Dana-Farber Cancer Institute
Physician, Medical Oncology, Dana-Farber Cancer Institute
Instructor, Medicine, Harvard Medical School
Conquer Cancer, The ASCO Foundation
Improving outcomes for breast cancer patients in Rwanda by ensuring they complete their treatments.
In Rwanda, patients with breast cancer are much more likely to die from their disease, with a death rate of over 50 percent, compared to less than 16 percent in the United States. This is not due to a lack of available medications, as free curative breast cancer therapy is available in Rwanda. Two-thirds of patients with breast cancer in Rwanda have tumors that express estrogen receptor (ER), for which endocrine therapy after surgery—also known as adjuvant endocrine therapy (AET)—is an effective intervention. Treatments are only effective when patients complete the full course of the therapeutic regimen, however. AET are oral daily medications that must be continued for five to ten years, but low adherence to AET by missing doses or prematurely stopping therapy is a major driver of poor outcomes and remains a challenge around the world. For his Conquer Cancer Career Development Award, funded by BCRF, Dr. Fadelu and his team at the Butaro Cancer Center of Excellence (BCCOE) in Rwanda are working to identify what barriers prevent patients from completing their therapy, and test an intervention to help address these barriers and improve survival.
With the assistance of the Dana-Farber Survey Core, the team created data collection tools including qualitative interview guides to assess patient perspectives on AET and preliminary drafts of survey instruments to assess adherence and patient quality of life. They identified significant gaps in testing for estrogen receptor (ER) at the time of diagnosis, frequent treatment interruptions greater than 30 days, and discontinuation of AET, including disease recurrence or death. One prominent factor that has emerged as a likely cause of AET interruptions is transportation challenges patients face with returning monthly to the healthcare facility to fill AET prescriptions. The team is also conducting a systematic review of educational materials to improve information AET patients receive on the importance of completing AET to reduce the risk of recurrence. They have also completed a review of oral medication adherence interventions beyond AET used in similar low-resource settings to help inform interventions to implement in Rwanda.
The research team is currently piloting a written and visual AET patient education booklet in the local language to assess the fit and acceptability in the Rwandan population. In addition, Dr. Fadelu is working with the local clinical team on a plan to decentralize dispensing of AET at four local district hospitals to address the transportation issues identified. The results of these pilots will feed into the development of a multi-level intervention plan to improve AET adherence in Rwanda.
Temidayo Fadelu, MD, MPH has a clinical and research focus in global breast cancer and implementation science research. Originally from Nigeria, Dr. Fadelu moved to the U.S. for his undergraduate education at Baylor University. He earned his medical degree from Yale University School of Medicine and completed his training in internal medicine at the Hospital of the University of Pennsylvania. He then moved to Rwanda to serve as clinical and programmatic implementation lead for an oncology program based at Butaro Cancer Center of Excellence in rural northern Rwanda, where he coordinated several major initiatives including the implementation of pathology and palliative care services. He subsequently completed his fellowship training in medical oncology at Dana-Farber Cancer Institute, during which he also earned a master’s in public health at the Harvard T.H. Chan School of Public Health. He remains at Dana-Farber as a member of their Center for Global Cancer Medicine, where engages in implementation research projects in Rwanda and Haiti to address global inequities in breast cancer care.
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