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Impact of Relative Dose Intensity (RDI) on Survival in Non-Metastatic Breast Cancer: Nigerian Experience

Journal of Biosciences and Medicines 2024年第7期12卷 120-131页

作者： Samira B. L. Makanjuola Abiodun Olaniyi Popoola mob.laji adew.le oludara Department of Pharmacology College of Medicine Lagos State University (LASUCOM) Lagos Nigeria Department of Radiology & Oncology College of Medicine Lagos State University (LASUCOM) Lagos Nigeria Department of Surgery Lagos State Teaching Hospital (LASUTH) Lagos Nigeria

Background: This study was initiated to determine practices patterns in adjuvant chemotherapy for non-metastatic breast cancer and to examine the relationship between received dose intensity (RDI) and survival in patients with breast cancer Nigeria. Methods: Our study was a retrospective analysis of patients with breast cancer recruited from 2012 and 2015. A total of 204 patients were initially entered into the study, 102 were lost to follow-up leaving 102 patients who were suitable for the survival analysis. Survival time was calculated from 106 days, the scheduled end of chemotherapy. Results: The total average RDI for patients was 74%. Over the 204 patients that were reviewed, 144 (70.6%) had some reduction of RDI. This subgroup had an average RDI of 63%. On average, 79% of the intended dose of chemotherapy was given. The time to completion of chemotherapy was 1.33 times that specified by the protocol. Dose delays an overall reduction was mainly attributed to intolerability and financial constraints. Survival by RDI showed a significant decrease in survival rate for patients with RDI of >49% (Hazard Ratio = 3.473, 95% CI 1.21 - 9.91, P = 0.020);RDI of 50% - 59% (Hazard Ratio = 3.916, 95% CI 1.01 - 15.18, P = 0.048);RDI of 60% - 69% (Hazard Ratio = 4.462, 95% CI 1.65 - 12.03, P = 0.003) compared with patients who received an RDI of 100%. Although associated with poorer prognosis, there were no significant changes in the survival rate for patients with RDI of 70% - 79% (Hazard Ratio = 1.667, 95% CI 0.56 - 4.96, P = 0.359);RDI of 80% - 89% (Hazard Ratio = 1.620, 95% CI 0.47 - 5.53, P = 0.441);RDI 90% - 99% (Hazard Ratio = 1.590, 95% CI 0.53 - 4.73, P = 0.405) compared with patients who received an RDI of 100%. Conclusion: This study provides evidence that decreased RDI of <70% in non-metastatic breast cancer patients is strongly associated with decreased overall survival.

关键词： Breast Cancer Chemotherapy RDI Survival Rate

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Heart Surgery Practice in Sub Saharan Africa: Single Nigerian Institutional Midterm Results and Challenges

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World Journal of Cardiovascular Surgery 2014年第3期4卷 35-41页

作者： Jonathan O. Nwiloh mob.laji A. oludara Philip A. Adebola Department of Medicine Lagos State University Teaching Hospital Lagos Nigeria Department of Surgery Atlanta Medical Center Atlanta USA Department of Surgery Lagos State University Teaching Hospital Lagos Nigeria

Background: The majority of prospective cardiac surgical patients in sub Saharan Africa lack access to open heart surgery. We reviewed our midterm results to identify the obstacles to growth and challenges with sustainability. Methods: Records of patients undergoing heart surgery at LASUTH from December 2004 to March 2006 were retrospectively reviewed for clinical and outcome data. Results: Twenty four patients age 10-50, mean 28.0 +/? 10.49 years and 13 (54.2%) males underwent surgery. 12 (50.0%) patients had mechanical valve replacements, 11 (45.8%) closure of septal defects and 1 (4.2%) left atrial myxoma resection. Logistic euroscore for valve patients was 5.81 +/? 4.74 while observed mortality was 8.3% (1/12). Overall 30 days operative mortality was 8.3% (2/24) and major morbidity 4.2% (1/24). Patients with septal defects closure stopped clinic visits within a year. Valve patients follow up was complete in 90.1% with mean duration of 55.2 +/? 15.3 months. Late events occurred only in females with mitral valve replacements. The 5-year freedom from thromboembolism and bleeding was 74.0% and survival 82.0% in valve patients. Conclusion: Despite limited resources heart surgery can safely be performed with good outcomes by trained local personnel under supervision of visiting foreign teams until they are proficient to operate independently. Patients with less complex congenital defects have excellent postsurgical outcomes, while patients with rheumatic valve replacement are subject to ongoing valve related morbidity and mortality therefore require lifetime follow up. Choice of prosthetic valve for the mostly indigent and poorly educated population remains a challenge. We now prefer stented tissue valve despite its known limitations, in child bearing age females desirous of childbirth and others unlikely to comply with anticoagulation regimen. Barriers to sustainability include poor infrastructures, few skilled manpower, inadequate funding and restricted patient acce

关键词： Open Heart Surgery Prosthetic Valve Choice Anticoagulation

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level of Adherence to Cytotoxic Drugs by Breast Cancer Patients’ in Lagos State University Teaching Hospital

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Journal of Cancer Therapy 2015年第4期6卷 383-389页

作者： Popoola Abiodun Samira Makanjuola Sowunmi Anthonia Igwilo Adaeze mob.laji oludara Ibrahim Nasir Omodele Foluso Oncology Unit Department of Radiology Lagos State University College of Medicine Ikeja Nigeria Department of Pharmacology Lagos State University College of Medicine Ikeja Nigeria Department of Radiotherapy Lagos University Teaching Hospital Idiaraba Nigeria Department of Surgery Lagos State University Teaching Hospital Ikeja Nigeria

Background: Breast cancer is one of the most common malignant diseases in women and adjuvant combination chemotherapy has been shown to reduce mortality from this disease. Adherence to medical treatment is a multifaceted issue that can substantially alter the outcomes of therapy. Patient non-adherence to chemotherapy is the ultimate barrier to the treatment effectiveness. Objective: This study was carried out to determine the relationship between cancer chemotherapy adherence and breast cancer staging, patient’s perception of cancer care and patient’s socio-demographic characteristics. Material and method: This was a cross sectional study selection of respondents and was based on simple random sampling technique, 184 patients were interviewed and data was collected using a semi-structured questionnaire to obtain socio-demographic data, adherence data, and facility-related information. Results: There was a significant association between marital status and non-adherence (P?= 0.013). Both separated and single subjects had higher proportion of non-adherence compared with married subjects. Analysis of perception of chemotherapy care revealed a significant association between the satisfaction score and non-adherence, with non-adherent patients showing higher scores or being less satisfied. The quality of service (P?= 0.0052);rating of needs been met (P?= 0.0079);rating on whether the services helped the subject (P?= 0.0405);rating on the general satisfaction of the services provided (P?= 0.0115);and rating on whether subject would seek help again (P?= 0.0320) all had a significant association with non-adherence. Conclusion: The awareness of oncologist and patient of the problem of non-adherence and communication regarding the importance of adherence to therapy may improve health outcomes.

关键词： Chemotherapy Adherence Breast Cancer

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Experience with Prosthetic Valve Replacement in Indigents with Rheumatic Heart Disease in Nigeria: 10-Year Follow-Up

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World Journal of Cardiovascular Surgery 2015年第8期5卷 75-81页

作者： Jonathan O. Nwiloh mob.laji A. oludara Phillip A. Adebola Sunday A. Edaigbini Solomon Danbauchi Anthonia C. Sowunmi JN Heart Center St. Joseph’s Hospital Adazi-Nnukwu Anambra State Nigeria Lagos State University Teaching Hospital Lagos Nigeria Ahmadu Bello University Teaching Hospital Zaria Nigeria Lagos University Teaching Hospital Lagos Nigeria

Purpose: Active heart surgery programs are few in sub Saharan Africa outside of South Africa, with majority being low volume centers performing small numbers annually. We reviewed our long term outcome to identify factors associated with increased morbidity and mortality, to guide future choice of prosthetic valves in our mostly indigent patients afflicted with rheumatic valvular disease. Methods: Retrospective analysis of patients who underwent heart valve replacement at Lagos State University and Ahmadu Bello University Teaching Hospitals from November 2004 to February 2009. Results: Twenty six patients, 19 (73.1%) females, age 12 - 47;mean 26.69 ± 9.87 years, underwent heart valve replacement. 19 (73.1%) patients had mitral and 7 (26.9%) aortic valve replacement. Mechanical valve was implanted in all except in 2 (7.7%) patients. left ventricular ejection fraction was >50% in 14 (53.8%), 24 (92.3%) were in New York Heart Association class III/IV, 10 (38.5%) had severe pulmonary hypertension and logistic euroscore was 5.84 ± 3.81. Operative mortality was 11.5% (3/26) and morbidity 7.7% (2/26). Follow-up for survivors was 83.0 ± 27.9 months. 10-year freedom from bleeding and thromboembolism was 70.0% and survival 86.0%. Linearized rate for bleeding was 4.58 and thromboembolism 1.52. Conclusion: Late complications in survivors were primarily anticoagulant related occurring predominantly in child bearing age females especially during pregnancy. Bleeding complications were often associated with noncompliance due to poor socioeconomic status. With average life expectancy of 53 years for females, bioprosthetic valves despite higher structural failure rate, may be best suited especially in child bearing age females still desirous of childbirth to decrease valve related complications. Longer duration of follow-up and meta-analysis of future reported series from the sub region may help clarify the optimal prosthetic valve in sub Saharan Africa with its known poor health inf

关键词： Rheumatic Valve Disease Prosthetic Valve Anticoagulation Complications

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