Health Care Professional Adherence to Breast Cancer Management Guidelines in Nigeria
Authors: Anya Romanoff, Olalekan Olasehinde, Kathleen Lynch, Sharif Folorunso, Oluwatosin Omoyiola, Betiku Omolade, Adeleye Omisore, Chukwuma Eze Okereke, Olayide Agodirin, Abubakar Bala Muhammad, Nuhu Ali, Omorodion Irowa, Nneka Sunday Nweke, Uchechukwu Emmanuel Nwokwu, Adewale Aderounmu, Funmilola Wuraola, Hannah L. Kalvin, Rivka Kahn, Grace Fitzgerald, Cristina Olcese, Alexia Iasonos, Victoria L. Mango, Jamie S. Ostroff, Rachel Vreeman, Benjamin O. Anderson, T. Peter Kingham, Olusegun Isaac Alatise
Journal: JAMA Network Open (2025)

Importance In Nigeria, 80% of breast cancer is diagnosed at an advanced stage, when clinical management is complex and necessitates multidisciplinary collaboration. The Nigerian Federal Ministry of Health promotes multidisciplinary tumor board (MDT) discussions and endorses the National Comprehensive Cancer Network Harmonized Guidelines for Sub-Saharan Africa (Harmonized Guidelines) to standardize breast cancer care, but the extent of their clinical utilization is not well understood. Objective To identify barriers to and facilitators of the standardization of breast cancer care in Nigeria as reflected by awareness and consultation of resource-adapted guidelines. Design, Setting, and Participants For this survey study, health care professionals (HCPs) involved in breast cancer care in Nigeria were recruited electronically through medical societies and snowball sampling from November 1, 2023, to January 31, 2024. Exposure Breast cancer care guidelines. Main Outcomes and Measures Current breast cancer guideline awareness, adherence among specialties, and multidisciplinary management in Nigeria were evaluated. A multinational, multidisciplinary team developed and distributed an HCP questionnaire. Cochran-Armitage trend tests and logistic regression assessed associations with guideline awareness and use. Results A total of 277 HCPs (median [IQR] age, 42 [38-48] years; 211 of 275 [77%] male), including 124 surgeons (45%), 59 radiologists (21%), 49 clinical oncologists (18%), and 45 pathologists (16%), responded to the survey. Of 274 HCPs, 253 (92%) believed that breast cancer guidelines contribute to better patient outcomes, and 100 of 195 (51%) routinely consulted guidelines. Of 273 HCPs, 103 (38%) had regular engagement in breast cancer MDT discussions. Only 93 of 277 HCPs (34%) were aware of resource-adapted Harmonized Guidelines; both guideline awareness and consultation increased with the frequency of MDT participation. Completing a cancer-related fellowship (OR, 14.56; 95% CI, 6.24-40.00; P &amp;amp;lt; .001), clinical oncology specialization (OR vs surgery, 0.20 [95% CI, 0.09-0.42]; OR vs pathology, 0.05 [95% CI, 0.02-0.14]; OR vs radiology, 0.02 [95% CI, 0.01-0.06]; P &amp;amp;lt; .001), devoting more time to breast health care delivery (OR, 1.04; 95% CI, 1.02-1.05; P &amp;amp;lt; .001), and regular MDT engagement (OR for weekly vs none, 5.13; 95% CI, 1.69-17.35; P = .04) were associated with consulting guidelines regularly on univariable analysis. To improve guideline adherence, 230 of 277 HCPs (83%) reported needing regular MDT discussions. Conclusions and Relevance In this survey of HCPs across Nigeria, half reported routinely consulting guidelines and only one-third were aware of the Harmonized Guidelines, which are resource adapted and endorsed by the Nigerian Federal Ministry of Health. Approximately one-third of HCPs reported engaging in regular breast cancer MDT discussions; guideline awareness and consultation increased as frequency of MDT participation increased. Opportunities for disseminating knowledge, such as MDT discussions and fellowship training, are essential to standardize breast cancer care delivery in Nigeria.