Assessment of Cervical and Breast Cancer Services at the Four Public Oncology Centers in Botswana

Abstract

PURPOSE Cervical and breast cancer are the two most frequently reported female cancers in Botswana and account for 45% of annual female cancer deaths. This high mortality can be attributed, in part, to access barriers along the cancer care continuum. In efforts to combat the increasing cancer burden, Botswana’s government has designated four hospitals as public oncology centers (POC). We conducted a needs assessment to understand the current resources for cancer care at the four POCs. METHODS From February-April 2021, interviews with key informants (nurses working in oncology) regarding cancer services were conducted during site visits at the four POCs. These centers are strategically located throughout Botswana and include Princess Marina Hospital (PMH) in the capital city of Gaborone, Nyangabwe Referral Hospital (NRH), Sekgoma Memorial Hospital (SMH), and Letsholathebe II Memorial Hospital (LMH). RESULTS The four POCs reported 62 combined staff working in oncology-7 oncologists, 11 physicians, and 44 nurses. Regarding prevention, the only national cancer screening program was for cervical cancer. All four POCs confirmed the availability of pap smears, while only PMH and NRH offered colposcopy. For breast cancer diagnostics, all four POCs reported fine needle aspiration (FNA) services, but only PMH and NRH provided diagnostic mammography services, and ultrasound guided FNA biopsy. For treatment, PMH, NRH and LMH provided intravenous chemotherapy. Though none of the POCs provided onsite radiation therapy, it was offered in Gaborone Private Hospital with costs covered by the government. For surgical procedures, only PMH offered radical hysterectomy for cervical cancer. For breast cancer, PMH, NRH and SMH offered complete mastectomies with axillary lymph node dissection, only PMH performed breast-conserving surgery and no POC offered breast reconstruction. LMH lacked an available surgeon for any procedures. PMH offered a comprehensive palliative care program, although the other centers reported having some aspects of palliative care. CONCLUSION PMH and NRH offered the most comprehensive set of cervical and breast cancer services among the POCs, albeit with gaps. LMH and SMH provided minimal cancer services. Additional support and funding are needed to expand equitable and comprehensive cancer care across the country.