Breast cancer care capacity in Côte d'Ivoire: Insights from a novel multidisciplinary provider survey.

Abstract

e13863 Background: Breast cancer mortality is disproportionately high in low-middle income countries (LMICs), but few tools exist to measure comprehensive breast cancer capacity in LMICs. Breast cancer is the highest cause of cancer-related death in women in Côte d'Ivoire. The objective of this study was to assess barriers to breast cancer diagnosis and treatment in Côte d'Ivoire through development of a multidisciplinary survey tool for breast cancer care capacity assessment in LMICs. Methods: The Breast Cancer Care Capacity (B-CCC) survey was structured as a multidisciplinary tool with free-standing sections for radiology, pathology, surgery, medical oncology, and radiation oncology to assess barriers to care within each discipline. The tool was first piloted at select institutions in Cote d’Ivoire in 2023, and then distributed to breast cancer care providers at a country-wide level in 2024. The results of the country-wide distribution were analyzed via descriptive statistics and resource availability was compared between the public and private sector. Results: The survey was completed by 52 breast cancer care providers in Côte d'Ivoire from a total 47 institutions (7 (14.9%) district hospitals, 3 (6.4%) regional hospitals, 8 (17%) national referral) including each of the largest cancer referral centers in the country. Respondents included 10 (16.4%) radiologists, 15 (24.6%) pathologists, 16 (26.2%) surgeons, 18 (29.5%) medical oncologists, and 2 (3.3%) radiation oncologists. There were 18 (34.6%) respondents from public institutions and 34 (65.4%) from private institutions. Several infrastructure and equipment barriers were noted in the public sector including lack of access to histology services and longer pathology wait times. Greater output of clinical care was seen in the public sector compared to the private (mean ultrasounds per month: 77.5 vs. 37.5; mean surgical biopsies per month: 62.5 vs. 39.5), mean number of patients receiving chemotherapy: 13.9 vs. 8.7). While the survey assessed resource availability and shortages based on the facility, common themes on barriers to care were detected regardless of the participating institution or department. Majority of the participants at both public and private institutions noted patient lack of ability to pay, late presentation to the primary healthcare center, and patient hesitation to obtain treatment as significant barriers to care. Conclusions: We identified important barriers to breast cancer diagnosis and treatment in Cote d’Ivoire especially within the public sector. This is the largest provider-based breast cancer care capacity assessment in the country, and the only survey that provides data on multidisciplinary cancer care resource availability at a facility-level. We hope that this tool will provide a model for multidisciplinary cancer care capacity assessment in LMICs and aid resource allocation and intervention programs.