Sociodemographic and treatment-related correlates of fatigue in breast cancer survivors at an oncology clinic in Nigeria.

Background: Breast cancer survivors (BCS) still experience fatigue that may impair their quality of life even after completion of treatment. There is a need to understand the sociodemographic and treatment-related factors associated with this to develop relevant and effective interventions. Aim: To assess the relationship between cancer-related fatigue and sociodemographic and treatment-related factors in BCS. Materials and methods: This is a cross-sectional study involving 80 BCS attending the radiation oncology University College Hospital Ibadan. Their sociodemographic, disease and treatment characteristics were obtained. Fatigue Symptom Inventory was used to assess fatigue. A score of at least 3 on average fatigue severity item was taken as cut-off for clinically meaningful fatigue. Result: The mean age of patients was 51.5 years. The prevalence of fatigue was 22.5%. On univariate analysis, fatigue was significantly associated with younger age (p = 0.022), employment (p = 0.006), stage of the disease(p = 0.014), anthracycline-based chemotherapy (p = 0.026), last chemotherapy less than 1 year (p = 0.001). Using logistic regression analysis, stage (Odds ratio (OR) 5.115, 95% CI 1.029-25.438, p = 0.046), employment status (OR 52.224, 95% CI 3.611-755.899, p = 0.004) and year of last cycle chemotherapy (OR 6.375, 95% CI 1.108-36.680, p = 0.038) were associated with fatigue in BCS. Conclusion: About a quarter of BCS reported fatigue. Advance stage disease, employment status and receiving last course of chemotherapy less than a year are correlates of fatigue.

Sexual characteristics of patients with prostate cancer seen for radiation treatment.

Background: Prostate cancer was estimated to be the second most diagnosed cancer and the fifth leading cause of cancer mortality among men, with an estimated 1.4 million new cases and 375,000 deaths globally in 2020. There are significant changes in sexual activities and subsequent changes in quality of life associated with the diagnosis and treatment of prostate cancer. Sexual problems experienced by prostate cancer patients include erectile dysfunction, reduced sexual desire, reduced sexual function, problems with ejaculation, as well as problems with orgasm, and these could occur before and/or after treatment. This study aims to highlight the sexual characteristics of prostate cancer patients, which would help identify altered sexuality that might require intervention by healthcare providers. Method: All patients who presented with pathologically diagnosed, organ-confined prostate cancer referred for high-dose-rate brachytherapy were approached for participation in the study. An interviewer-administered questionnaire was administered to the consenting patients. Results: A total of 56 patients gave consent for the study out of 60. All the patients were married, with 5 (8.9%) having multiple wives. Only ten respondents (17.9%) reported having other sexual partners besides their wives. More than half of the patients (34) (60.7%) started having sexual intercourse between the ages of 18 and 20. Many patients claimed that the diagnosis of prostate cancer had affected their sexual lives. About half of the respondents (44.6%) believed that their partners were less satisfied with their sexual performance, as evidenced by the loss of partners (5.4%), partners refusing sexual advances (14.3%), partners complaints (10.7%), and partners' reduced inclination to ask for sex (33.9%). One patient expressed fears of passing the disease to their partners. Conclusion: The management of prostate cancer should include sex therapy and rehabilitation in couples from the point of diagnosis to maintain sexual function as close as possible to that in the general population in order to maintain an improved quality of life.

Examining Cancer Patients' Perceptions of the Impact of COVID-19 on Teleoncology: Findings From 15 Nigerian Outpatient Cancer Clinics.

PURPOSE: To examine cancer patients' perspectives on the impact of COVID-19 on teleoncology in Nigeria. METHODS: Data from a multicenter survey conducted at 15 outpatient clinics to 1,097 patients with cancer from April and July 2020 were analyzed. The study outcome was telemedicine, defined as patients who reported their routine follow-up visits were converted to virtual visits because of COVID-19 (coded yes/no). Covariates included patient age, ethnicity, marital status, income, cancer treatment, service disruption, and cancer diagnosis/type. Stata/SE.v.17 (StataCorp, College Station, TX) was used to perform chi-square and logistic regression analyses. P values ≤ .05 were considered statistically significant. RESULTS: The majority of the 1,097 patients with cancer were female (65.7%) and age 55 years and older (35.0%). Because of COVID-19, 12.6% of patients' routine follow-ups were converted to virtual visits. More patients who canceled/postponed surgery (17.7% v 7.5%; P ≤ .001), radiotherapy (16.9% v 5.3%; P ≤ .001), and chemotherapy (22.8% v 8.5%; P ≤ .001), injection chemotherapy (20.6% v 8.7%; P ≤ .001) and those who reported being seen less by their doctor/nurse (60.3% v 11.4%; P ≤ .001) reported more follow-up conversions to virtual visits. In multivariate analyses, patients seen less by their doctors/nurses were 14.3 times more likely to have their routine follow-ups converted to virtual visits than those who did not (odds ratio, 14.33; 95% CI, 8.36 to 24.58). CONCLUSION: COVID-19 caused many patients with cancer in Nigeria to convert visits to a virtual format. These conversions were more common in patients whose surgery, radiotherapy, chemotherapy, and injection chemotherapy treatments were canceled or postponed. Our findings suggest how COVID-19 affects cancer treatment services and the importance of collecting teleoncological care data in Nigeria.

Totally implantable venous access ports and associated complications in sub-Saharan Africa: a single-centre retrospective analysis.

Purpose: Although totally implantable venous access ports (TIVAPs) have been safe and valuable in the management of cancer and other chronically ill patients who require long-term intermittent venous access, a few complications have been reported with their use. Data on the use of TIVAPs in sub-Saharan Africa and other low- and middle-income regions is limited. In this study, we determine the complications that arise from TIVAP use at a cancer centre in Nigeria. Patients and Methods: Between 4 January 2018 and 15 September 2020, 100 patients received TIVAPs at our centre, primarily for the administration of chemotherapy for the treatment of solid tumours. Data were retrospectively extracted from the institutional electronic medical records and descriptive analysis of patient and disease characteristics, port-specific data and data on complications and outcomes was conducted. Results: The 100 patients who were implanted with TIVAPs at our cancer centre had their devices in situ for a total of 27,183 days, with a mean duration of use of 272 catheter-days (SD: 267 days; range: 2-952). TIVAP-related complications were identified in 13 patients (13%), i.e., an incidence of 0.478 complications/1,000 catheter-days. The mean time to onset of complications was 61 days (SD: 105 days; median: 23 days; range: 0-389). The complications observed include port-site bleeding, pocket infection, cutaneous site infection, arterial puncture, wound dehiscence, difficult access (due to port malpositioning and port site fibrosis) and others. No deaths, pneumothorax, haemothorax, catheter occlusions, or catheter-associated venous thromboses were recorded. Conclusion: Our study shows that TIVAPs can be used successfully in our environment and presents a case for more widespread use to improve both the patient experience and the ability of healthcare providers to deliver optimal treatment.

Patient's Perspective on the Impact of COVID-19 on Cancer Treatment in Nigeria.

PURPOSE: Because of the global COVID-19 pandemic, health care organizations introduced guidelines for modifications to health and cancer medical care delivery to mitigate transmission and ensure quality health outcomes. To examine the extent and impact of these modifications on oncology service disruptions in Nigeria, we surveyed oncology patients across selected public and private cancer treatment centers. MATERIALS AND METHODS: Participating in the study were 15 tertiary cancer treatment centers across 12 Nigerian states. We recruited adult patients with cancer (18+ years) on active treatment to complete a self-administered survey on cancer care during COVID-19. We conducted descriptive and multivariate data analysis using Stata 16.1. RESULTS: Respondents were (n = 1,072), female (65.7%), ages 18-49 years (50.3%), and married (80.7%). The top two cancers were breast and prostate. Overall, 17.3% of respondents reported disruptions to cancer care, and more than half (51.0%) reported difficulties accessing care. Changes in chemotherapy regimens or route of administration were reported in 8.4% of respondents. Odds for any disruption were highest for older patients, western states, patients with prostate cancer, and patients with two or more flu symptoms. Odds for radiotherapy cancellation were highest for older patients, those with prostate cancer, and those with medium service perception. CONCLUSION: This study investigated COVID-19-influenced cancer treatment disruptions in Nigeria. Patients with cancer experienced significant disruptions to cancer care. Vulnerable patients are most likely to be negatively affected. Policies and strategies aimed at minimizing service disruptions while maintaining cancer patients' safety should be a priority for all health care institutions in the COVID-19 era.

Chemotherapy-Induced Electrolyte Disorder and Nephrotoxicity in Cancer Patients from Selected Nigerian Tertiary Health Care Hospitals.

Background: Chemotherapy is an important treatment modality widely employed for cancer management. The study investigated nephrotoxicity and electrolytes disorders induced by chemotherapy in the cancer patients undergoing chemotherapy in selected Nigerian Tertiary Health care. Methodology: The participants of the study comprised 130 cancer patients aged 18- 70 years, purposively recruited from three medical centers in south-west Nigeria. Participants' socio-demographics and chemotherapy administered were obtained using questionnaire. Three milliliters of blood sample was collected intravenously from the participants before and after the last course of chemotherapy and centrifuged at 3000rpm for 10 minutes to obtain serum. The levels of electrolytes, creatinine, and urea in the serum samples were determined spectrophotometrically by automated Roche Hitachi 912 Chemistry Auto-Analyzer. The estimated glomeruli filtration rate (eGFR) was calculated using creatinine based Ukidney online eGFR-calculator while nephrotoxicity was determined according to U.S National Cancer Institute Common Terminology Criteria for Adverse events version 4.0. Collected data were expressed as mean ±standard error of the mean using IBM- SPSS version 22.0software. T- test were employed to test for significance at P< 0.05. Results: Findings from the study revealed significant decrease in the pre-chemotherapy sodium, potassium, chloride ion levels and eGFR as compared to that of post chemotherapy. Also, a significant increase in the pre-chemotherapy creatinine and urea levels as compared to that of post chemotherapy was observed. Conclusion: Overall, the significant reduction in the electrolyte profiles and estimated eGFR alongside with the significant increase in the mean creatinine and urea profiles recorded after chemotherapy administration confirmed chemotherapy-induced electrolytes disorders and renal toxicity in the cancer participants.

Contextualizing the Cultural Factors Associated With Cancer Care in Nigeria: An Ethnonursing Study.

Introduction: Culture and care are two important phenomena of particular concern to transcultural nursing. Cancer care is generally affected by certain cultural factors that influence how cancer patients experience diseases and seek and utilize care services. This study aimed to explore the cultural factors that affect cancer care in a Nigerian cancer care institution. Method: This study adopted an ethnonursing method involving participant observation and individual interviews. The study was conducted in the oncology unit of University College Hospital, Nigeria. Seven nurses and six patients were key participants, while four physicians, three ward assistants, and six patients' relatives constituted the general participants. Result: Two themes and five patterns were identified. Participants described how the interplay of several cultural factors influenced or inhibited cancer care. Findings revealed significant influence of kinship, family, and social structure as well as the roles played by cultural beliefs, values, and practices in cancer care in Nigeria. Discussion: Cultural factors need to be considered broadly for the efforts toward prevention, early diagnosis, and treatment of cancer to be effective in Nigeria.

Pre-Treatment Knowledge and Side-Effects Experienced during Chemotherapy for Breast Cancer in a Nigerian Tertiary Hospital.

Background: Chemotherapy is an important component of treatment for breast cancer as it improves tumour control, overall survival or disease-free survival but is associated with side effects that could affect patients' quality of life. Patients' understanding and expectation of these side effects can improve their coping abilities. Exploring these understanding and expectations before chemotherapy can reduce the burden of chemotherapy side effects and improve compliance to treatment by increasing their physical and psychological preparedness. The study aimed to assess how the knowledge of expected side effects of chemotherapy affected the level of coping with the side effects of chemotherapy. Methodology: This study was carried out at the Radiation Oncology and the Surgical Oncology clinics of the University College hospital Ibadan Nigeria. Patients with breast cancer were randomly selected to participate in the study. Before commencement of 1st-course chemotherapy data on sociodemographic variables, clinical characteristics and patients' knowledge about chemotherapy side effects was collected using a set of questionnaires. While presenting for the second course, patients were asked if they encountered side effects and how long it took them to recover from the side effects. The data collected was analysed using the Statistical Package for the Social Sciences (SPSS) software version 21. Result: A total of 110 women participated in the study. Most of the patients (85%) knew chemotherapy side effects (SE).Most of the respondents, (73.5%), received their information on the side effects of chemotherapy from doctors, followed by nurses (40.9%), internet (32.7%), peers (32.7%) and family members (12.7%). Currently employed and younger patients tended to have more knowledge concerning chemotherapy SE (p = 0.018). Patients who knew SE before treatment recovered faster than those who did not (p=0.01). Conclusion: Majority of the patients were aware of the side effects of chemotherapy. Having knowledge about side effects was associated with faster recovery. Pre-Chemotherapy counselling should be done routinely for patients starting on chemotherapy.

The role of radiation treatment in the management of inflammatory musculoskeletal conditions: a revisit.

Inflammatory musculoskeletal conditions are a common group of diseases among the elderly, worldwide. They are characterized by articular degenerative changes accompanied with often debilitating pain. Treatments often involve life-long analgesic therapy or joint replacement in extreme cases. The aim of this current review is to look at the role of radiation treatment with the hope of further study into the effectiveness of radiation treatment in reducing pain, eliminate or reduce the need for life-long analgesic therapy and thereby avoiding the analgesics' side effects. Extensive literature search was done on PubMed and other available data base and the findings are presented and discussed. Literature showed that many countries in Europe, especially Germany use radiation routinely for the treatment of many degenerative disorders including osteoarthritis with good results and few side effects. A pilot study is therefore recommended with a view to establish the effectiveness or otherwise of this treatment method in patients.

The Troubled Nurse: A Qualitative Study of Psychoemotional Effects of Cancer Care on Nurses in A Nigerian Cancer Care Setting.

OBJECTIVE: Nurses who care for cancer patients are exposed to varying degrees of psychological pressure. These psychological issues among nurses are thought to have some consequences relating to professional satisfaction, quality of care, and patient outcome. This study aimed to explore the psychological and emotional impact of caring for persons among cancer care nurses. METHODS: A qualitative, descriptive approach was employed, and a purposive sampling technique was used to select seven nurses who were interviewed one-on-one. Interview data were coded and analyzed using NVivo 12 to generate the final themes and patterns. The EQUATOR's COREQ guideline for qualitative studies was adhered to. RESULTS: Data analysis yielded two major themes and four sub-themes. Participants expressed concerns about their frequent encounter with dying patients on the ward which affects their own mental well-being as persons. Sometimes, the health-care professionals used emotional distance to mitigate the emotional and psychological effects of the frequent deaths encountered on the ward. Professional dissatisfaction was also brought about by the increased amount of patients who died on the ward, the gloomy nature of the care environment, and the feeling of incapacitation to help. CONCLUSIONS: The findings indicate that nurses who care for cancer patients need to be supported to enhance their psychological and emotional well-being. The findings of this study could help nurse managers to understand the level of psychological pressure cancer care impose on nurses and the importance of improving the mental health of nurses in cancer care.

Study of the relationships between brachytherapy plan parameters in an attempt to verify total dwell time in vaginal cylinder applications.

PURPOSE: Source strength (Sk ), sizes of vaginal cylinder applicators (VCA), number of dwell positions (DPs), and the prescribed dose (D) are basic parameters in brachytherapy (BT) treatment planning contributing to total dwell time (TDT). This study was aimed at assessing the relationships between the specified variables in an attempt to verify the TDT in high-dose-rate (HDR) vaginal cylinder applications. METHODS: One hundred and twenty-one patients treated with Gynesource-Co60 (Bebig, Germany) using VCAs of diameters 20, 25, and 30 mm at University College Hospital, Nigeria, were enrolled in this study. Brachytherapy doses ranging from 3 to 7 Gy were always prescribed to points 5 mm away from the cylinder's surface. Treatment planning was undertaken on HDR-Basic treatment planning system (TPS) which utilizes source step size of 5 mm. Data on the stated parameters related to the first BT fractions of the patients were acquired. With the aid of EViews statistical software, two forms of mathematical models were thereafter developed. The resulting TDTs from the models were compared with the TPS values using Minitab statistical software. RESULTS: The relationships obtained for the increasing sizes of the VCA were TDT1(min)=2.22+3.17DSk;TDT1(min)=3.52+3.74DSk;TDT1(min)=-1.96+6.91DSkandTDT2(min)=0.50-0.03Sk+0.02D+0.55DPs;TDT2(min)=7.08-0.06Sk+0.02D+0.67DPs;TDT2(min)=7.02-0.11Sk+0.03D+1.25DPs The model-based TDTs correlate with the TPS-calculated values with r1 = 0.80 (P = 0.412) and r2 = 0.97 (P = 0.468). CONCLUSIONS: The findings of this study could suggest likely variations in the treatment time when certain changes occur in the related parameters. The increasing size of the vaginal cylinder has a positive influence on the brachytherapy treatment time. The latter model has been a useful tool in the verification of the dose delivery time at the first HDR brachytherapy center in Nigeria and West Africa.

Role of Private Enterprise in Cancer Control in Low to Middle Income Countries.

Background. About 65% of cancer deaths globally occur in low to middle income countries (LMICs) where prioritization and allocation of resources to cancer care are often quite poor. In the absence of governmental focus on this problem, public-private partnerships may be an avenue to provide effective cancer control. Methods. This manuscript highlights the establishment of a nongovernmental organization (NGO) to stimulate the development of partnerships between oncology professionals, private enterprise, and academic institutions, both locally and internationally. Examples of capacity building, grant support, establishment of collaborative networks, and the development of a facility to provide clinical care are highlighted. Results. Collaborations were established between oncology professionals at academic institutions in the US and Nigeria. Cancer control workshops were conducted in Nigeria with grant support from the Union for International Cancer Control (UICC). A monthly tumor board conference was established at LASUTH in Lagos, and further capacity building is underway with grant support from the United States NCI. An outpatient, privately funded oncology clinic in Lagos has been launched. Conclusion. In LMICs, effective partnership between public and private institutions can lead to tangible strides in cancer control. The use of creative healthcare financing models can also support positive change.