Abstract
Haematological malignancies are major cause of mortality and morbidity worldwide. The aim of this review was to summarize some of the challenges that hamper proper diagnosis and management of haematological malignancies in Nigeria and how they affect outcome. MEDLINE Entrez PubMed, Google scholar and African Journals Online (AJOL) search were performed in April 2020 and studies that investigated challenges in diagnosis and management of haematological malignancies from 2005 to 2019 were sought. Search keywords included “haematological malignancies, challenges, Nigeria”. Only studies that provided information on the challenges of diagnosis and management of haematological malignancies in Nigeria were eligible and were selected. Inclusion criteria were original scientific investigations or case reports, not reviews, studies conducted in Nigeria between 2005 and 2019 and studies written in the English language. A total of eight relevant studies that fulfilled the study inclusion criteria were identified out of 4,129 studies found. Challenges of diagnosis and management of haematological malignancies reported by the studies include late presentation of patients in advanced stage of disease, inability to pay for investigations and/or treatment due to financial constraint, wrong/ delayed diagnosis due to poor diagnostic facility such as use of only morphology for histological diagnosis without immunohistochemistry and poorly equipped health facilities to manage haematological malignancies. Poor outcome as a result of those challenges were also reported by the studies. Awareness creation and education on the importance of early presentation to health facility should be encouraged. Health system should be strengthened by including haematological malignancies in National Health Insurance and providing well equipped health facility for proper diagnosis and management of haematological malignancies.
Highlights
Cancer is a malignant disease condition resulting from uncontrolled division of cells of the body to form abnormal mass of tissue, the growth of which exceeds and is uncoordinated with that of the normal tissues and persists in the same excessive manner after cessation of the stimuli which evoked the change.[1]
The following study inclusion criteria were used: i) studies conducted in Nigeria between 2005 and 2019. ii) Original scientific investigations and case reports, not reviews. iii) Studies conducted which determined the challenges of diagnosis and management of haematological cancers. iv) Studies written in the English language
Challenges of diagnosis and management of haematological malignancies reported by the selected publications[23,24,25,26,27,28,29,30] include: late presentation of patients in advanced stage of disease, difficulty in diagnosis / misdiagnosis due to use of only morphology for histological diagnosis without immunohistochemistry, inability to pay for investigations and/or treatment due to high cost of cytotoxic drugs and financial constraint associated with poverty as well as lack of well-equipped facilities to manage haematological malignancies
Summary
Cancer is a malignant disease condition resulting from uncontrolled division of cells of the body to form abnormal mass of tissue, the growth of which exceeds and is uncoordinated with that of the normal tissues and persists in the same excessive manner after cessation of the stimuli which evoked the change.[1]. Some factors have been identified to increase the risk of their occurrence Such factors include infections with viruses such as human immunodeficiency virus (HIV), Epstein Barr virus, human T-lymphotrophic virus; chronic bacterial infection like Helicobacter pylori; immunosuppression or immunodeficiency states, radiation and chemicals such as benzene.[9,10,11,12,13,14] These factors are thought to be involved in a complex interplay of genetic damage in somatic cells as a result of mutations, cytokine dysregulation and chronic antigenic stimulation resulting in development of these malignancies.[15] The incidence of haematologic malignancies has been shown to vary according to age, gender, geographic region, and histologic subtypes, while cure rates can vary according to region and may be impacted by prompt and accurate diagnosis, treatment availability and access to care.[16,17] Haematologic malignancies are major burden to afflicted patients and their families medically, financially and psychologically.[18,19] The cost of managing these disorders are very expensive. This review aimed to summarize some of the challenges that hamper proper diagnosis and management of haematological malignancies in Nigeria and how they affect outcome
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