International Journal of Current Research and Review
Introduction: The quality approach implementation in Moroccan public hospitals (MPH) is a major c... more Introduction: The quality approach implementation in Moroccan public hospitals (MPH) is a major challenge for improving access, safety, quality, and performance in health care provision. Faced with the increasingly demanding expectations of the health system users and the universal health recommendations, the development of a national health system in accordance with international quality standards is becoming a challenge for the Moroccan health system, hence the importance of implementing a quality approach adapted to each hospital’s context. Design and Methods: This is a cross-sectional study that occurred from January 01, 2018, to March 31, 2021, at the National Institute of oncology (NIO), 12 resource persons participated in the focus group; the documents used included the NIO establishment project, quality activity reports, and the service quality manual. They were chosen using the non-probability sampling method with the conventional technique for resource persons. Results: Th...
Background: The aim of this study is to document the time intervals of breast cancer and especial... more Background: The aim of this study is to document the time intervals of breast cancer and especially the delays of patient, diagnosis and treatment and to evaluate how clinical, socio-demographic and treatment factors influence the delays along the clinical course of a patient. Methods: A retrospective study was conducted at the FEZ Oncology Hospital of the Hassan II University Hospital Center in MOROCCO. Results: 410 medical records of breast cancer patients were collected. The 31.2% of the patients were 45-54 years old. Median patient delay was 6 days, median diagnostic delay was 97 days, and median treatment delay was 44 days. Multivariate analysis revealed that the patient age was associated with the delay in diagnosis and treatment. The diagnosis year (the year in which the patient was diagnosed (either from 2012 to 2014 or 2015 to 2017), was associated with the patient delay and the diagnosis delay. The age, the type of medical consultation (general physician, private physician, specialist physician or Health Care Worker), the Union for International Cancer Control (UICC) tumour stage and the biopsy exam were associated with the diagnosis delay. Thus, the delay of the treatment was significantly associated with the nodal status. Conclusion: The concept of measuring time intervals in the cancer patient pathway is a crucial indicator for improving the quality of care.
Colorectal cancer (CRC) incidence and mortality rates are increasing rapidly in many low‐income a... more Colorectal cancer (CRC) incidence and mortality rates are increasing rapidly in many low‐income and middle‐income countries. A demonstration project was implemented in Morocco in collaboration with the Ministry of Health to assess the feasibility, acceptability, and challenges of implementing CRC screening through routine primary care facilities.
Introduction. The objective of this study was to investigate the impact of socioeconomic determin... more Introduction. The objective of this study was to investigate the impact of socioeconomic determinants on the quality of life of Moroccan women with breast cancer two years after their diagnosis who are followed up at the National Institute of Oncology (INO) in Rabat. Methods. This is a cross-sectional study that was conducted between May 2019 and September 2020. The sample size was 304 women. Data were collected using the EORTC QLQ-C30 and EORTC QLQ-BR 23 questionnaires in the Moroccan dialect. Results. The mean age of participants was 53.5 ± 12.4 years, where the majority resided in urban areas and more than half were illiterate. Moreover, three-quarters of the survivors were not working, and almost all have basic medical coverage. Nearly one-third of the respondents had experienced discrimination from those around them, and nearly half attributed the decrease in income to their state of health. In addition, 38.2 percent of participants stated that they had great difficulty living ...
Objective: The aim of this study was the measure- ment of cancer patient's satisfaction regar... more Objective: The aim of this study was the measure- ment of cancer patient's satisfaction regarding health care services received during their hospitalizations. Methods: A cross-sectional study of cancer patients treated at two oncology hospitals (Ibn Rochd in Casablanca and the National Institution of Oncology in Rabat) was assessed. A patient satisfaction questionnaire (EORTC IN-Patsat32) was used. The clinical, demographic and EORTC In-Patsat32 factors were evaluated for predictive significance. Results: The mean age of the sample was 46.6 years (SD = 14.08, range 16 to 89), with a preponderance of fema- les (66.5%). The majority of patients received chemotherapy (60.1%). The patients'satisfaction had generally average sco- res below 52. Patients living in rural areas reported satisfac- tion more than residents in urban areas towards the comfort of the institution (p < 10 -3 ). The patients' satisfaction towards the nurses' information provision, the waiting time...
In Morocco, most Hospital Information System projects undertaken by the Moroccan health sector ar... more In Morocco, most Hospital Information System projects undertaken by the Moroccan health sector are technical-oriented and executed as independent projects, with a focus on the management of administrative and financial activities above patient needs and the importance of business process improvement. This paper aims to fill this gap by proposing a global architecture for a Moroccan 'Patient-centered Health Information System' and a method to deploy it. This proposal is based on national and international eHealth experiences and provides a clear and comprehensive view of what a Moroccan Health Information System should look like. This paper focuses on describing the main requirements that should be implemented to enhance the quality of Moroccan patient care.
We are thankful to Dr. Motiaa Youssef and Dr. Ghannam Abdelilah for referring to our breast cance... more We are thankful to Dr. Motiaa Youssef and Dr. Ghannam Abdelilah for referring to our breast cancer ‘pattern of care’ study in Morocco in their article [1]. While we fully agree with the authors about cancer pain management being an important quality indicator for oncology care, our retrospective study didn't have adequate data on the quality of cancer pain management at the two oncology centers in Morocco. The aim of our study was not to identify and/or validate any indicator for quality of cancer care. We used selected EUSOMA quality Standards that we could report for Morocco based on our retrospective data. It will be a useful initiative to define quality standards for breast cancer care in theMiddle East and North Africa (MENA) region.
Guided by a national cancer plan (2010–19), Morocco made significant investments in improving bre... more Guided by a national cancer plan (2010–19), Morocco made significant investments in improving breast cancer detection and treatment. A breast cancer pattern-of-care study was conducted to document the socio-demographic profiles of patients and tumour characteristics, measure delays in care, and assess the status of dissemination and impact of state-of-the-art management. The retrospective study conducted among 2120 breast cancer patients registered during 2008–17 at the two premier-most oncology centres (Centre Mohammed VI or CM-VI and Institut National d’Oncologie or INO) also measured temporal trends of the different variables. Median age (49 years) and other socio-demographic characteristics of the patients remained constant over time. A significant improvement in coverage of the state-financed health insurance scheme for indigent populations was observed over time. Median interval between onset of symptoms and first medical consultation was 6 months with a significant reduction over time. Information on staging and molecular profile were available for more than 90% and 80% of the patients respectively. Approximately 55% of the patients presented at stage I/II and proportion of triple-negative cancers was 16%; neither showing any appreciable temporal variation. Treatment information was available for more than 90% of the patients; 69% received surgery with chemotherapy and/or radiation. Treatment was tailored to stage and molecular profiles, though breast conservation therapy was offered to less than one-fifth. When compared using the EUSOMA quality indicators for breast cancer management, INO performed better than CM-VI. This was reflected in nearly 25% difference in 5-year disease-free survival for early-stage cancers between the centres.
In Morocco, most of the cervical cancer patients have been reported diagnosed at advanced stage i... more In Morocco, most of the cervical cancer patients have been reported diagnosed at advanced stage indicating delay in seeking diagnosis and treatment. The main purpose of this investigation was to measure the delay from the first symptom to treatment among Moroccan women with cervical cancer. Methods: We conducted a cross-sectional study at the National Institute of Oncology Sidi Mohammed Ben Abdellah in Rabat, Morocco. A consecutive series of patients with locally advanced cervical cancer or metastasic [stage II-IV] were recruited. We calculated delay by using two events dates of two periods in patient's pathway. Multivariate binary logistic regression analysis was performed to measure the association between all categories of delay and magnitude of total delay. Results: Four hundred and one patients were reached in this study. The median total delay was 183 days, the median patient delay was 120 days, the median diagnosis delay was 110 days, and the median Treatment delay was 57 days. Bivariate analysis showed that patients who did not have respectively patient and diagnosis delay were less likely to have total delay (p<0.001, p<0.001). Conclusions: Future studies are needed to better inform the scientific and healthcare system to effectively address a clear picture of delays.
Introduction. The aim of this study is to document time intervals in cervical cancer care pathway... more Introduction. The aim of this study is to document time intervals in cervical cancer care pathways, from symptom onset to disease detection and start of treatment, and evaluate how clinical, sociodemographic, and treatment factors influence delays throughout a patient’s clinical pathway. Methods. A retrospective study was conducted at the FEZ Oncology Hospital of the Hassan II University Hospital Center in Morocco. Results. 190 medical records of cervical cancer patients were collected. The dominant age group was 35–44, the median patient delay (PD) was 6 days, the median healthcare provider’s delay (HCP) was 21 days, the median referral delay (RD) was 17 days, the median diagnostic delay (DD) was 9.5 days, the median total diagnostic delay (TDD) was 16 days, the median treatment delay (TD) was 67 days, and the median health system interval (HSI) was 92 days. Multivariate analysis revealed that age was associated with the patient delay, the healthcare provider’s delay, the diagnosis...
Background: Breast cancer is characterized in Morocco, by the delay in diagnosis, with a high rat... more Background: Breast cancer is characterized in Morocco, by the delay in diagnosis, with a high rate of metastatic extension which leads to the difficulty of treatment and an increasement of mortality. It is often the woman who detects breast abnormalities through self-examination. Self-examination alone does not diagnose the breast cancer. Despite it is accessible method in developing countries because it is easy, convenient, private, safe and requires no specific equipment. Aim: The objective was to study the practice of breast self-examination in women in Morocco. Methods: This was a cross-sectional observational study that was conducted in July 2011 based on early detection programs in basic health centers. A total of 1444 women aged from 17 to 86 years were included on the eligibility basis for early detection of breast and cervical cancer in Morocco. For each participant we collected sociodemographic data, information on breast cancer factors, data on the level of knowledge of b...
Examples of successful implementations of national cancer control plans in low-income or middle-i... more Examples of successful implementations of national cancer control plans in low-income or middle-income countries remain rare. Morocco, a country where cancer is already the second leading cause of death after cardiovascular diseases, is one exception in this regard. Population ageing and lifestyle changes are the major drivers that are further increasing the cancer burden in the country. Facing this challenge, the Moroccan Ministry of Health has developed a we l planned and pragmatic National Plan for Cancer Prevention and Control (NPCPC) that, since 2010, has been implemented with government financial support to provide basic cancer care services across the entire range of cancer control. Several features of the development and implementation of the NPCPC and health-care financing in Morocco provide exemplars for other low-income and middle-income countries to follow. Additionally, from the first 5 years of NPCPC, several areas were shown to require further focus through implementa...
Asian Pacific journal of cancer prevention : APJCP, Apr 1, 2017
Background: Breast cancer is the most common cancer of women in Morocco and its diagnosis is usua... more Background: Breast cancer is the most common cancer of women in Morocco and its diagnosis is usually made at advanced stages. The aim of this study was to describe the knowledge, practices and attitudes of general practitioners regarding early detection of breast cancer. Methods: A cross-sectional study was carried out during July 2011 on a sample of 140 general practitioners employed in basic health care facilities. Results: The majority (85.7%) of general practitioners were aware of the existence of a ministerial circular which aimed to generalize breast cancer screening. Systematic practice of clinical breast examination was reported by 18.0% of doctors for every woman between 45 and 70 years and a systematic breast self-examination check-up was reported by 59.4% of physicians. Mammography was requested by 54.1% of physicians in the presence of risk factors. Females and physicians practicing in urban areas were less likely to have a knowledge, attitudes and practices score higher...
Asian Pacific journal of cancer prevention : APJCP, Jun 25, 2017
Background: Moroccan cancer patients usually have to go through several steps before they are dia... more Background: Moroccan cancer patients usually have to go through several steps before they are diagnosed. It is important to assess factors associated with diagnosis delay for lymphomas, which might have significant effects on survival. The aim of this study was to determine factors leading to late diagnosis of lymphomas. Methods: A cross-sectional study was conducted with three hematology centers in Morocco in 2008, to analyze the impact of sociodemographic and clinical factors on delay-time from symptoms to diagnosis. Results: A total of 151 patients were included in the study. Late delay was significantly associated with gender, (for men compared to women: OR=2.46; 95% CI: 1.06-5.74), to marital status (not married: OR=2.50; 95% CI: 1.06-5.92) and low socioeconomic level (OR=5.82; 95% CI: 2.23-15.17). Late medical delay was significantly associated with having three or more medical visits before diagnosis (Adjusted OR=5.67; 95% CI: 2.55-12.59). Late total delay was observed for pa...
Introduction. This study sought to investigate potential determinants of patient delay among Moro... more Introduction. This study sought to investigate potential determinants of patient delay among Moroccan women with cervical cancer. Methods. A cross-sectional study was conducted from June 2014 to June 2015 at the National Institute of Oncology in Rabat. Data were collected using questionnaire among patients with cervical cancer locally advanced or metastatic (stages IIA–IVB). Medical records were abstracted to complete clinical information. An interval longer than 90 days between discovery of initial symptoms and presentation to a provider was defined as a patient delay. Results. Four hundred and one patients with cervical cancer enrolled in this study. The mean age was 52.4 years (SD = 11.5). 53.6% were illiterate. Abnormal vaginal bleeding was identified for 65.8% of patients. 60.1% were diagnosed at stages IIA-IIB. 55.4% were found having patient delay. The regression analyses showed the association between literacy (p<0.001), distance of the place of the first consultation (p=...
Asian Pacific journal of cancer prevention : APJCP, May 1, 2017
Background. The EORTC IN-PATSAT32 questionnaire was developed by the EORTC Quality of Life (QL) G... more Background. The EORTC IN-PATSAT32 questionnaire was developed by the EORTC Quality of Life (QL) Group to assess the satisfaction of patients affected by cancer and hospitalized in oncology centers. The aim of this study is to assess the psychometric properties of the EORTC IN-PATSAT32 administered to Moroccan patients. Methods. A total of 133 hospitalized patients affected by cancer in different sites completed the translated EORTC IN-PATSAT32 questionnaire in oncology hospitals. The internal consistence reliability, reproducibility and construct validity were assessed. Results. The homogeneity was good for all scales with Cronbach’s coefficients from 0.72 to 0.95 for all scales. Reproducibility test-retest was very satisfactory and the intra-class correlations coefficients (ICCs) for the scales were all above 0.70 except for the single general satisfaction with a ICC of 0.67. All items were highly correlated with own rather than other scales. Conclusion. The results of this study c...
Breast cancer appears to be a disease of both the developing and developed worlds. Among Moroccan... more Breast cancer appears to be a disease of both the developing and developed worlds. Among Moroccan women, breast cancer represents 34.4% of all cancers seen in women. This study aimed to give an overview of the knowledge, attitudes and perceptions related to breast cancer among Moroccan women. To our knowledge there is no previous study in Morocco to assess Moroccan women awareness of breast cancer. A national Cross-sectional study started in July 2011 based on eligible women for early detection programs in basal health centers from five Moroccan regions. A self-filled questionnaire was used to collect data outside working time. Knowledge was assessed using 24 true-false items. The questions were asked about symptoms and risk factors of breast cancer. A score ranging from 0 to 24 was calculated by weighting each item 1 point. Then the score was dichotomized according to the threshold 12 (50% correct answers). The study included 1,444 women from the regions of Rabat, Casablanca, Marrakech, Fez and Meknes. The average age was 40.6 ± 10 years, 2 women with a minimum age of 17 years and a 1 with a maximum age of 86 years. At the bivariate analysis using chi-square test we found that Marital Status, Social Security, Education, Origin, Sport, Personal History of Cancer, Medical and Surgical personal History were associated with knowledge score. At the multivariate analysis (Logistic regression), we found that Social Security, Education, Origin, Sport were associated to knowledge score at the final model. This study has important implications for health care providers. The poor knowledge of risk factors and practice of breast screening leads to late stage presentation at diagnosis of breast cancer.
Background: A multicentre cohort study was held in Morocco, designed to evaluate the quality of l... more Background: A multicentre cohort study was held in Morocco, designed to evaluate the quality of life of cancer patients. The aim of this paper is to report the assessment of the quality of life of early colorectal cancer patients, before and after cancer treatment, to identify other factors which are related to this quality of life. Methods: We used the third version of the QLQ-C30 questionnaire of the European organization for Research and treatment of Cancer (EORTC) after a transcultural validation. The Data collection was done at inclusion and then every twelve weeks to achieve one year of follow up. Results: Overall 294 patients presented with early colorectal cancer, the median age was 56 years (range: 21-88). The male-female sex ratio was 1.17. At inclusion, the global health status was the most affected functional dimension. For symptoms: financial difficulties and fatigue scores were the highest ones. Emotional and social functions were significantly worse in rectal cancer. Most symptoms were more present in rectal cancer. At inclusion, global health status score was significantly worse in stage III. Anorexia was significantly more important among colorectal female patients. For Patients over 70 years-old, the difference was statistically significant for the physical function item which was lower. Overall, Functional dimensions scores were improved after chemotherapy. The symptoms scores did not differ significantly for patients treated by radiotherapy, between inclusion and at one year. Conclusion: Our EORTC QLQ C30 scores are overall comparable to the reference values. Neither chemotherapy, nor radiotherapy worsened the quality of life at one year.
Background: Quality of life has become an important concept in cancer care. Among the quality of ... more Background: Quality of life has become an important concept in cancer care. Among the quality of lifestudies in cancer patients, breast cancer has received most attention. This review reports on quality of life in Arab patients with breast cancer. Methods: The search was conducted using inclusion and exclusion criteria and in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The databases consulted were PubMed,
International Journal of Current Research and Review
Introduction: The quality approach implementation in Moroccan public hospitals (MPH) is a major c... more Introduction: The quality approach implementation in Moroccan public hospitals (MPH) is a major challenge for improving access, safety, quality, and performance in health care provision. Faced with the increasingly demanding expectations of the health system users and the universal health recommendations, the development of a national health system in accordance with international quality standards is becoming a challenge for the Moroccan health system, hence the importance of implementing a quality approach adapted to each hospital’s context. Design and Methods: This is a cross-sectional study that occurred from January 01, 2018, to March 31, 2021, at the National Institute of oncology (NIO), 12 resource persons participated in the focus group; the documents used included the NIO establishment project, quality activity reports, and the service quality manual. They were chosen using the non-probability sampling method with the conventional technique for resource persons. Results: Th...
Background: The aim of this study is to document the time intervals of breast cancer and especial... more Background: The aim of this study is to document the time intervals of breast cancer and especially the delays of patient, diagnosis and treatment and to evaluate how clinical, socio-demographic and treatment factors influence the delays along the clinical course of a patient. Methods: A retrospective study was conducted at the FEZ Oncology Hospital of the Hassan II University Hospital Center in MOROCCO. Results: 410 medical records of breast cancer patients were collected. The 31.2% of the patients were 45-54 years old. Median patient delay was 6 days, median diagnostic delay was 97 days, and median treatment delay was 44 days. Multivariate analysis revealed that the patient age was associated with the delay in diagnosis and treatment. The diagnosis year (the year in which the patient was diagnosed (either from 2012 to 2014 or 2015 to 2017), was associated with the patient delay and the diagnosis delay. The age, the type of medical consultation (general physician, private physician, specialist physician or Health Care Worker), the Union for International Cancer Control (UICC) tumour stage and the biopsy exam were associated with the diagnosis delay. Thus, the delay of the treatment was significantly associated with the nodal status. Conclusion: The concept of measuring time intervals in the cancer patient pathway is a crucial indicator for improving the quality of care.
Colorectal cancer (CRC) incidence and mortality rates are increasing rapidly in many low‐income a... more Colorectal cancer (CRC) incidence and mortality rates are increasing rapidly in many low‐income and middle‐income countries. A demonstration project was implemented in Morocco in collaboration with the Ministry of Health to assess the feasibility, acceptability, and challenges of implementing CRC screening through routine primary care facilities.
Introduction. The objective of this study was to investigate the impact of socioeconomic determin... more Introduction. The objective of this study was to investigate the impact of socioeconomic determinants on the quality of life of Moroccan women with breast cancer two years after their diagnosis who are followed up at the National Institute of Oncology (INO) in Rabat. Methods. This is a cross-sectional study that was conducted between May 2019 and September 2020. The sample size was 304 women. Data were collected using the EORTC QLQ-C30 and EORTC QLQ-BR 23 questionnaires in the Moroccan dialect. Results. The mean age of participants was 53.5 ± 12.4 years, where the majority resided in urban areas and more than half were illiterate. Moreover, three-quarters of the survivors were not working, and almost all have basic medical coverage. Nearly one-third of the respondents had experienced discrimination from those around them, and nearly half attributed the decrease in income to their state of health. In addition, 38.2 percent of participants stated that they had great difficulty living ...
Objective: The aim of this study was the measure- ment of cancer patient's satisfaction regar... more Objective: The aim of this study was the measure- ment of cancer patient's satisfaction regarding health care services received during their hospitalizations. Methods: A cross-sectional study of cancer patients treated at two oncology hospitals (Ibn Rochd in Casablanca and the National Institution of Oncology in Rabat) was assessed. A patient satisfaction questionnaire (EORTC IN-Patsat32) was used. The clinical, demographic and EORTC In-Patsat32 factors were evaluated for predictive significance. Results: The mean age of the sample was 46.6 years (SD = 14.08, range 16 to 89), with a preponderance of fema- les (66.5%). The majority of patients received chemotherapy (60.1%). The patients'satisfaction had generally average sco- res below 52. Patients living in rural areas reported satisfac- tion more than residents in urban areas towards the comfort of the institution (p < 10 -3 ). The patients' satisfaction towards the nurses' information provision, the waiting time...
In Morocco, most Hospital Information System projects undertaken by the Moroccan health sector ar... more In Morocco, most Hospital Information System projects undertaken by the Moroccan health sector are technical-oriented and executed as independent projects, with a focus on the management of administrative and financial activities above patient needs and the importance of business process improvement. This paper aims to fill this gap by proposing a global architecture for a Moroccan 'Patient-centered Health Information System' and a method to deploy it. This proposal is based on national and international eHealth experiences and provides a clear and comprehensive view of what a Moroccan Health Information System should look like. This paper focuses on describing the main requirements that should be implemented to enhance the quality of Moroccan patient care.
We are thankful to Dr. Motiaa Youssef and Dr. Ghannam Abdelilah for referring to our breast cance... more We are thankful to Dr. Motiaa Youssef and Dr. Ghannam Abdelilah for referring to our breast cancer ‘pattern of care’ study in Morocco in their article [1]. While we fully agree with the authors about cancer pain management being an important quality indicator for oncology care, our retrospective study didn't have adequate data on the quality of cancer pain management at the two oncology centers in Morocco. The aim of our study was not to identify and/or validate any indicator for quality of cancer care. We used selected EUSOMA quality Standards that we could report for Morocco based on our retrospective data. It will be a useful initiative to define quality standards for breast cancer care in theMiddle East and North Africa (MENA) region.
Guided by a national cancer plan (2010–19), Morocco made significant investments in improving bre... more Guided by a national cancer plan (2010–19), Morocco made significant investments in improving breast cancer detection and treatment. A breast cancer pattern-of-care study was conducted to document the socio-demographic profiles of patients and tumour characteristics, measure delays in care, and assess the status of dissemination and impact of state-of-the-art management. The retrospective study conducted among 2120 breast cancer patients registered during 2008–17 at the two premier-most oncology centres (Centre Mohammed VI or CM-VI and Institut National d’Oncologie or INO) also measured temporal trends of the different variables. Median age (49 years) and other socio-demographic characteristics of the patients remained constant over time. A significant improvement in coverage of the state-financed health insurance scheme for indigent populations was observed over time. Median interval between onset of symptoms and first medical consultation was 6 months with a significant reduction over time. Information on staging and molecular profile were available for more than 90% and 80% of the patients respectively. Approximately 55% of the patients presented at stage I/II and proportion of triple-negative cancers was 16%; neither showing any appreciable temporal variation. Treatment information was available for more than 90% of the patients; 69% received surgery with chemotherapy and/or radiation. Treatment was tailored to stage and molecular profiles, though breast conservation therapy was offered to less than one-fifth. When compared using the EUSOMA quality indicators for breast cancer management, INO performed better than CM-VI. This was reflected in nearly 25% difference in 5-year disease-free survival for early-stage cancers between the centres.
In Morocco, most of the cervical cancer patients have been reported diagnosed at advanced stage i... more In Morocco, most of the cervical cancer patients have been reported diagnosed at advanced stage indicating delay in seeking diagnosis and treatment. The main purpose of this investigation was to measure the delay from the first symptom to treatment among Moroccan women with cervical cancer. Methods: We conducted a cross-sectional study at the National Institute of Oncology Sidi Mohammed Ben Abdellah in Rabat, Morocco. A consecutive series of patients with locally advanced cervical cancer or metastasic [stage II-IV] were recruited. We calculated delay by using two events dates of two periods in patient's pathway. Multivariate binary logistic regression analysis was performed to measure the association between all categories of delay and magnitude of total delay. Results: Four hundred and one patients were reached in this study. The median total delay was 183 days, the median patient delay was 120 days, the median diagnosis delay was 110 days, and the median Treatment delay was 57 days. Bivariate analysis showed that patients who did not have respectively patient and diagnosis delay were less likely to have total delay (p<0.001, p<0.001). Conclusions: Future studies are needed to better inform the scientific and healthcare system to effectively address a clear picture of delays.
Introduction. The aim of this study is to document time intervals in cervical cancer care pathway... more Introduction. The aim of this study is to document time intervals in cervical cancer care pathways, from symptom onset to disease detection and start of treatment, and evaluate how clinical, sociodemographic, and treatment factors influence delays throughout a patient’s clinical pathway. Methods. A retrospective study was conducted at the FEZ Oncology Hospital of the Hassan II University Hospital Center in Morocco. Results. 190 medical records of cervical cancer patients were collected. The dominant age group was 35–44, the median patient delay (PD) was 6 days, the median healthcare provider’s delay (HCP) was 21 days, the median referral delay (RD) was 17 days, the median diagnostic delay (DD) was 9.5 days, the median total diagnostic delay (TDD) was 16 days, the median treatment delay (TD) was 67 days, and the median health system interval (HSI) was 92 days. Multivariate analysis revealed that age was associated with the patient delay, the healthcare provider’s delay, the diagnosis...
Background: Breast cancer is characterized in Morocco, by the delay in diagnosis, with a high rat... more Background: Breast cancer is characterized in Morocco, by the delay in diagnosis, with a high rate of metastatic extension which leads to the difficulty of treatment and an increasement of mortality. It is often the woman who detects breast abnormalities through self-examination. Self-examination alone does not diagnose the breast cancer. Despite it is accessible method in developing countries because it is easy, convenient, private, safe and requires no specific equipment. Aim: The objective was to study the practice of breast self-examination in women in Morocco. Methods: This was a cross-sectional observational study that was conducted in July 2011 based on early detection programs in basic health centers. A total of 1444 women aged from 17 to 86 years were included on the eligibility basis for early detection of breast and cervical cancer in Morocco. For each participant we collected sociodemographic data, information on breast cancer factors, data on the level of knowledge of b...
Examples of successful implementations of national cancer control plans in low-income or middle-i... more Examples of successful implementations of national cancer control plans in low-income or middle-income countries remain rare. Morocco, a country where cancer is already the second leading cause of death after cardiovascular diseases, is one exception in this regard. Population ageing and lifestyle changes are the major drivers that are further increasing the cancer burden in the country. Facing this challenge, the Moroccan Ministry of Health has developed a we l planned and pragmatic National Plan for Cancer Prevention and Control (NPCPC) that, since 2010, has been implemented with government financial support to provide basic cancer care services across the entire range of cancer control. Several features of the development and implementation of the NPCPC and health-care financing in Morocco provide exemplars for other low-income and middle-income countries to follow. Additionally, from the first 5 years of NPCPC, several areas were shown to require further focus through implementa...
Asian Pacific journal of cancer prevention : APJCP, Apr 1, 2017
Background: Breast cancer is the most common cancer of women in Morocco and its diagnosis is usua... more Background: Breast cancer is the most common cancer of women in Morocco and its diagnosis is usually made at advanced stages. The aim of this study was to describe the knowledge, practices and attitudes of general practitioners regarding early detection of breast cancer. Methods: A cross-sectional study was carried out during July 2011 on a sample of 140 general practitioners employed in basic health care facilities. Results: The majority (85.7%) of general practitioners were aware of the existence of a ministerial circular which aimed to generalize breast cancer screening. Systematic practice of clinical breast examination was reported by 18.0% of doctors for every woman between 45 and 70 years and a systematic breast self-examination check-up was reported by 59.4% of physicians. Mammography was requested by 54.1% of physicians in the presence of risk factors. Females and physicians practicing in urban areas were less likely to have a knowledge, attitudes and practices score higher...
Asian Pacific journal of cancer prevention : APJCP, Jun 25, 2017
Background: Moroccan cancer patients usually have to go through several steps before they are dia... more Background: Moroccan cancer patients usually have to go through several steps before they are diagnosed. It is important to assess factors associated with diagnosis delay for lymphomas, which might have significant effects on survival. The aim of this study was to determine factors leading to late diagnosis of lymphomas. Methods: A cross-sectional study was conducted with three hematology centers in Morocco in 2008, to analyze the impact of sociodemographic and clinical factors on delay-time from symptoms to diagnosis. Results: A total of 151 patients were included in the study. Late delay was significantly associated with gender, (for men compared to women: OR=2.46; 95% CI: 1.06-5.74), to marital status (not married: OR=2.50; 95% CI: 1.06-5.92) and low socioeconomic level (OR=5.82; 95% CI: 2.23-15.17). Late medical delay was significantly associated with having three or more medical visits before diagnosis (Adjusted OR=5.67; 95% CI: 2.55-12.59). Late total delay was observed for pa...
Introduction. This study sought to investigate potential determinants of patient delay among Moro... more Introduction. This study sought to investigate potential determinants of patient delay among Moroccan women with cervical cancer. Methods. A cross-sectional study was conducted from June 2014 to June 2015 at the National Institute of Oncology in Rabat. Data were collected using questionnaire among patients with cervical cancer locally advanced or metastatic (stages IIA–IVB). Medical records were abstracted to complete clinical information. An interval longer than 90 days between discovery of initial symptoms and presentation to a provider was defined as a patient delay. Results. Four hundred and one patients with cervical cancer enrolled in this study. The mean age was 52.4 years (SD = 11.5). 53.6% were illiterate. Abnormal vaginal bleeding was identified for 65.8% of patients. 60.1% were diagnosed at stages IIA-IIB. 55.4% were found having patient delay. The regression analyses showed the association between literacy (p<0.001), distance of the place of the first consultation (p=...
Asian Pacific journal of cancer prevention : APJCP, May 1, 2017
Background. The EORTC IN-PATSAT32 questionnaire was developed by the EORTC Quality of Life (QL) G... more Background. The EORTC IN-PATSAT32 questionnaire was developed by the EORTC Quality of Life (QL) Group to assess the satisfaction of patients affected by cancer and hospitalized in oncology centers. The aim of this study is to assess the psychometric properties of the EORTC IN-PATSAT32 administered to Moroccan patients. Methods. A total of 133 hospitalized patients affected by cancer in different sites completed the translated EORTC IN-PATSAT32 questionnaire in oncology hospitals. The internal consistence reliability, reproducibility and construct validity were assessed. Results. The homogeneity was good for all scales with Cronbach’s coefficients from 0.72 to 0.95 for all scales. Reproducibility test-retest was very satisfactory and the intra-class correlations coefficients (ICCs) for the scales were all above 0.70 except for the single general satisfaction with a ICC of 0.67. All items were highly correlated with own rather than other scales. Conclusion. The results of this study c...
Breast cancer appears to be a disease of both the developing and developed worlds. Among Moroccan... more Breast cancer appears to be a disease of both the developing and developed worlds. Among Moroccan women, breast cancer represents 34.4% of all cancers seen in women. This study aimed to give an overview of the knowledge, attitudes and perceptions related to breast cancer among Moroccan women. To our knowledge there is no previous study in Morocco to assess Moroccan women awareness of breast cancer. A national Cross-sectional study started in July 2011 based on eligible women for early detection programs in basal health centers from five Moroccan regions. A self-filled questionnaire was used to collect data outside working time. Knowledge was assessed using 24 true-false items. The questions were asked about symptoms and risk factors of breast cancer. A score ranging from 0 to 24 was calculated by weighting each item 1 point. Then the score was dichotomized according to the threshold 12 (50% correct answers). The study included 1,444 women from the regions of Rabat, Casablanca, Marrakech, Fez and Meknes. The average age was 40.6 ± 10 years, 2 women with a minimum age of 17 years and a 1 with a maximum age of 86 years. At the bivariate analysis using chi-square test we found that Marital Status, Social Security, Education, Origin, Sport, Personal History of Cancer, Medical and Surgical personal History were associated with knowledge score. At the multivariate analysis (Logistic regression), we found that Social Security, Education, Origin, Sport were associated to knowledge score at the final model. This study has important implications for health care providers. The poor knowledge of risk factors and practice of breast screening leads to late stage presentation at diagnosis of breast cancer.
Background: A multicentre cohort study was held in Morocco, designed to evaluate the quality of l... more Background: A multicentre cohort study was held in Morocco, designed to evaluate the quality of life of cancer patients. The aim of this paper is to report the assessment of the quality of life of early colorectal cancer patients, before and after cancer treatment, to identify other factors which are related to this quality of life. Methods: We used the third version of the QLQ-C30 questionnaire of the European organization for Research and treatment of Cancer (EORTC) after a transcultural validation. The Data collection was done at inclusion and then every twelve weeks to achieve one year of follow up. Results: Overall 294 patients presented with early colorectal cancer, the median age was 56 years (range: 21-88). The male-female sex ratio was 1.17. At inclusion, the global health status was the most affected functional dimension. For symptoms: financial difficulties and fatigue scores were the highest ones. Emotional and social functions were significantly worse in rectal cancer. Most symptoms were more present in rectal cancer. At inclusion, global health status score was significantly worse in stage III. Anorexia was significantly more important among colorectal female patients. For Patients over 70 years-old, the difference was statistically significant for the physical function item which was lower. Overall, Functional dimensions scores were improved after chemotherapy. The symptoms scores did not differ significantly for patients treated by radiotherapy, between inclusion and at one year. Conclusion: Our EORTC QLQ C30 scores are overall comparable to the reference values. Neither chemotherapy, nor radiotherapy worsened the quality of life at one year.
Background: Quality of life has become an important concept in cancer care. Among the quality of ... more Background: Quality of life has become an important concept in cancer care. Among the quality of lifestudies in cancer patients, breast cancer has received most attention. This review reports on quality of life in Arab patients with breast cancer. Methods: The search was conducted using inclusion and exclusion criteria and in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The databases consulted were PubMed,
Uploads
Papers by Rachid Bekkali