Management of Locally Advanced Breast Cancer: Challenges and Treatment Outcomes in an Emerging Tertiary Hospital in South-Western Nigeria

Abstract

Introduction: Patients presenting with advanced breast cancer is a common phenomenon in Nigeria and many developing countries. At this stage, patients’ high expectations of survival conflict with the realities of the clinical outcome, thus creating enormous challenges to the attending surgeon practicing in a resource-poor setting. Aim: To evaluate patients who presented with Locally Advanced Breast Cancer (LABC), management challenges and treatment outcomes. Materials and Methods: This was a retrospective study of patients with LABC at Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti between January 2016 and December 2018. The variables of interest were patients’ demographics, findings of triple assessment, presentation, diagnosis, treatment intervals, the treatment received and follow-up outcomes. Results were presented using descriptive statistics mean±SD, median and Interquartile Range (IQR) Results: Seventy-eight patients had LABC in the study period. ages ranged from 24-94 years (mean 50.1±14.0). Total 77 (98.7%) were females and patients had breast lump ranging in size from 3-22 cm (mean 8.7±3.3, median 8, IQR 6-10). A vast majority of patients (84.6%) had tumour >5 cm in size. More than two-thirds (69.2%) were clinical stage IIIB. The duration of symptoms was 2-42 months (mean 10.1±7.8). The duration between presentation and cancer confirmation ranged from 7-140 days (mean 40.1±32.1, median 28.5, IQR 16.5-60.0). There was no facility to determine the receptor status of the tumours. Forty-six (59.0%) patients were routinely placed on tamoxifen (hormone therapy). Fifty-six (71.8%) patients had Modified Radical Mastectomy (MRM). Only 30 (38.5%) completed the chemotherapy schedules while the rest had them haphazardly, mainly due to financial reasons. Five out of 22 (22.7%) referred for radiotherapy received it after an average of 5.2 months. Postmastectomy, 7 had loco-regional recurrence at one year and 15 within three years. Overall, 40 were alive, 16 were dead while 22 were lost to follow-up at three years. There was significant difference in 3-year survival among those who had chemotherapy and mastectomy compared to those who had just one of the two (Fisher’s-exact p=0.002). Conclusion: Delayed presentation, diagnostic and treatment inadequacies are the common challenges of management of LABC. Early diagnosis, adequate provision of diagnostic facilities and subsidisation of all aspects of care will be a reasonable panacea to some of the challenges.