Health Services Research

SS 11 - HSR 1

82 - Infrastructural Challenges to Radiation Therapy in a Nigerian Teaching Hospital

Monday, October 22
8:35 AM - 8:45 AM
Location: Room 007 A/B

Infrastructural Challenges to Radiation Therapy in a Nigerian Teaching Hospital
J. Leng1, A. Ibraheem2, O. I. Olopade2, and A. Ntekim3; 1The University of Chicago Pritzker School of Medicine, Chicago, IL, 2University of Chicago, Chicago, IL, 3University of Ibadan, Ibadan, Nigeria

Purpose/Objective(s): In low middle-income countries (LMICs), there has been an exponential increase in cancer incidence. According to the International Atomic Energy Agency, the biggest gap in radiation therapy availability and need is in Nigeria, where each machine serves 19.4 million people. To address this disparity, we aimed to characterize the barriers to receiving radiation therapy and to identify specific areas for future intervention.

Materials/Methods: This was a cross sectional study conducted at the University College Hospital in Ibadan, Nigeria from June to August 2017. Demographics, sociocultural and infrastructural factors relating to radiation therapy were collected from patients through a questionnaire (n=186). Univariate and multivariate ordinal logistic regression was used to identify the factors leading to delays in radiation therapy referral and delays in treatment initiation post-consultation.

Results: In ordinal logistic regression, sociocultural factors increased the odds of referral delay to radiation therapy, including inability to pay (OR=1.99, p=0.034), previous bad experience at hospital (OR=7.05, p=0.001), and travel time to treatment facility (OR=1.36, p=0.001). In contrast, there was no significant relationship between time to treatment initiation post-consultation and sociocultural factors including age, education, use of traditional healer, and inability to pay. Infrastructural barriers increased the odds of treatment delay, including machine breakdown (OR=2.92, P=0.001), worker strikes (OR=2.64, P = 0.001), and power outages (OR=2.81, P=0.022). Patients traveled from 20 states and as far as 800 miles by road to receive treatment. Treatment was for curative intent for the majority (83.8%) of patients, and most patients (92.5%) believed that cancer can be cured. In addition, patients exhibited a high level of trust in their doctors always doing everything possible for their cancer (91.8%).

Conclusion: While healthcare delays due to patient factors have been extensively reported, we see here that patients are overcoming these barriers in hopes of a curative treatment. Yet, staff and equipment malfunctions prevent patients from receiving timely treatment. In fact, at the time of this study only 3 of Nigeria’s 8 machines were functional. Policies aimed at ensuring machine maintenance and interprofessional training must be implemented to address these infrastructural barriers. As the burden of cancer continues to grow, it is now more important than ever to improve radiation therapy access for cancer patients in Nigeria and other developing countries.

Author Disclosure: J. Leng: None. A. Ibraheem: None. O.I. Olopade: Employee; CancerIQ, Tempus. Partnership; CancerIQ. Board of Directors; CancerIQ. A. Ntekim: None.

Jim Leng, BA

Disclosure:
No relationships to disclose.

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