Search

Introduction In the South African Breast Cancer and HIV Outcomes (SABCHO) study, we previously found that breast cancer patients living with HIV and treated with neoadjuvant chemotherapy achieve lower rates of complete pathologic response than patients without HIV. We now assess the impact of comorbid HIV on receipt of timely and complete neoadjuvant and adjuvant chemotherapy. Materials and Methods Since June 2015, the SABCHO study has collected data on women diagnosed with breast cancer at 6 South African hospitals. We selected a sample of participants with stages I-III cancer who received ≥2 doses of neoadjuvant or adjuvant chemotherapy. Data on chemotherapies prescribed and received, filgrastim receipt, and laboratory values measured during treatment were captured from patients' medical records. We calculated the mean relative dose intensity (RDI) for all prescribed chemotherapies. We tested for association between full regimen RDI and HIV status, using linear regression to control for demographic and clinical covariates, and for association of HIV with laboratory abnormalities. Results The 166 participants living with HIV and 159 without HIV did not differ in median chemotherapy RDI: 0.89 (interquartile range (IQR) 0.77-0.95) among those living with HIV and 0.87 (IQR 0.77-0.94) among women without HIV. Patients living with HIV experienced more grade 3+ anemia and leukopenia than those without HIV (anemia: 10.8% vs. 1.9%, P =.001; leukopenia: 8.4% vs. 1.9%, P =.008) and were more likely to receive filgrastim (24.7% vs. 10.7%, P =.001). Conclusions HIV status did not impact neoadjuvant or adjuvant chemotherapy RDI, although patients with breast cancer living with HIV experienced more myelotoxicity during treatment. [ABSTRACT FROM AUTHOR]

There is a rising noncommunicable disease (NCD) burden in low- and middle-income countries. Sub-Saharan Africa (SSA) bears a higher burden than the global average with South Africa (SA) enduring the highest regional burden. SA among other southern African countries also bears a high prevalence of HIV and other chronic communicable diseases. Having a perspective on common chronic diseases in the ever-increasing numbers of adult cancer patients in SA will inform our understanding of approaches to better manage them. This commentary reviews regional and national studies and data of low- and middle-income countries and particularly SA on the chronic infectious and NCD multimorbidity burden among adult cancer patients. It also reflects on the considerable health system challenges of managing discordant multimorbidity among adult cancer patients within the SA Public Health System. Despite the critical need to better manage the growing MM burden in general and particularly the high prevalence of discordant multimorbidity among cancer patients, there is a dearth of research into MM management generally and in LMICs particularly. [ABSTRACT FROM AUTHOR]

Background In high-income settings, delays from breast cancer (BC) diagnosis to initial treatment worsen overall survival (OS). We examined how time to BC treatment initiation (TTI) impacts OS in South Africa (SA). Methods We evaluated women enrolled in the South African BC and HIV Outcomes study between July 1, 2015 and June 30, 2019, selecting women with stages I-III BC who received surgery and chemotherapy. We constructed a linear regression model estimating the impact of sociodemographic and clinical factors on TTI and separate multivariable Cox proportional hazard models by first treatment (surgery and neoadjuvant chemotherapy (NAC)) assessing the effect of TTI (in 30-day increments) on OS. Results Of 1260 women, 45.6% had upfront surgery, 54.4% had NAC, and 19.5% initiated treatment >90 days after BC diagnosis. Compared to the surgery group, more women in the NAC group had stage III BC (34.8% vs 81.5%). Living further away from a hospital and having hormone receptor positive (vs negative) BC was associated with longer TTI (8 additional days per 100 km, P =. 003 and 8 additional days, P =. 01, respectively), while Ki67 proliferation index >20 and upfront surgery (vs NAC) was associated with shorter TTI (12 and 9 days earlier; P =. 0001 and.007, respectively). Treatment initiation also differed among treating hospitals (P <. 0001). Additional 30-day treatment delays were associated with worse survival in the surgery group (HR 1.11 [95%CI 1.003-1.22]), but not in the NAC group. Conclusions Delays in BC treatment initiation are common in SA public hospitals and are associated with worse survival among women treated with upfront surgery. [ABSTRACT FROM AUTHOR]

Background: Despite advances in availability and access to antiretroviral therapy (ART), HIV still ranks as a major cause of global mortality. Hence, the aim of this study was to develop and internally validate a risk score capable of accurately predicting in‐hospital mortality in HIV‐positive patients requiring hospital admission. Methods: Consecutive HIV‐positive patients presenting to the Charlotte Maxeke Johannesburg Academic Hospital adult emergency department between 7 July 2017 and 18 October 2018 were prospectively enrolled. Multivariate logistic regression was used to determine parameters for inclusion in the final risk score. Discrimination and calibration were assessed by means of the area under the receiver operating curve (AUROC) and the Hosmer–Lemeshow goodness‐of‐fit test, respectively. Internal validation was conducted using the regular bootstrap technique. Results: The overall in‐hospital mortality rate was 13.6% (n = 166). Eight predictors were included in the final risk score: ART non‐adherence or not yet on ART, Glasgow Coma Scale < 15, respiratory rate > 20 breaths/min, oxygen saturation < 90%, white cell count < 4 × 109/L, creatinine > 120 μmol/L, lactate > 2 mmol/L and albumin < 35 g/L. After internal validation, the risk score maintained good discrimination [AUROC 0.83, 95% confidence interval (CI): 0.78–0.88] and calibration (Hosmer–Lemeshow χ2 = 2.26, p = 0.895). Conclusion: The HIV In‐hospital Mortality Prediction (HIV‐IMP) risk score has overall good discrimination and calibration and is relatively easy to use. Further studies should be aimed at externally validating the score in varying clinical settings. [ABSTRACT FROM AUTHOR]

The presence of preexisting morbidities poses a challenge to cancer patient care. There is little information on the profile and prevalence of multi‐morbidities in breast cancer patients across middle income countries (MIC) to lower income countries (LIC) in sub‐Saharan Africa (SSA). The African Breast Cancer–Disparities in Outcomes (ABC‐DO) breast cancer cohort spans upper MICs South Africa and Namibia, lower MICs Zambia and Nigeria and LIC Uganda. At cancer diagnosis, seven morbidities were assessed: obesity, hypertension, diabetes, asthma/chronic obstructive pulmonary disease, heart disease, tuberculosis and HIV. Logistic regression models were used to assess determinants of morbidities and the influence of morbidities on advanced stage (stage III/IV) breast cancer diagnosis. Among 2189 women, morbidity prevalence was the highest for obesity (35%, country‐specific range 15‐57%), hypertension (32%, 15‐51%) and HIV (16%, 2‐26%) then for diabetes (7%, 4%‐10%), asthma (4%, 2%‐10%), tuberculosis (4%, 0%‐8%) and heart disease (3%, 1%‐7%). Obesity and hypertension were more common in upper MICs and in higher socioeconomic groups. Overall, 27% of women had at least two preexisting morbidities. Older women were more likely to have obesity (odds ratio: 1.09 per 10 years, 95% CI 1.01‐1.18), hypertension (1.98, 1.81‐2.17), diabetes (1.51, 1.32‐1.74) and heart disease (1.69, 1.37‐2.09) and were less likely to be HIV positive (0.64, 0.58‐0.71). Multi‐morbidity was not associated with stage at diagnosis, with the exception of earlier stage in obese and hypertensive women. Breast cancer patients in higher income countries and higher social groups in SSA face the additional burden of preexisting non‐communicable diseases, particularly obesity and hypertension, exacerbated by HIV in Southern/Eastern Africa. What's new? Patients who get cancer on top of other health conditions can be challenging to treat. Here, the authors analyze the prevalence of chronic conditions in women newly diagnosed with breast cancer in sub‐Saharan Africa. They looked at obesity, hypertension, diabetes, asthma/COPD, heart disease, tuberculosis, and HIV. Overall, 27% of the women had 2 pre‐existing conditions. Obesity boosts breast cancer risk, and obesity rates are rising among higher income groups. HIV is a problem in the southern African populations, and while HIV is not thought to contribute to breast cancer, reports suggest that HIV‐positive patients have poorer prognosis. [ABSTRACT FROM AUTHOR]

Multimorbidity in women with breast cancer may delay presentation, affect treatment decisions and outcomes. We described the multimorbidity profile of women with breast cancer, its determinants, associations with stage at diagnosis and treatments received. We collected self‐reported data on five chronic conditions (hypertension, diabetes, cerebrovascular diseases, asthma/chronic obstructive pulmonary disease, tuberculosis), determined obesity using body mass index (BMI) and tested HIV status, in women newly diagnosed with breast cancer between January 2016 and April 2018 in five public hospitals in South Africa. We identified determinants of ≥2 of the seven above‐mentioned conditions (defined as multimorbidity), multimorbidity itself with stage at diagnosis (advanced [III–IV] vs. early [0–II]) and multimorbidity with treatment modalities received. Among 2,281 women, 1,001 (44%) presented with multimorbidity. Obesity (52.8%), hypertension (41.3%), HIV (22.0%) and diabetes (13.7%) were the chronic conditions that occurred most frequently. Multimorbidity was more common with older age (OR = 1.02; 95% CI 1.01–1.03) and higher household socioeconomic status (HSES) (OR = 1.06; 95% CI 1.00–1.13). Multimorbidity was not associated with advanced‐stage breast cancer at diagnosis, but for self‐reported hypertension there was less likelihood of being diagnosed with advanced‐stage disease in the adjusted model (OR 0.80; 95% CI 0.64–0.98). Multimorbidity was associated with first treatment received in those with early‐stage disease, p = 0.003. The prevalence of multimorbidity is high among patients with breast cancer. Our findings suggest that multimorbidity had a significant impact on treatment received in those with early‐stage disease. There is need to understand the impact of multimorbidity on breast cancer outcomes. What's new? Multimorbidity in women with breast cancer increases with age and may influence treatment decisions and outcome. The authors find that in South Africa 44%, of women newly diagnosed with breast cancer also suffered from other chronic conditions, most prevalently obesity, hypertension, HIV and diabetes. Asian and white women were less likely to present with multimorbidity when compared to black women, but multimorbidity was more common in women with higher socioeconomic status. The authors propose to evaluate the effect of multimorbidity on the South African health system and its impact on scarce health care resources. [ABSTRACT FROM AUTHOR]

PURPOSE: The quality of breast cancer care in sub-Saharan Africa contributes to the region's dismal breast cancer mortality. ASCO has issued quality measures focusing on delivery of adjuvant chemotherapy, radiotherapy, and endocrine therapy. We applied these measures in five South African public hospitals and analyzed factors associated with care concordance. MATERIALS AND METHODS: Among 1,736 women with breast cancer who were enrolled in the South African Breast Cancer and HIV Outcomes study over 24 months, we evaluated care using ASCO's three measures. We also evaluated adjuvant chemotherapy receipt in 957 women with an indication. We used logistic regression to estimate associations between measure-concordant care and patient factors. RESULTS: Of 235 women with hormone receptor–negative cancer, 173 (74%) began adjuvant chemotherapy within 120 days from diagnosis. Of 194 patients who received breast-conserving surgery, 73 (37%) began radiotherapy within 365 days from diagnosis. Of 999 women with hormone receptor–positive cancer, 719 (72%) initiated endocrine therapy within 365 days from diagnosis. Chemotherapy and radiotherapy measure-concordant care were more common among women residing < 20 km from the hospital (odds ratio [OR], 1.79; 95% CI, 1.32 to 2.44 and OR, 3.17; 95% CI, 1.57 to 6.42). Endocrine therapy measure-concordant care was more common among English-speaking women (OR, 2.12; 95% CI, 1.12 to 4.02). Participating hospitals varied in care concordance. HIV infection did not affect care quality. CONCLUSION: More timely delivery of chemotherapy, radiotherapy, and endocrine therapy is needed in South Africa, particularly for women living > 20 km from the hospital or not speaking English. Focused quality improvement efforts could support that goal. [ABSTRACT FROM AUTHOR]