Dedey, Florence, Nellermoe, Jonathan, Flores-Huidobro Martinez, Angel, Tounkara, Mamadou D, Price, Raymond R, Brownson, Kirstyn E
Format:	Journal Article
Language:	English
Published:	San Francisco Public Library of Science 15-09-2023 Public Library of Science (PLoS)
Subjects:	Analysis Aromatase Availability Biopsy Breast cancer Cancer Cancer therapies Care and treatment Cervical cancer Chemotherapy Diagnosis Drug therapy Endocrine therapy ErbB-2 protein Geospatial data Ghana Health aspects Health facilities Health services Hospitals Lumpectomy Lymph nodes Lymphatic system Mammaplasty Mastectomy Medicine and Health Sciences Mortality Patients People and Places Personnel Public health Radiation Reconstructive surgery Spatial analysis Surveys Tamoxifen Teaching hospitals Ghana United States > US
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Summary:	Breast cancer in Ghana is a growing public health problem with increasing incidence and poor outcomes. Lack of access to comprehensive treatment in Ghana may be a contributing factor to its high mortality. The purpose of this study was to evaluate the availability of treatments nationwide and systematically identify high yield areas for targeted expansion. We conducted a cross-sectional, nationwide hospital-based survey from November 2020-October 2021. Surveys were conducted in person with trained research assistants and described hospital availability of all breast cancer treatments and personnel. All individual treatment services were reported, and hospitals were further stratified into levels of multi-modal treatment modeled after the National Comprehensive Cancer Network (NCCN) Framework treatment recommendations for low-resource settings. Level 3 included Tamoxifen and surgery (mastectomy with axillary lymph node sampling); Level 2 included Level 3 plus radiation, aromatase inhibitors, lumpectomy, and sentinel lymph node biopsy; Level 1 included Level 2 plus Her2 therapy and breast reconstruction. Hospitals were identified that could expand to these service levels based on existing services, location and personnel. The distance of the total population from treatment services before and after hypothetical expansion was determined with a geospatial analysis. Of the 328 participating hospitals (95% response rate), 9 hospitals had Level 3 care, 0 had Level 2, and 2 had Level 1. Twelve hospitals could expand to Level 3, 1 could expand to Level 2, and 1 could expand to Level 1. With expansion, the population percentage within 75km of Level 1, 2 and 3 care would increase from 42% to 50%, 0 to 6% and 44% to 67%, respectively. Multi-modal breast cancer treatment is available in Ghana, but it is not accessible to most of the population. Leveraging the knowledge of current resources and population proximity provides an opportunity to identify high-yield areas for targeted expansion.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Competing Interests: The authors have declared that no competing interests exist.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0291454