Beth A. Virnig

Background: Breast cancer is a serious public health concern in Ghana. This study investigated the anticipated healthcare‐seeking behaviour and preferences of women for possible breast cancer symptoms. Specifically, the study examined women's first point of contact as well as the timeliness of seeking healthcare for possible breast cancer symptoms. Methods: This cross‐sectional survey data involved 810 women in 14 rural communities in the Ashanti region, Ghana. The outcome variables were preferred first contact and timing for healthcare seeking. Descriptive analysis and two sets of binary logistic regression models were used. Results: The results indicate that 58.9% of the participants would first contact a medical doctor, whereas 41.1% would contact alternative sources (herbalist/traditional healer, fetish priest/faith healer and pastor/Man of God). Almost all respondents (95.6%) anticipated seeking care early. Women who anticipated contacting alternative sources (e.g., herbalists, pastors or family members) over medical doctors had 2.58 times higher odds of anticipating delays in their healthcare seeking (AOR = 2.58, 95% CI: 1.28–5.21). Compared to women in agricultural/farming, those who worked in civil/government/private sectors had 7.87 times higher odds of anticipated delays in seeking healthcare (AOR = 7.87, 95% CI: 2.11–29.40). Women with tertiary education had 92% lower odds of anticipated delays (AOR = 0.08, 95% CI: 0.01–0.84). Additionally, women who based their healthcare decisions on advice from others had 66% lower odds of delaying healthcare seeking (AOR = 0.34, 95% CI: 0.14–0.85). Conclusion: Almost all women would seek healthcare early for possible breast cancer symptoms; however, a significant proportion anticipated contacting alternative/non‐medical sources. There is a need to raise awareness among women about the importance of consulting a medical doctor for breast cancer symptoms to ensure timely and appropriate medical assessment and treatment. Addressing hurdles such as limited access to medical facilities and financial constraints can improve health‐seeking preferences for breast cancer symptoms. Public Contribution: At the start of the project, a community‐based project advisory board (CPAB) was set up. The CPAB included local government representatives from the Ghana Health Service ( n = 1) and District Assembly ( n = 4), traditional leaders ( n = 3), public sector health services (health service providers and managers) ( n = 4), community women representatives ( n = 4), breast cancer survivor ( n = 1) and breast health advocates ( n = 2). In this study, the CPAB members assisted in gaining community access, recruiting local women as study recruitment links in each site and providing guidance on field work safety. The study results have been discussed with CPAB members and field workers in a series of project meetings. Trial Registration: Not applicable.

Cervical cancer screening has reduced cervical cancer-related mortality by over 70% in countries that have achieved high coverage. However, there are significant geographic disparities in access to screening. In Ghana, although cervical cancer is the second most common cancer in women, there is no national-level cervical cancer screening program, and only 2–4% of eligible Ghanaian women have ever been screened for cervical cancer. This study used an exploratory, sequential mixed-methods approach to examine barriers and facilitators to cervical cancer screening from women’s and healthcare workers’ perspectives. These were further informed by the Dynamic Sustainability Framework (DSF), in particular, two domains, namely the practice setting and ecological system. Two convenience samples of 215 women and 17 healthcare personnel were recruited for this study. All participants were from one of three selected clinics (Ejisu Government Hospital, Kumasi South Hospital, and the Suntreso Government Hospital) in the Ashanti region of Ghana. Descriptive analyses were used to group the data by practice setting. Statistical differences in means and proportions were used to evaluate women’s barriers to cervical cancer screening. Quantitative findings from the women’s survey informed qualitative, in-depth interviews with the healthcare workers and were analyzed using an inductive thematic analysis. The median age of women and healthcare workers was 37.0 years and 38.0 years, respectively. Most women (n = 194, 90.2%) reported never having been screened. Women who had not been screened were more likely to have no college or university education. Practice setting factors included long clinic wait times and distance to the clinic. Ecological system factors identified were population characteristics such as lack of knowledge about available services, shyness when undergoing a clinician-performed pelvic exam, and requiring a spouse’s permission before scheduling. These findings highlight the need for non-clinician-based, culturally sensitive cervical cancer screening options such as self-collected HPV tests to increase screening participation in Ghana.

Objective: Older adults may pay healthcare-related costs for work injuries if Medicare covers claims over workers' compensation (WC). We assessed Medicare enrollee costs after a work-related injury by WC status. Methods: We longitudinally analyzed Medicare fee-for-service claims (2016-2019) for age 65+ Medicare enrollees with work-related injuries, estimating WC effects on healthcare use and enrollee costs using difference-in-differences and quantile regression models. Results: WC covered at least one Medicare claim for 16% of the 13,039 enrollees with work-related injuries. Over 90 days, mean Medicare out-of-pocket costs were lower with WC ($447) than without ($778). With WC, enrollees owed $1,432 at the 90th percentile compared to $2,465 without, an adjusted difference of $600 (95% CL -767, -432). Conclusions: While WC covers some costs, Medicare claim billing increases after a work-related injury, often leading to substantial patient expenses.

Cervical cancer screening has reduced cervical cancer-related mortality by over 70% in countries that have achieved high coverage. However, there are significant geographic disparities in access to screening. In Ghana, although cervical cancer is the second most common cancer in women, there is no national-level cervical cancer screening program, and only 2 to 4% of eligible Ghanaian women have ever been screened for cervical cancer. This study used an exploratory, sequential mixed-methods approach to examine barriers and facilitators to cervical cancer screening from women and healthcare workers perspectives, guided by the Dynamic Sustainability Framework. Two convenience samples of 215 women and 17 healthcare personnel were recruited for this study. All participants were from one of three selected clinics (Ejisu Government Hospital, Kumasi South Hospital, and the Suntreso Government Hospital) in the Ashanti region of Ghana. Descriptive analyses were used to group the data by practice setting and ecological system. Statistical differences in means and proportions were used to evaluate women’s barriers to cervical cancer screening. Quantitative findings from the women’s survey informed qualitative, in-depth interviews with the healthcare workers and analyzed using an inductive thematic analysis. The median age of women and healthcare workers was 37.0 years and 38.0 years respectively. Most women (n=194, 90.2%) reported never having been screened. Women who had not been screened were more likely to have no college or university education. Ecologic factors identified were lack of knowledge about available services, distance to a clinic and requiring a spouse’s permission prior to scheduling. Practice setting barriers included long clinic wait times and culturally sensitive issue. The quantitative and qualitative data were integrated in the data collection stage, results, and subsequent discussion. These findings highlight the need for non-clinician-based culturally sensitive tool options for screening such as self-collected HPV tests to increase screening participation in Ghana.

Purpose: To assess whether the poor prognosis of triple-negative breast cancer (TNBC) necessitates a more aggressive surgical approach. Methods: We examined the association of: breast-conserving surgery (BCS); BCS plus radiotherapy; mastectomy; and mastectomy plus radiotherapy with overall and breast cancer-specific survival of stage I–III TNBC patients aged 66 years and older. We used unweighted and inverse probability of treatment weighted Cox proportional hazards regression and the Fine and Gray sub-distribution model. Results: Among 4333 women, individuals who were selected for BCS, mastectomy or mastectomy plus radiotherapy had lower adjusted overall and breast cancer-specific survival compared with women who had BCS plus radiotherapy. Conclusion: In this population-based study, women with TNBC treated with BCS plus radiotherapy have a better prognosis than those treated with BCS, mastectomy or mastectomy plus radiotherapy. Given the poor prognosis of TNBC and selection bias inherent in observational studies, these findings should be confirmed in further studies such as randomized clinical trials.

PURPOSE: To decrease the financial burden on people with cancer, clinicians and patients increasingly use medication price comparison websites to seek pharmacies where medications may be cheaper. Shopping around at different pharmacies can add additional time and logistic burden to patients and care partners. We sought to determine whether a single pharmacy consistently offered the lowest price for symptom control medications. METHODS: We compiled medications/formulations used to manage two common cancer-associated symptoms: nausea/vomiting and anorexia/cachexia. We extracted discounted, lowest price with coupon prices for a typical fill of these medications at nine pharmacies in Minneapolis, MN, using GoodRx. We compared prices across formulations and pharmacies to assess whether a pharmacy consistently offered the lowest price. RESULTS: We included 24 formulations for nausea/vomiting (14 generic and 10 brand-name) and 19 for anorexia/cachexia (12 generic and seven brand-name). Prices for brand-name formulations were similar across pharmacies, but prices of generic formulations varied widely across pharmacies. For example, the prices of a seven-unit fill of generic 5-mg olanzapine tablets ranged from $4 to $57 US dollars. No single pharmacy consistently offered the lowest price across the formulations studied. For example, for the 12 generic formulations for anorexia/cachexia, one pharmacy had the highest price for four formulations and the lowest price for two others. CONCLUSION: In this study of discounted medication prices, we found that no single pharmacy in an urban zip code consistently offered the lowest price for medications used to manage two common cancer-associated symptoms. Well-intentioned efforts to pursue the cheapest source of each medication by visiting multiple pharmacies may add extra time and logistic toxicity to patients and care partners. This approach can increase redundant scripts and expose patients to medication-related adverse events.