title: Direct integration of government funding and family support for musculoskeletal tumor care in a resource-constrained country.
abstract: BACKGROUND
  Malignant musculoskeletal tumor (MMST) outcome reflects the level of supportive care provided. In Nigeria, the supportive care available to patients with MMST is limited by a lack of funding. Patients often present late, and receive only orthodox care as psychosocial care is not available. We evaluated the effect of direct incorporation of government funding and family support on MMST patient acceptance and completion of treatment.
  
  
  METHODS
  A 3-year prospective multicenter intention-to-treat study was undertaken in a tertiary care setting. The first step was a nonselective randomization of MMST patients into 2 groups, Wesley Guilds Hospital Firm A (WGHFA) and Wesley Guilds Hospital Firm B (WGHFB) using the computer software Excel. The control group was WGHFA, which consisted of patients who self-financed their oncology care. The WGHFB patients' governments (local or state) provided funds according to medical reports and the patients had relatives who offered psychosocial support. The second step entailed treatment (surgery, chemotherapy and radiotherapy) and follow-up. Outcome measures were the interval between presentation at hospital and surgical intervention, acceptability of limb amputation, completeness of treatment courses, duration of hospital stay and mortality. The reproducibility of the methodology was reappraised at the Federal Medical Center. Kruskal-Wallis analysis was used, and an alpha error of <0.05 at a CI of 95% was taken to be significant.
  
  
  RESULTS
  A total of 112 cases of MMST were managed during the study period. Seventy-one (63.4%; 37 WGHFA; 34 WGHFB) met the inclusion criteria. Age, sex, tribe, religion, comorbid factors and mean weekly income were not significant factors influencing improved MMST care among the WGHFB patients. 32 WGHFB versus 7 WGHFA patients accepted the treatment plan. The mean duration of hospital stay before surgery (p < 0.001), discharge against medical advice (p < 0.000), limb salvage (21 vs. 2, p < 0.001), limb amputation (3 vs. 12, p < 0.05, 95% CI 8.3-37.9), completeness of treatment (33 vs. 7, p < 0.05), mean duration of hospital stay, in days (23 vs. 39, p < 0.05) and mortality at 1-year follow-up (13 vs. 28, p < 0.02) were significant.
  
  
  CONCLUSIONS
  The cost of cancer care is a challenge for patients with MMST in a resource-constrained country such as Nigeria. Direct integration of the government and family into MMST care will serve as a link between the cancer patient and the source of funds. It raises the possibility of an effective psychosocial approach to improve patient outcome through enhanced treatment acceptability and completion, and so reduce morbidity and short-term mortality.
authors.affiliation: Department of Orthopedic Surgery and Traumatology, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria. olayinkaadegbehingbe@yahoo.co.uk
authors.forename: O O
authors.initials: OO
authors.lastname: Adegbehingbe
authors.forename: A L
authors.initials: AL
authors.lastname: Akinyoola
authors.forename: A L
authors.initials: AL
authors.lastname: Ariyibi
authors.forename: L M
authors.initials: LM
authors.lastname: Oginni
mesh_terms: D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000523:psychology / Q000628:therapy*; D002648:Child; D005192:Family Health; D005260:Female; D005380:Financing, Government; D014943:Global Health; D006291:Health Policy; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000191:economics; D008875:Middle Aged; D019042:Muscle Neoplasms / Q000523:psychology / Q000628:therapy*; D009549:Nigeria; D017060:Patient Satisfaction; D011203:Poverty; D011446:Prospective Studies; D012944:Social Support