title: Characterizing breast cancer treatment pathways in Kumasi, Ghana from onset of symptoms to final outcome: outlook towards cancer control.
abstract: BACKGROUND
  Cancer rates are increasing in Africa, including Ghana. Breast cancer is the second most common cancer in incidence and mortality in Ghana.
  
  
  OBJECTIVE
  We outlined both breast cancer patient characteristics and management at the Komfo Anokye Teaching Hospital (KATH), the main cancer management hospital in central Ghana. Moreover, we identified the treatment interventions predictive of patient outcome.
  
  
  METHODS
  Medical records of 597 breast cancer patients seen in 2008-2011 were abstracted to investigate management and treatment patterns. Abstracted variables included type and extent of surgery, number and cycles of chemotherapy and radiotherapy, as well as the course of treatment completed.
  
  
  RESULTS
  Late stage at diagnosis was common, treatment plans of the study hospital were relatively standardized according to disease severity, and defaulting/interrupting treatment in the records was also common. Patients diagnosed with late stage cancer who received adjuvant therapy and patients with hormone status evaluation were more likely to have complied with treatment guidelines and continued oncotherapy at the study hospital than those who never had hormone status requested or reported.
  
  
  CONCLUSIONS
  Our study lends support to improving patient outcomes in low- and middle-income countries through raising knowledge and reporting of tumor hormonal status and providing appropriately tailored treatment. Achieving improved outcomes should also consider enhancing public understanding of the importance of early detection and completion of treatment.
authors.affiliation: Department of Epidemiology, University of Michigan School of Public Health, Omaha, NE, USA.
authors.forename: Samuel
authors.initials: S
authors.lastname: Scherber
authors.affiliation: College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Amr S
authors.initials: AS
authors.lastname: Soliman
authors.affiliation: Central Administration, Komfo Anokye Teaching Hospital, Omaha, NE, USA.
authors.forename: Baffour
authors.initials: B
authors.lastname: Awuah
authors.affiliation: Department of Medical Oncology and Radiation, Komfo Anokye Teaching Hospital, Omaha, NE, USA.
authors.forename: Ernest
authors.initials: E
authors.lastname: Osei-Bonsu
authors.affiliation: Department of Pathology, Komfo Anokye Teaching Hospital, Omaha, NE, USA.
authors.forename: Ernest
authors.initials: E
authors.lastname: Adjei
authors.affiliation: Department of Surgery, Komfo Anokye Teaching Hospital, Omaha, NE, USA.
authors.forename: Frank
authors.initials: F
authors.lastname: Abantanga
authors.affiliation: Department of Epidemiology, University of Michigan School of Public Health, Omaha, NE, USA Department of Internal Medicine, University of Michigan, Omaha, NE, USA.
authors.forename: Sofia D
authors.initials: SD
authors.lastname: Merajver
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000628:therapy*; D005260:Female; D005869:Ghana; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D010342:Patient Acceptance of Health Care
keywords: Breast cancer; Ghana; developing countries (LMIC); health systems navigation