Mortality rate and predictors among patients with breast cancer at a referral hospital in northwest Ethiopia: A retrospective follow-up study

PLOS ONE RESEARCH ARTICLE Mortality rate and predictors among patients with breast cancer at a referral hospital in northwest Ethiopia: A retrospective follow-up study Mekides Misganaw ID1*, Haymanote Zeleke ID2, Henok Mulugeta2,3, Birtukan Assefa4 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Department of Adult Health Nursing, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia, 2 Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia, 3 School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney (UTS), Sydney, NSW, Australia, 4 Department of Pediatric Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia * Abstract OPEN ACCESS Background Citation: Misganaw M, Zeleke H, Mulugeta H, Assefa B (2023) Mortality rate and predictors among patients with breast cancer at a referral hospital in northwest Ethiopia: A retrospective follow-up study. PLoS ONE 18(1): e0279656. https://doi.org/10.1371/journal.pone.0279656 Breast cancer is one of the common global health concerns that affects2.1 million women each year and causes the highest number of cancer-related morbidity and mortality among women. The objective of this study was to determine the mortality rate and its predictors among breast cancer patients at the referral hospitals, in northwest Ethiopia. Editor: Elda Tagliabue, Fondazione IRCCS Istituto Nazionale dei Tumori, ITALY Methods Received: September 1, 2022 Accepted: December 12, 2022 Published: January 26, 2023 Copyright: © 2023 Misganaw et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: Debre Markos University is the source of funds for our study. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist A retrospective follow-up study was conducted on breast cancer patients registered between February 01, 2015 and February 28, 2018. They were selected by simple random sampling using computer-generated method and followed until February 29, 2020, in Amhara region referral hospital. A pre-tested data extraction checklist was used to collect data from the registration book and patient medical records. The collected data were entered into Epi-Data version 3.1 and exported to STATA version 14 for analysis. The mortality rate by person-year observation was computed. The Kaplan-Meier survival curve with the log-rank test was used to estimate the survival probabilities of the patients. Bivariate and multivariate Cox regression model was used to identify predictors of mortality. Results The overall mortality rate of breast cancer was 16.9 per 100 person-years observation. The median survival time was 38.3 (IQR: 26.23, 49.4) months. Independent predictors of breast cancer mortality was; Clinical stage IV and stage III (aHR:10.44,95% CI: 8.02,11.93 and aHR: 9.43, 95% CI: 6.29,11.03respectively), number of positive lymph node in the category of 10 and more and number of positive lymph node within the category of 4–9 (aHR:12.58, 95%CI: 5.2, 30.46 and aHR: 4.78, 95% CI: 2.19, 10.43respectively), co-morbidities PLOS ONE | https://doi.org/10.1371/journal.pone.0279656 January 26, 2023 1 / 15 PLOS ONE Abbreviations: aHR, adjusted hazard ratio; GLOBOCAN, Global burden of cancer; HIC, highincome country; IDC, invasive ductal carcinoma; LMIC, low- and middle- income countries; SSA, Sub-Saharan Africa; USA, United States of America; UOGCSRH, University of Gondar compressive specialized referral hospital; WHO, world health organization. Mortality rate and predictors of breast cancer (aHR:1.5, 95%CI: 1.01,2.21), Postmenopausal (aHR:2.03,95% CI: 1.37, 3), histologic grade III (aHR:2.12, 95% CI: 1.26,3.55) and not received hormonal therapy (aHR: 2.19, 95%CI: 1.52,3.15) were independent predictors of mortality. Conclusion The overall mortality rate was 16.9 per 100 person-years. The finding was higher compared to high-income countries. Advanced clinical stage, co-morbidities, menopausal status, and hormonal therapy are the significant predictors of mortality. Early detection and treatment of breast cancer is needed to reduce the mortality rate. Background Breast cancer is the leading cause of cancer-related death among women [1]. Globally, approximately 25% of cancer cases and 15% of cancer deaths among women were due to breast cancer. The mortality and incidence rate of breast cancer is highest in Africa, especially in the subSaharan African countries(SSA) [2]. According to the 2018 report by the World Health Organization (WHO), breast cancer is responsible for the deaths of 627,000 women worldwide. An ecological study showed that the highest standardized mortality rate in Eastern Europe was 18.6 per 100,000 and the lowest rate in Western Europe was 7 per 100,000 [3]. In Africa, the mortality rate was 17 per 100,000 and in eastern Asia, the mortality rate was 6.9 per 100,000 [4]. The five year survival status of patient with breast cancer was 84% in the US, 89.5% in Australia, 81% in Europe [5], 69.55 in Iran [6], 74% in Vietnam [7], 51.07% in Indonesia [8], 49.45 in Malaysia [9] and 66.1% in India [10]. Furthermore, a study conducted in Central Iran, shows that survival rates at one, two, three, four and five years were estimated at 98.0%, 96.0%, 92.0%, 89.0% and 87.0%, respectively [11]. Concerning Sub-Saharan countries the five year survival status was South Africa (53.4%), Gambia (11.9%), and Mali (13.6%) [19]. In Ethiopia A retrospective cohort study showed that the overall survival of breast cancer patients at the end of five years was 25.8% [12]. The survival of breast cancer patients was affected by many factors such as socio-demographic variables (age, educational level, financial status, family history), tumor pathological, and clinical parameters(tumor size, nodal status, presence of metastatic disease, clinical stage, tumor location, histology grade), the presence of co-morbidities and type of treatment [13– 15]. Breast cancer is becoming a challenging health condition in Ethiopia with a high rate of morbidity and mortality [16]. The national crude death rate of breast cancer was 9.8 per 100 person- years [17]. It is also the most common type of cancer, accounting for more than one third of all cancer cases among women and one-fifth of all national cancer cases in the general population [18]. The average survival probability of metastatic breast cancer was about 12 months [19]. The overall median survival time was 56.5 months according to recent study conducted in a B (...truncated)