Temidayo Fadelu, MD, MPH

Improving outcomes for breast cancer patients in Rwanda by ensuring they complete their treatments.

Impact

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.

Progress thus far

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.

What’s next

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.