In Botswana, 70% of cancers reported where staging information is available are diagnosed at advanced stages, severely limiting the impact of treatment and long-term survival. Advanced disease at presentation is multifactorial and hampered by delays in pathology turnaround times and consequent loss to follow-up. In addition, there is a critical need to better support women with advanced breast cancer by understanding and addressing patient fears, from the time of diagnosis throughout the cancer treatment cycle and beyond. At present, a critical gap in treatment compliance exists because patients with advanced breast cancer complete neoadjuvant chemotherapy, however, often decline the necessary surgery.
Established in 1996, the Botswana Harvard AIDS Institute Partnership (BHP) is a collaborative research and training initiative between Botswana’s Ministry of Health and Wellness, and the Harvard T.H. Chan School of Public Health AIDS Initiative. As a world class research centre, BHP is the leading HIV/AIDS research, training and capacity building institution in Botswana. Areas of research include clinical and basic science, epidemiology, socio-behavioural science and community-based bio-clinical research relevant to the AIDS epidemic and emerging public health challenges in Botswana, Sub-Saharan Africa and globally.
BHP was awarded a SPARC award in October 2019 as part of the Round 3 cohort of 11 new grantees with their project “Improving timely access to care for women with advanced stage breast cancer in Botswana.”
Identifying and addressing gaps in information and support at patient, clinician and health system levels are critical to address the rising burden of breast cancer in Botswana. As a result, the project will aim at improving timely access to care for patients with MBC by evaluating all these aspects.
"We believe the outcomes of our research will have broad applicability to improve timely access to breast cancer care in Botswana and in other countries facing similar challenges."
Focus groups with patients and clinicians will be run to identify patient concerns, fears and beliefs regarding treatment modalities such as chemotherapy and surgery. Current gaps in knowledge regarding cancer diagnosis, familiarity with cancer presentations, and management options for metastatic breast cancer will also be explored. Evaluations will be conducted to assess the potential of rapid pathological diagnosis in clinic situations. Finally, the effectiveness of patient navigators in improving patient support, shared decision-making, implementing patient-centred care plans, compliance with management, and ensuring timely access to treatment will also be measured. These analyses will be used to develop new guidelines to assist clinicians to better manage advanced breast cancer in Botswana.
Patient navigators who will work as part of the tertiary treatment facilities and regional clinics will be trained on how to navigate the diagnostic and treatment journey.
Improving access to a breast cancer diagnosis by increasing access to clinic-based testing will help with diagnostic delays currently impacting breast cancer patients in Botswana.
The training of patient navigators will provide the necessary support and guidance to assist patients and help achieve the goal of improved quality and length of life for patients with advanced breast cancer. It is envisaged that targeted approaches that address patient fears of treatment will improve patient compliance.
Through this project BPH aims to achieve greater empowerment of women with breast cancer, shared decision-making, timely access and improved compliance with the full suite of available treatments for metastatic breast cancer in Botswana.
In addition, through our focus groups, patients and their caregivers affected by breast cancer will have an opportunity to directly influence treatment guidelines, support mechanisms, and national policy for breast cancer care provision in Botswana.
(Information from the project description and context is compiled from the grant application)