AN EVALUATION OF THE MANAGEMENT OF BREAST CANCER AT UNIVERSITY TEACHING HOSPITAL
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ABSTRACT
The incidence and mortality from breast cancer in Nigeria is on the increase. The health care system in Nigeria is overburdened by the task of providing proper treatment and care to breast cancer patients. Preventative strategies in the fight against breast cancer have not been fully adopted. Anti-cancer drugs are not readily available and are expensive. This retrospective study was designed to evaluate the therapeutic protocol used in the management of breast cancer in a Nigerian Teaching Hospital, and also to investigate factors influencing the management of breast cancer, with a view of improving the care of patients with the disease. The clinical records of all cancer patients seen over a one year period (January to December, 2008) were reviewed. The study sample consisted of all breast cancer patients who had received therapy for a minimum of 6 months (total of 67 patients). Relative occurrence of breast cancer vis-à-vis other cancer types was 29%, closely followed by cervical cancer (27%). Mean age of diagnosis was 47.82 years. There were 66 females and 1male. Fifty-three of the 67 patients (79%) were married; and almost unemployed. Prevalence by tribe, state of origin and geopolitical zone showed that breast cancer was ubiquitous. Previous family history of breast cancer was reported in 24% of the patients. About 68% of the patients had a previous lump and or cancer. Fifty-two per cent of the female patients were premenopausal and 56% were multiparous (para 4 and above). Thirty three percent used oral contraceptives. History of alcohol intake was recorded in 23% of the patients. Presence of a lump (93%) was the most common symptom and the cancer was mostly in the right breast (50.7%). Invasive ductal carcinoma was the most 8 frequently diagnosed type of breast cancer (76%). Individual pharmacy records were not available for all the patients. Majority of the patients were placed on Cyclophosphamide/Adriamycin/Fluorouracil regimen (43%). Few patients received a taxane-based regimen which is a more targeted therapy for breast cancer. Fifty per cent of the patients had radiotherapy. Hormonal therapy used in 75% of the patient was tamoxifen. Oncologists favored the use of newer hormonal drugs like anstrazole and exemestane. There were lots of discrepancies on which healthcare professional was responsible for providing services in a given information area. Surgeons and oncologists perceived themselves as being responsible for providing services in most of the information areas outlined. Roles of pharmacists in the management of breast cancer were not recognized by other health care professionals. In conclusion, there is the urgent need for the therapeutic protocol used in the management of breast cancer in the hospital be updated, standardized and harmonized, especially between the surgeons and the oncologists. Though the hospital protocol was in line with the Nigerian guidelines there is still need for the Nigerian guidelines be kept up to date with the recent advances in breast cancer chemotherapy, as outlined in the National Comprehensive Cancer Network clinical practice guidelines for breast cancer so as to improve the quality of care offered to patients, thus improving their relative survival rate.
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