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Ethiopia Breast Cancer Project attracts expertise of Upstate’s Timothy Dye

Photo by Douglas Rea

SYRACUSE, N.Y. — Findings from a study led by medical anthropologist Timothy D. Dye, Ph.D., of Upstate Medical University, offers insight into the complexities faced by Ethiopian breast cancer patients as they navigate through Ethiopia’s healthcare system.

The findings will help the country to incorporate into its healthcare system best practices for access, treatment and care of people with breast cancer, the second most common cancer among young women in Ethiopia. The study was conducted under the auspices of the Ethiopia Breast Cancer Project.

Dye and colleagues recently reported the findings in a scientific article published in Cancer, the interdisciplinary international journal of the American Cancer Society.

“Understanding how breast cancer patients navigate health systems to reach appropriate levels of care is critical in assessing and improving the health system response in countries to an increasing breast cancer burden in their populations,” said Dye, professor of public health and preventive medicine and director of the Center for Research and Evaluation at Upstate. “Ethiopia has accelerated its attention to breast cancer, expanding clinical and public health efforts at diagnosing and treating breast cancer earlier and more efficiently.”

The study used a mixed-method, qualitative and quantitative approach to better understand the experiences of breast cancer patients who receive care at Ethiopia’s only cancer referral hospital, Tikur Anbessa Hospital (TAH), located in Addis Ababa. Patients or their family proxies were interviewed using interview protocols that were developed after open-ended culturally sensitive interviews and observations to learn more about the participant’s navigation through the health system that culminated in the treatment at the hospital. In total, 69 patients representative of the entire breast cancer clinical population at TAH were interviewed.

What Dye and his colleagues found was a complex navigation system that delayed the patient from receiving prompt and appropriate care at TAH. Complicating the system was a lack of patient and provider awareness of breast cancer and institutional capacity and ability to accurately diagnose breast cancer. Other patient-related factors included disbelief, distance and expense.

“Often, also complicating care decisions in Ethiopia are substantial beliefs that traditional therapies can offer relief or cures, resulting in a delay to seek care at a cancer hospital, ” said Dye.

The study showed that navigation chains are widely divergent and typically involve three or more care sites, or nodes, until the patient reached the cancer referral hospital.

Patients who consulted traditional healers had significantly more care nodes to reach the referral hospital than others, and patients who had direct access to local and regional hospitals had the smallest number of care nodes. Patients reported moving laterally from one health institution to another or regressing to lower levels of care, sometimes complicated by reinvolving traditional healers.

“The study demonstrates that, even among breast cancer patients who did ultimately gain access to care, health system navigation very often is indirect, unclear and resource-intensive,” said Dye. “The tertiary cancer facility in Addis Ababa perhaps could facilitate the strengthening of local healthcare systems around cancer by enhancing communications with local healthcare providers and through helping streamline access to their services by aligning more closely with local facilities,” he said.

Dye added that efforts to join local, district and regional institutions and resources into a more coordinated system to enhance access to breast cancer care that supports awareness, resource- appropriate detection, treatment and follow-up for breast cancer patients in Ethiopia would maximize the efficiency of the emerging breast cancer focus, clinical capacity and programs in the country.