{
  "abstract": "Objective The expenses associated with cancer treatment are increasing at a rapid pace. The financial strain of providing care is experienced worldwide, but is particularly pronounced in low and middle-income countries (LMICs). This has resulted in a growing acknowledgement of the importance of value-based cancer care. Choosing Wisely Africa (CWA) is an initiative aimed at reducing the excessive use and expenses associated with cancer treatment. In this study, we assessed adherence to CWA recommendations for the treatment of breast cancer in three high-volume cancer centres in Sub-Saharan Africa (SSA).Design A cross-sectional study across Rwanda, Ghana and Tanzania was conducted, involving a review of medical records to assess adherence to five measurable CWA practices in breast cancer care. The study used inferential statistics, such as χ 2 tests, to compare adherence among these countries.Settings This study was conducted in three cancer centres (Ocean Road Cancer Institute, Rwanda Military Hospital and Korle Bu Teaching Hospital) in three countries (Tanzania, Rwanda and Ghana, respectively).Participants A total of 542 patients were recruited. Eligible patients were those with a breast cancer diagnosis and complete data as pertaining to five CWA recommendations.Results A total of 542 participants with a mean age of 51 years were included. Participants were well distributed across Ghana (37%), Rwanda (34%) and Tanzania (29%). Female patients represented 97% of the study cohort. Half (51%) of the participants had some form of insurance. The study observed high adherence to cancer staging (94%) before treatment and histological confirmation (91%) before breast lump removal across all sites. Hypofractionation was used in 0% of cases in Rwanda, 42% in Ghana and 70% in Tanzania.Conclusion This study provides critical insights into the implementation of CWA recommendations in breast cancer care in SSA. It highlights the disparities in adherence to CWA recommendations across different centres, showing the need for policy-driven changes and healthcare infrastructure improvement to standardise cancer care practices in LMICs.",
  "authors": [
    {
      "affiliations": [
        "Rwanda Military Hospital, Kigali, Rwanda"
      ],
      "name": "Fidel Rubagumya"
    },
    {
      "affiliations": [
        "Department of Oncology, Butaro Hospital, Burera, Rwanda",
        "School of Medicine, University of Global Health Equity, Kigali, Rwanda"
      ],
      "name": "Eulade Rugengamanzi"
    },
    {
      "affiliations": [
        "Department of Oncology, Muhimbili National Hospital, Dar es Salaam, Tanzania"
      ],
      "name": "Sarah K Nyagabona"
    },
    {
      "affiliations": [
        "Department of Oncology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania"
      ],
      "name": "Jerry Ndumbalo"
    },
    {
      "affiliations": [
        "Department of Research, RD Rwanda, Kigali, Rwanda"
      ],
      "name": "Vincent Kwizera"
    },
    {
      "affiliations": [
        "Department of Research, RD Rwanda, Kigali, Rwanda"
      ],
      "name": "Aline Uwimbabazi"
    },
    {
      "affiliations": [
        "Department of Oncology, Korle Bu Teaching Hospital, Accra, Ghana"
      ],
      "name": "Kaligirwa Celyna"
    },
    {
      "affiliations": [
        "Department of Oncology, Korle Bu Teaching Hospital, Accra, Ghana"
      ],
      "name": "Hannah Ayettey"
    },
    {
      "affiliations": [
        "Department of Oncology, Korle Bu Teaching Hospital, Accra, Ghana"
      ],
      "name": "Verna Vanderpuye"
    },
    {
      "affiliations": [
        "Department of Public Health Sciences, Queen’s University, Kingston, ON, Canada"
      ],
      "name": "Wilma M Hopman"
    },
    {
      "affiliations": [
        "Department of Oncology, St Michael’s Hospital, Toronto, ON, Canada"
      ],
      "name": "Nazik Hammad"
    },
    {
      "affiliations": [
        "Department of Public Health Sciences, Queen’s University, Kingston, ON, Canada"
      ],
      "name": "Christopher M Booth"
    }
  ],
  "title": "Adherence to Choosing Wisely Africa recommendations in breast cancer care: a cross-sectional study across three Sub-Saharan African centres",
  "uid": "b0d1e8a1-d446-59c8-b496-8b1cb1b01fbf"
}