Cancer burden in Africa and opportunities for prevention

Paediatric oncology physiotherapy in Africa: International Society of Paediatric Oncology (SIOP) Global Mapping Programme

Childhood cancer treatment in Africa has a dramatically increasing patient population resulting in greater rehabilitation needs. The International Society of Paediatric Oncology (SIOP) mapped childhood cancer services in Africa including access to physiotherapy. Irrespective of income classification, just over two-thirds of countries in Africa reported having access to physiotherapy services in paediatric oncology sites. There is a lack of knowledge about African childhood physiotherapy services. Research is needed to understand the rehabilitation needs of these children/adolescents and how to meet their needs in a globally equitable and sustainable way.

Cancer Care Disparities: Overcoming Barriers to Cancer Control in Low- and Middle-Income Countries

The rising global burden of cancer disproportionately affects low- and middle-income countries (LMICs), which account for over half of new patients and cancer deaths worldwide. However, LMIC health systems face profound challenges in implementing comprehensive cancer control programs because of limited health care resources and infrastructure. This analytical review explores contemporary evidence on barriers undermining cancer control efforts in resource-constrained LMIC settings. We conducted a comprehensive literature review of peer-reviewed evidence on cancer control challenges and solutions tailored to resource-limited settings. We provide a conceptual framework categorizing these barriers across the cancer care continuum, from raising public awareness to palliative care. We also appraise evidence-based strategies proposed to overcome identified obstacles to cancer control in the published literature, including task-shifting to nonspecialist health workers, strategic prioritization of high-impact interventions, regional collaborations, patient navigation systems, and novel financing mechanisms. Developing strong primary care delivery platforms integrated with specialized oncology care, alongside flexible and resilient health system models tailored to local contexts, will be critical to curb the rising tide of cancer in resource-limited settings. Urgent global commitments and investments are needed to dismantle barriers and expand access to prevention, early detection, diagnosis, treatment, and palliation services for all patients with cancer residing in LMICs as an ethical imperative. The review elucidates priority areas for policy actions, health systems strengthening, and future research to guide international efforts toward more equitable cancer control globally.

Drivers of breast cancer and cervical cancer screening among women of reproductive age: insights from the Ghana Demographic and Health Survey

BACKGROUND

The two major causes of cancer-related deaths among women in Ghana are breast cancer (BC) and cervical cancer (CC). These types of cancers typically do not show any symptoms until they have progressed. Therefore, it is important to screen for early detection. This research aimed to investigate the rate of breast cancer and cervical cancer screening, as well as the factors associated with it, among women of reproductive age in Ghana.

METHODS

This study analysed data from the 2022 Ghana Demographic and Health Survey. A total of 15,014 women aged 15 to 49 years were included in the analysis. Descriptive statistics and binary logistic regression were employed to analyse the data with the aid of STATA/SE, version 17.

RESULTS

It was found that 18.4% and 5.0% of the women had screened for BC and CC, respectively. Women aged 45-49 years were about three times more likely (aOR = 2.83, 95% CI: 1.88-4.24) to screen for BC compared to those aged 15-19 years. Women who had tested for HIV had increased odds (aOR = 1.88, 95% CI: 1.56-2.25) of screening for BC compared to their counterparts. Women within the richest wealth index (aOR = 1.95, 95% CI: 1.40-2.72) had increased odds of screening for BC compared to those in the poorest wealth index. Regarding CC screening, women with higher education (aOR = 2.56, 95% CI: 1.53-4.29) were two times more likely to screen for CC compared to those with no formal education. Women who did not use tobacco (aOR = 0.45, 95% CI: 0.21-0.96) had decreased odds of CC screening compared to their counterparts.

CONCLUSIONS

This study showed that the uptake of BC and CC screening services among women in Ghana was very low. The drivers of BC and CC screening included enabling, predisposing, and need factors. Stakeholders can leverage the mass media to raise awareness and educate women in reproductive age about the importance of BC and CC screening. This study provides relevant information that can inform BC and CC policies and programmes in Ghana.

Emerging cancer disease burden in a rural sub-Saharan African population: northeast Nigeria in focus

Introduction

Sub-Saharan Africa (SSA) is plagued by myriads of diseases, mostly infectious; but cancer disease burden is rising among non-communicable diseases. Nigeria has a high burden of cancer, however its remote underserved culturally-conserved populations have been understudied, a gap this study sought to fill.

Methods

This was a cross-sectional multi-institutional descriptive study of histologically diagnosed cancers over a four-year period (January 2019-December 2022) archived in the Departments of Pathology and Cancer Registries of six tertiary hospitals in the northeast of Nigeria. Data obtained included age at diagnosis, gender, tumor site and available cancer care infrastructure. Population data of the study region and its demographics was obtained from the National Population Commission and used to calculate incident rates for the population studied.

Results

A total of 4,681 incident cancer cases from 2,770 females and 1,911 males were identified. The median age at diagnosis for females was 45 years (range 1-95yrs), and 56 years (range 1-99yrs) for males. Observed age-specific incidence rates (ASR) increased steadily for both genders reaching peaks in the age group 80 years and above with the highest ASR seen among males (321/100,000 persons) compared to females (215.5/100,000 persons). Breast, cervical, prostatic, colorectal and skin cancers were the five most common incident cancers. In females, breast, cervical, skin, ovarian and colorectal cancers were the top five malignancies; while prostate, haematolymphoid, skin, colorectal and urinary bladder cancers predominated in men.

Conclusion

Remote SSA communities are witnessing rising cancer disease burden. Proactive control programs inclusive of advocacy, vaccination, screening, and improved diagnostics are needed.

Uncovering Risks Associated with Smoking Types and Intensities in Esophageal Cancer within High-Prevalence Regions in Africa: A Comprehensive Meta-analysis

Tobacco is usually cited among the well-known risk factors of esophageal cancer; nevertheless, the extent of the contribution of the type of smoking and its intensity to the disease has not been comprehensively elucidated in Africa. We searched MEDLINE/PubMed, Excerpta Medica Database, Web of Science, Scopus, Cochrane Library, and African Journals Online studies published before September 2023. The quality of the studies was assessed using the Newcastle-Ottawa scale, and the funnel plot was used for assessing potential publication bias. Meta-analyses were conducted to estimate summary effects using random-effects models. This study included 22,319 participants from 27 studies. The results strongly indicate a significant association between tobacco use and a higher risk of esophageal cancer. The risk of esophageal cancer is notably higher among pipe smokers [OR = 4.68; 95% confidence interval (CI), 3.38-6.48], followed by hand-rolled cigarette smokers (OR = 3.79; 95% CI, 2.68-5.35), in comparison with those who smoked commercially manufactured cigarettes (OR = 2.46; 95% CI, 1.69-3.60). Our findings also showed that the risk of esophageal cancer is highest in people smoking >183 packs per year (OR = 5.47; 95% CI, 3.93-7.62), followed by those smoking 93 to 183 packs per year (OR = 3.90; 95% CI, 3.13-4.86), in comparison with those smoking ≤92 packs per year (OR = 2.90; 95% CI, 2.19-3.84). Our findings strongly show that among the different types of tobacco use in Africa, pipe and hand-roller smokers face a higher risk of esophageal cancer.

Cancer mortality patterns in selected Northern and Southern African countries

BACKGROUND

Non-communicable diseases have been rapidly increasing in African countries. We provided updated cancer death patterns in selected African countries over the last two decades.

METHODS

We extracted official death certifications and population data from the WHO and the United Nations Population Division databases. We computed country- and sex-specific age-standardized mortality rates per 100 000 person-years for all cancers combined and ten major cancer sites for the periods 2005-2007 and 2015-2017.

RESULTS

Lung cancer ranked first for male cancer mortality in all selected countries in the last available period (with the highest rates in Réunion 24/100 000), except for South Africa where prostate cancer was the leading cause of death (23/100 000). Prostate cancer ranked second in Morocco and Tunisia and third in Mauritius and Réunion. Among Egyptian men, leukemia ranked second (with a stable rate of 4.2/100 000) and bladder cancer third (3.5/100 000). Among women, the leading cancer-related cause of death was breast cancer in all selected countries (with the highest rates in Mauritius 19.6/100 000 in 2015-2017), except for South Africa where uterus cancer ranked first (17/100 000). In the second rank there were colorectal cancer in Tunisia (2/100 000), Réunion (9/100 000) and Mauritius (8/100 000), and leukemia in Egypt (3.2/100 000). Colorectal and pancreas cancer mortality rates increased, while stomach cancer mortality rates declined.

CONCLUSION

Certified cancer mortality rates are low on a global scale. However, mortality rates from selected screening detectable cancers, as well as from infection-related cancers, are comparatively high, calling for improvements in prevention strategies.

Hepatitis B and hepatitis C virus infections and associated factors among prisoners in Gondar City, Northwest Ethiopia

BACKGROUND

Globally, hepatitis B virus (HBV) and hepatitis C virus (HCV) cause considerable morbidity and mortality from their acute and chronic infections. The transmission of the viruses within the prisons is high due to overcrowding, and other risk behaviors such as drug use, and unsafe sexual practices. This study aimed at determining the prevalence and associated factors of HBV and HCV infections among prisoners in Gondar city, Northwest Ethiopia.

METHODS

A cross-sectional study was conducted in the Gondar City Prison Center from May 1, 2022, to July 30, 2022. A total of 299 prison inmates were selected by using a systematic random sampling technique. A semi-structured questionnaire was used to collect data on sociodemographic, clinical, behavioral and prison related factors. Five milliliters of blood sample were collected, and the serum was separated from the whole blood. The serum was tested for HBV surface antigen (HBsAg) and anti-HCV antibody by using an Enzyme-Linked Immunosorbent Assay (ELISA). Data was entered using EpiData version 4.6.0 and exported to SPSS version 20 for analysis. Logistic regression analysis was done to assess the association between the independent variables and HBV and HCV infections. P-values < 0.05 were considered statistically significant.

RESULTS

The overall seroprevalence of HBV or HCV infections was 10.4%. The seroprevalence of HBV and HCV infections was 7.0% and 4.0%, respectively. It has been demonstrated that having several heterosexual partners, sharing sharp materials in prison, having longer imprisonment, and having a body tattoo are significantly associated with HBV infection. The presence of a body tattoo, a history of surgical procedures, and previous imprisonment are associated risk factors for HCV infection.

CONCLUSION

The prevalence of HBV and HCV were high-intermediate and high, respectively. Therefore, preventative and control initiatives are needed in prisons to decrease the rate of infection and transmission.

Women's experiences with breast cancer during diagnosis and therapy, Wolaita, Ethiopia: a qualitative study

BACKGROUND

Breast cancer is the most common cancer in women and the most frequent cancer worldwide. After being diagnosed with breast cancer, women experience unexpected and stressful events. In Ethiopia, specifically in the study area, the experiences of women with breast cancer, the challenges they face during treatment and follow-up have not been thoroughly investigated.

OBJECTIVE

This qualitative study explores the experiences of women diagnosed with breast cancer and undergoing therapy at a University-based hospital in Ethiopia.

METHODS

A qualitative research design was used, to explore the experiences of women diagnosed with breast cancer and undergoing therapy. A purposively selected sample of ten women who had been diagnosed with breast cancer and were receiving therapy was recruited. Recruitment was conducted from August 1 to September 30, 2022. Semi-structured face-to-face interviews were conducted to collect data on their experiences. The interviews were transcribed verbatim, and a thematic analysis approach was employed utilizing open coding. The coded data were then analysed to reveal important insights and understandings about the participants' experiences with breast cancer during the diagnosis and therapy journey.

RESULT

The thematic analysis of the data revealed four prominent themes: women's mixed emotions, characterized by a sense of high threat and hope upon receiving breast cancer diagnosis results; dealing with the changes, both physical and psychological, that the cancer and its treatment bring about in women's bodies and emotional well-being; dealing with the challenges associated with accessing therapy, including unfavourable hospital conditions and financial hardship; and experiencing care and supports from health care providers, family and friends, and faith-based communities.

CONCLUSION

These findings underscore the importance of providing comprehensive support and care for women with breast cancer. Enhancing the hospital environment, addressing resource shortages, and prioritising patient well-being are crucial steps towards improving the experiences of breast cancer patients in the study area.

Geographic differences in lung cancer: focus on carcinogens, genetic predisposition, and molecular epidemiology

Lung cancer poses a global health challenge and stands as the leading cause of cancer-related deaths worldwide. However, its incidence, mortality, and characteristics are not uniform across all regions worldwide. Understanding the factors contributing to this diversity is crucial in a prevalent disease where most cases are diagnosed in advanced stages. Hence, prevention and early diagnosis emerge as the most efficient strategies to enhance outcomes. In Western societies, tobacco consumption constitutes the primary risk factor for lung cancer, accounting for up to 90% of cases. In other geographic locations, different significant factors play a fundamental role in disease development, such as individual genetic predisposition, or exposure to other carcinogens such as radon gas, environmental pollution, occupational exposures, or specific infectious diseases. Comprehensive clinical and molecular characterization of lung cancer in recent decades has enabled us to distinguish different subtypes of lung cancer with distinct phenotypes, genotypes, immunogenicity, treatment responses, and survival rates. The ultimate goal is to prevent and individualize lung cancer management in each community and improve patient outcomes.

Unmet Supportive Care Needs Among Cancer Patients in Sub-Saharan African Countries: A Mixed Method Systematic Review and Meta-Analysis

INTRODUCTION

Supportive cancer care is vital to reducing the current disparities in cancer outcomes in Sub-Saharan Africa (SSA), including poor survival and low quality of life, and ultimately achieving equity in cancer care. This is the first review aimed to evaluate the extent of unmet supportive care needs and identify their contributing factors among patients with cancer in SSA.

METHODS

Six electronic databases (CINAHL, Embase, Medline [Ovid], PsycINFO, PubMed, and Cochrane Library of Databases] were systematically searched. Studies that addressed one or more domains of unmet supportive cancer care needs were included. Findings were analyzed using narrative analysis and meta-analysis, as appropriate.

RESULT

Eleven articles out of 2732 were retained in the review. The pooled prevalence of perceived unmet need for cancer care in SSA was 63% (95% CI: 45, 81) for physical, 59% (95% CI: 45, 72) for health information and system, 58% (95% CI: 42, 74) for psychological, 44% (95% CI: 29, 59) for patient care and support, and 43% (95% CI: 23, 63) for sexual. Older age, female sex, rural residence, advanced cancer stage, and low access to health information were related to high rates of multiple unmet needs within supportive care domains.

CONCLUSION

In SSA, optimal cancer care provision was low, up to two-thirds of patients reported unmet needs for one or more domains. Strengthening efforts to develop comprehensive and integrated systems for supportive care services are keys to improving the clinical outcome, survival, and quality of life of cancer patients in SSA.

Aridanin and oleanane-3- O-β-D-glucoside-2'-acetamide obtained from Tetrapleura tetraptera (Schumach. & Thonn) Taub. (Fabaceae) induces potent apoptotic activity in human prostate cancer cells

ETHNOPHARMACOLOGICAL RELEVANCE

Tetrapleura tetraptera (Schumach. and Thonn.) Taub. (Fabaceae) is a tropical plant that is used in Cameroon pharmacopeia for the treatment of many cancers including prostate cancer (PCa), which is a major cause of men's death worldwide. The objective of this study was to evaluate the anticancer properties as well as underlying mechanisms of isolates from T. tetraptera on DU145, PC3 and LNCaP cancer cell lines.

MATERIALS AND METHODS

Eight (8) compounds were purified from T. tetraptera stem bark extract through silica gel column chromatography (CC) and characterized using spectroscopic techniques (1D and 2D NMR), HRESIMS. Cell growth was assessed by a well-characterized MTT assay, while BrdU and clonogenicity assays provided information on the cell proliferation index. Further, the impact of the compounds on cell cycle progression and cell death were performed through Flow cytometry. Cell adhesion, cell migration and chemotaxis along with some proteins of epithelial-mesenchymal transition (EMT) were assayed.

RESULTS

Out of the eight (1-8) isolates from T. tetraptera only oleanane-3-O-β-D-glucoside-2'-acetamide and aridanin showed potent cell growth arrest with an estimated CC50 of 15, 23, 16 and 17, 26, 16 μg/mL on DU145, PC3 and LNCaP cells, respectively. A 15% (DU145) and 25% (LNCaP) increase in apoptotic cells induced by oleanane-3-O-β-D-glucoside-2'-acetamide and aridanin at 10 μg/mL were noticed. Oleanane-3-O-β-D-glucoside-2'-acetamide and aridanin at 2.5 and 10 μg/mL reduced the number of cells in S-phase and raised cells in G2/M phase. At the same concentrations, they decreased the number of invading DU145 cells and increased the adherence of DU145 cells to fibronectin and collagen matrix at tested concentrations, accompanied by an increase in integrin β-1 (10 μg/mL) and integrin β-4 (2.5 μg/mL) expression. Furthermore, a down-regulation of pcdk1, cdk2, Bcl-2, N-Cad, vimentin and cytokeratine 8-18 was noticed while, p19, p27, p53 pAKT, Bax, caspase-3 and E-Cad were up-regulated.

CONCLUSIONS

This study outlines for the first time, the anticancer ability of compounds oleanane-3-O-β-D-glucoside-2'-acetamide (4) and aridanin (6) from Tetrapleura tetraptera and proposes their putative mechanisms of action.

The role of clinical breast examination and fine needle aspiration cytology in early detection of breast cancer: A cross-sectional study nested in a cohort in a low-resource setting

BACKGROUND

Breast cancer is prevalent worldwide, with disparities in screening, diagnosis, treatment outcomes, and survival. In Africa, the majority of women are diagnosed at advanced stages, affecting treatment outcomes. Screening is one of the best strategies to reduce mortality rates caused by this cancer. Yet in a resource-constrained setting, there is limited access to screening and early detection services, which are available only at a few referral hospitals.

OBJECTIVES

We aimed to evaluate the prevalence and screening results of breast cancer using clinical breast examination coupled with fine needle aspiration cytology in a resource-constraint setting.

DESIGN

A combined cross-sectional and cohort study.

METHODS

Women at risk of developing breast cancer in the Kilimanjaro region of Tanzania were invited, through public announcements, to their primary healthcare facilities. A questionnaire was used to assess the participants' characteristics. The women received a clinical breast examination, and detectable lesions were subjected to a confirmatory fine needle aspiration cytology or an excisional biopsy. Preliminary data from this ongoing breast cancer control program were extracted and analyzed for this study.

RESULTS

A total of 3577 women were screened for breast cancer; their mean age was 47 ± 7.53 years. About a third of them (1145, 32%) were practicing self-breast examination at least once a month. Of 200 (5.6%) with abnormal clinical breast examination, 18 (9%) were confirmed to be breast cancer, making the prevalence to be 0.5%. The vast majority of participants with breast cancer (13, 72.2%) had early disease stages, and infiltrating ductal carcinoma, no special type, was the most common (15, 83.3%) histopathology subtype. Hormonal receptor status determination results indicated that 11 (61.1%), 7 (38.9%), and 5 (27.8%) of the tumors overexpressed estrogen receptor, progesterone receptor, and human epidermal receptor-2, respectively.

CONCLUSION

Our study demonstrates 5.6% of Tanzanian women have abnormal clinical breast examination findings, with 9% having breast cancer. Nearly three-quarters (72.2%) of breast cancer screened for early disease were detected in the early disease stages. This finding suggests that organized screening with clinical breast examination coupled with fine needle aspiration cytology, which is a simple and cost-effective screening method, has the potential to improve early detection and outcomes for breast cancer patients in a resource-constraint setting.

Global Cancer Surgery: pragmatic solutions to improve cancer surgery outcomes worldwide

The first Lancet Oncology Commission on Global Cancer Surgery was published in 2015 and serves as a landmark paper in the field of cancer surgery. The Commission highlighted the burden of cancer and the importance of cancer surgery, while documenting the many inadequacies in the ability to deliver safe, timely, and affordable cancer surgical care. This Commission builds on the first Commission by focusing on solutions and actions to improve access to cancer surgery globally, developed by drawing upon the expertise from cancer surgery leaders across the world. We present solution frameworks in nine domains that can improve access to cancer surgery. These nine domains were refined to identify solutions specific to the six WHO regions. On the basis of these solutions, we developed eight actions to propel essential improvements in the global capacity for cancer surgery. Our initiatives are broad in scope, pragmatic, affordable, and contextually applicable, and aimed at cancer surgeons as well as leaders, administrators, elected officials, and health policy advocates. We envision that the solutions and actions contained within the Commission will address inequities and promote safe, timely, and affordable cancer surgery for every patient, regardless of their socioeconomic status or geographic location.

Assessing the utilization of cancer medicines in Rwanda: an analysis of treatment patterns

Introduction

Cancer is a growing public health concern in Africa, especially in low- and middle-income countries (LMICs) like Rwanda. Increased cancer incidences translate into increased utilisation of cancer medicine. Access to affordable cancer medicines in Rwanda is a pressing issue as the National Health Insurance plan does not provide coverage for cancer medicines. In this study, we investigated the utilisation patterns of cancer medicines in Rwanda.

Methods

This retrospective cross-sectional study was conducted at all referral hospitals (n = 3) capable of delivering chemotherapy in Rwanda. The data collection was over a period of 6 months, during which a team of trained research assistants reviewed a convenience sample of selected patient charts. Both paper charts and electronic medical records were used to collect patients' data, including cancer type, stage, treatment setting, type of drugs or regimen used and completed cycles. Data were analysed using descriptive statistics.

Results

A total of 630 patients received chemotherapy during the study period and were included. Seventy-seven percent (n = 486) were female and mean age was 51 (SD ± 13). Among all patients receiving chemotherapy, 43% (n = 270) had breast cancer, 22% (n = 140) had cervical cancer and 19% (n = 121) had colorectal cancer. The majority of patients (71%) had a community-based insurance. Butaro Cancer Centre treated the most patients (48%, n = 303). Thirty-six percent (221/630) had stage III cancer. The most common regimens within the cohort were adriamycin, cyclophosphamide and taxane, capecitabine and oxaliplatin (CAPOX), paclitaxel + carboplatin and a single agent cisplatin given concurrently with radiotherapy. The proportion of chemotherapy that was given in the curative and palliative setting was 72% and 28% respectively.

Conclusion

Access to affordable cancer medicines remains a challenge in Rwanda. The study's findings provide valuable information on the utilisation patterns of cancer medicines in Rwanda, which can be used to guide policy decisions and improve cancer care in the country.

Predictors of caregiver burden among primary caregivers of cancer patients at Hawassa oncology center Northern, Ethiopia, 2022: institution-based cross-sectional study

BACKGROUND

Approximately 60,960 people are diagnosed with cancer each year, and more than 44,000 people die from it. Family caregivers face a range of difficulties because cancer affects many facets of life, such as nursing care, communication, financial issues, and emotional conflicts. Consequently, family caregivers are more susceptible to developing demanding physical and mental conditions. Despite these problems, cancer remains the most neglected and underfunded health problem in Ethiopia. Therefore, this study aimed to assess the caregiver burden experienced by family caregivers of patients with cancer; as well as its associated factors.

METHODS

An institutional-based cross-sectional study was employed among 347 family caregivers of cancer patients who attended Hawassa University Comprehensive Specialized Hospital Oncology Center from May 30 to July 30, 2022. The data were checked for completeness and consistency and then coded. The coded data were entered into Epi-data version 4.6 and then exported into Statistical Package for Social Science (SPSS) version 25 for analysis. The caregiver's burden was assessed by a short form of Zarit burden Interview. The explanatory variables, like clinical and care-related factors, were assessed by a structured questionnaire. Family caregivers' perceptions of social support were assessed by the multidimensional scale of perceived social support. Binary logistic regression was used to assess the strength of the association between outcome and explanatory variables. Each explanatory variable was entered separately in the bivariate analysis, and a variable with a p-value less than 0.25 goes further for multivariate analysis to control the possible confounding. The statistical significance of the factors influencing the outcome variable was declared in multivariate logistic regression analysis using an adjusted odds ratio at a 95% confidence interval when a p-value < 0.05.

RESULTS

The response rate of the caregiver was 100%. This study reported that 66.6% (95% CI 61.5-71.5) of the caregivers had a high caregiver burden. Being female, caring hours, previous history of hospitalization, and sleeping hours were significantly associated with the caregiver's burden.

CONCLUSION

In this finding, more than two-thirds of the caregivers had a higher caregiver burden. This suggested that there is a need to focus on and give more attention to caregivers to decrease their burden by including caregiver burden in routine nursing activities by the oncology unit, and further study should be done at the national level using other study designs.

A retrospective study of Kaposi's sarcoma in Hotan region of Xinjiang, China

Kaposi sarcoma (KS) is the most common cancer in patients with human immunodeficiency virus/acquired immunodeficiency syndrome (AIDS). In 1994, Chang and Moore discovered Kaposi sarcoma associated herpesvirus for the first time in KS lesions in AIDS patients. KS is a low-grade mesenchymal neoplasm of blood and lymphatic vessels that primarily affects the skin, although the disease may become disseminated to the lymphatic system, lungs, airways, or abdominal viscera. In this research, clinical characteristics and treatment of patients of Kaposi sarcoma were retrospectively analyzed in Hotan District, Xinjiang China. We look into the clinical traits, prognosis, and therapy of Kaposi sarcoma. From May 2017 to August 2022, 32 patients were treated in the People's Hospital of Hotan District, Xinjiang Uygur Autonomous Region, China. Twenty-two of these were classic Kaposi sarcomas (cKS), and 10 of these were Kaposi sarcomas linked to AIDS (AIDS-KS). The majority of KS patients were Uyghur. In terms of age at onset, AIDS-KS patients were younger than cKS patients. cKS and AIDS-KS are most frequently manifested in the feet and lower limbs. Ten patients with AIDS-KS have treated with combination antiretroviral therapy (combination antiretroviral therapy) combination chemotherapy, 5 of 10 patients had a complete response, 2 patients achieved partial response, the overall effective rate was 70%, and CD4 + T cells were greater than before. For cKS and AIDS-KS, the median overall survival was 56 and 50.8 months, respectively (P > .05). As a result, antiviral combination chemotherapy can also improve the prognosis of AIDS-KS patients.

The met and unmet health needs for HIV, hypertension, and diabetes in rural KwaZulu-Natal, South Africa: analysis of a cross-sectional multimorbidity survey

BACKGROUND

The convergence of infectious diseases and non-communicable diseases in South Africa is challenging to health systems. In this analysis, we assessed the multimorbidity health needs of individuals and communities in rural KwaZulu-Natal and established a framework to quantify met and unmet health needs for individuals living with infectious and non-communicable diseases.

METHODS

We analysed data collected between May 25, 2018, and March 13, 2020, from participants of a large, community-based, cross-sectional multimorbidity survey (Vukuzazi) that offered community-based HIV, hypertension, and diabetes screening to all residents aged 15 years or older in a surveillance area in the uMkhanyakude district in KwaZulu-Natal, South Africa. Data from the Vukuzazi survey were linked with data from demographic and health surveillance surveys with a unique identifier common to both studies. Questionnaires were used to assess the diagnosed health conditions, treatment history, general health, and sociodemographic characteristics of an individual. For each condition (ie, HIV, hypertension, and diabetes), individuals were defined as having no health needs (absence of condition), met health needs (condition that is well controlled), or one or more unmet health needs (including diagnosis, engagement in care, or treatment optimisation). We analysed met and unmet health needs for individual and combined conditions and investigated their geospatial distribution.

FINDINGS

Of 18 041 participants who completed the survey (12 229 [67·8%] were female and 5812 [32·2%] were male), 9898 (54·9%) had at least one of the three chronic diseases measured. 4942 (49·9%) of these 9898 individuals had at least one unmet health need (1802 [18·2%] of 9898 needed treatment optimisation, 1282 [13·0%] needed engagement in care, and 1858 [18·8%] needed a diagnosis). Unmet health needs varied by disease; 1617 (93·1%) of 1737 people who screened positive for diabetes, 2681 (58·2%) of 4603 people who screened positive for hypertension, and 1321 (21·7%) of 6096 people who screened positive for HIV had unmet health needs. Geospatially, met health needs for HIV were widely distributed and unmet health needs for all three conditions had specific sites of concentration; all three conditions had an overlapping geographical pattern for the need for diagnosis.

INTERPRETATION

Although people living with HIV predominantly have a well controlled condition, there is a high burden of unmet health needs for people living with hypertension and diabetes. In South Africa, adapting current, widely available HIV care services to integrate non-communicable disease care is of high priority.

FUNDING

Fogarty International Center and the National Institutes of Health, the Bill & Melinda Gates Foundation, the South African Department of Science and Innovation, the South African Medical Research Council, the South African Population Research Infrastructure Network, and the Wellcome Trust.

TRANSLATION

For the isiZulu translation of the abstract see Supplementary Materials section.

A SEER data-based nomogram for the prognostic analysis of survival of patients with Kaposi's sarcoma

Background

This study developed the first comprehensive nomogram for predicting the cancer-specific survival (CSS) of patients with Kaposi's sarcoma (KS).

Methods

Data on the demographic and clinical characteristics of 4143 patients with KS were collected from the Surveillance, Epidemiology, and End Results (SEER) database and used for the prognostic analysis. The patients were randomly divided into two groups: training cohort (n = 2900) and validation cohort (n = 1243). Multivariate Cox regression analysis was used to identify the predictive variables for developing the first nomogram for the survival prediction of patients with KS. The new survival nomogram was further evaluated using the concordance index (C-index), area under the time-dependent receiver operating characteristic curve (AUC), net reclassification improvement (NRI), integrated discrimination improvement (IDI), calibration plotting, and decision curve analysis (DCA).

Results

A nomogram was developed for determining the 3-, 5-, 8-, and 10-year CSS probabilities for patients with KS. The nomogram showed that tumor stage had the greatest influence on the CSS of patients with KS, followed by demographic variables (race, marital status, and age at diagnosis) and other clinical characteristics (surgery status, chemotherapy status, tumor risk classification, and radiotherapy status). The nomogram exhibited excellent performance based on the values of the C-index, AUC, NRI, and IDI as well as calibration plots. DCA further confirmed that the nomogram had good net benefits for 3-, 5-, 8-, and 10-year survival analyses.

Conclusions

In this study, by using data from the SEER database, we developed the first comprehensive nomogram for analyzing the survival of patients with KS. This nomogram could serve as a convenient and reliable tool for clinicians to predict CSS probabilities for individual patients with KS.

Patterns and trends of in-hospital mortality due to non-communicable diseases and injuries in Tanzania, 2006-2015

BACKGROUND

Globally, non-communicable diseases (NCD) kill about 40 million people annually, with about three-quarters of the deaths occurring in low- and middle-income countries. This study was carried out to determine the patterns, trends, and causes of in-hospital non-communicable disease (NCD) and injury deaths in Tanzania from 2006-2015.

METHODS

This retrospective study involved primary, secondary, tertiary, and specialized hospitals. Death statistics were extracted from inpatient department registers, death registers, and International Classification of Diseases (ICD) report forms. The ICD-10 coding system was used to assign each death to its underlying cause. The analysis determined leading causes by age, sex, annual trend and calculate hospital-based mortality rates.

RESULTS

Thirty-nine hospitals were involved in this study. A total of 247,976 deaths (all causes) were reported during the 10-year period. Of the total deaths, 67,711 (27.3%) were due to NCD and injuries. The most (53.4%) affected age group was 15-59 years. Cardio-circulatory diseases (31.9%), cancers (18.6%), chronic respiratory diseases (18.4%), and injuries (17.9%) accounted for the largest proportion (86.8%) of NCD and injuries deaths. The overall 10-year hospital-based age-standardized mortality rate (ASMR) for all NCDs and injuries was 559.9 per 100,000 population. It was higher for males (638.8/100,000) than for females (444.6/100,000). The hospital-based annual ASMR significantly increased from 11.0 in 2006 to 62.8 per 100,000 populations in 2015.

CONCLUSIONS

There was a substantial increase in hospital-based ASMR due to NCDs and injuries in Tanzania from 2006 to 2015. Most of the deaths affected the productive young adult group. This burden indicates that families, communities, and the nation at large suffer from premature deaths. The government of Tanzania should invest in early detection and timely management of NCDs and injuries to reduce premature deaths. This should go hand-in-hand with continuous efforts to improve the quality of health data and its utilization.

Knowledge and Attitudes towards Prostate Cancer and Screening among Males in Limpopo Province, South Africa

Inadequate knowledge and poor attitudes about prostate cancer (PC) negatively affect early screening practices among males. The PC mortality rate is increasing due to late reporting, screening, and treatment. This study explored the awareness, attitudes, and PC screening behaviours among males in the Limpopo, Thulamela municipality. This descriptive cross-sectional study involved 245 males that were randomly selected. A structured questionnaire was used to collect data. Fisher's exact tests and logistic regression analysis were used to examine the association between sociodemographic variables, awareness, and attitudes towards PC. Our findings revealed that 64.1% demonstrated inadequate awareness about PC. The overall score (84.9%) showed a positive attitude towards PC. However, 87.4% had a negative attitude towards the effectiveness of treatment for PC. The majority (96.7%) of respondents had never undergone a PSA test, although 53.1% were willing to undergo a PSA test. There was a significant positive correlation between awareness of prostate cancer and attitudes toward prostate cancer (r = 0.280, p < 0.001). Health status predicted awareness about PC, while age and health status predicted attitudes towards PC among men. Rural community-based programmes and heightened awareness campaigns are needed to conscientize men about the risk factors, symptoms, diagnosis, and treatment of PC in rural areas of Limpopo.

Access to Radiation Therapy and Related Clinical Outcomes in Patients With Cervical and Breast Cancer Across Sub-Saharan Africa: A Systematic Review

PURPOSE

To better understand the barriers to accessing standard-of-care radiation therapy (RT) for breast and cervical cancer in sub-Saharan Africa and their impact on outcomes.

METHODS

A comprehensive literature search was completed with a medical librarian. Articles were screened by title, abstract, and full text. Included publications were analyzed for data describing barriers to RT access, available technology, and disease-related outcomes, and further grouped into subcategories and graded according to predefined criteria.

RESULTS

A total of 96 articles were included: 37 discussed breast cancer, 51 discussed cervical cancer, and eight discussed both. Financial access was affected by health care system payment models and combined burdens of treatment-related costs and lost wages. Staffing and technology shortages limit the ability to expand service locations and/or increase capacity within existing centers. Patient factors including use of traditional healers, fear of stigma, and low health literacy decrease the likelihood of early presentation and completion of therapies. Survival outcomes are worse than most high- and middle-income countries and are affected by many factors. Side effects are similar to other regions, but these findings are limited by poor documentation capabilities. Access to palliative RT is more expeditious than definitive management. RT was noted to lead to feelings of burden, lower self-esteem, and worsened quality of life.

CONCLUSION

Sub-Saharan Africa represents a diverse region with barriers to RT that differ on the basis of funding, available technology and staff, and community populations. Although long-term solutions must focus on building capacity by increasing the number of treatment machines and providers, short-term improvements should be implemented, such as interim housing for traveling patients, increased community education to reduce late-stage diagnoses, and use of virtual visits to avoid travel.

A study on the changing trend and influencing factors of hospitalization costs of schizophrenia in economically underdeveloped areas of China

The public health problems caused by schizophrenia are becoming increasingly prominent and can place a huge economic burden on society. This study takes Gansu Province as an example to analyze the level and changing trend of the economic burden of schizophrenia inpatients in economically underdeveloped areas of China. Using a multi-stage stratified cluster sampling method, 39,054 schizophrenics from 197 medical and health institutions in Gansu Province were selected as the research objects, and their medical expenses and related medical records were obtained from the medical information system. The rank sum test and Spearman rank correlation were used for univariate analysis. Quantile regression and random forest were used to analyze the influencing factors. The results show that the average length of stay of schizophrenics in Gansu Province of China was 52.01 days, and the average hospitalization cost was USD1653.96 from 2014 to 2019. During the six years, the average hospitalization costs per time decreased from USD2136.85 to USD1401.33. The average out-of-pocket costs per time decreased from USD1238.78 to USD267.68. And the average daily hospitalization costs increased from USD38.18 to USD41.25. The main factors influencing hospitalization costs are length of stay, proportion of medications, and schizophrenic subtype. The hospitalization costs per time of schizophrenics in Gansu Province have decreased but remain at a high level compared to some other chronic non-communicable diseases. In the future, attention should be paid to improving the efficiency of medical institutions, enhancing community management, and promoting the transformation of the management model of schizophrenia.

Patterns of better breast cancer care in countries with higher human development index and healthcare expenditure: Insights from GLOBOCAN 2020

Background

The huge burden of breast cancer (BC) necessitates the profound and accurate knowledge of the most recent cancer epidemiology and quality of care provided. We aimed to evaluate BC epidemiology and quality of care and examine the effects of socioeconomic development and healthcare expenditure on disparities in BC care.

Methods

The results from the GLOBOCAN 2020 study were utilized to extract data on female BC, including incidence and mortality numbers, crude rates, and age-standardized rates [age-standardized incidence rates (ASIRs) and age-standardized mortality rates (ASMRs)]. The mortality-to-incidence ratio (MIR) was calculated for different locations and socioeconomic stratifications to examine disparities in BC care, with higher values reflecting poor quality of care and vice versa. In both descriptive and analytic approaches, the human development index (HDI) and the proportion of current healthcare expenditure (CHE) to gross domestic product (CHE/GDP%) were used to evaluate the values of MIR.

Results

Globally, 2,261,419 (95% uncertainty interval (UI): 2,244,260-2,278,710) new cases of female BC were diagnosed in 2020, with a crude rate of 58.5/100,000 population, and caused 684,996 (675,493-694,633) deaths, with a crude rate of 17.7. The WHO region with the highest BC ASIR (69.7) was Europe, and the WHO region with the highest ASMR (19.1) was Africa. The very high HDI category had the highest BC ASIR (75.6), and low HDI areas had the highest ASMR (20.1). The overall calculated value of female BC MIR in 2020 was 0.30, with Africa having the highest value (0.48) and the low HDI category (0.53). A strong statistically significant inverse correlation was observed between the MIR and HDI values for countries/territories (Pearson's coefficient = -0.850, p-value < 0.001). A significant moderate inverse correlation was observed between the MIR and CHE/GDP values (Pearson's coefficient = -0.431, p-value < 0.001).

Conclusions

This study highlighted that MIR of BC was higher in less developed areas and less wealthy countries. MIR as an indicator of the quality of care showed that locations with higher healthcare expenditure had better BC care. More focused interventions in developing regions and in those with limited resources are needed to alleviate the burden of BC and resolve disparities in BC care.

Hepatitis B and C virus infections and associated factors among HIV-positive and HIV-negative tuberculosis patients in public health facilities, Northeast Ethiopia: A comparative cross-sectional study

Objective

Viral hepatitis, particularly hepatitis B virus and hepatitis C virus, is the leading cause of global liver-related morbidity and mortality. Concomitant infections of hepatitis B virus, hepatitis C virus, and tuberculosis are risks of hepatotoxicity and death due to antituberculosis therapy. Hepatitis and human immunodeficiency virus coinfection poses challenges in treating hepatotoxic patients and leads to mortality during antituberculosis treatment. Thus, this study aimed to determine the prevalence of hepatitis B virus and hepatitis C virus infections, and associated factors among human immunodeficiency virus-positive and human immunodeficiency virus-negative tuberculosis patients attending public health facilities, Northeast Ethiopia.

Methods

A comparative cross-sectional study was conducted among 229 tuberculosis patients from January 1 to April 30, 2021 in public health facilities' tuberculosis treatment centers. Study participants were selected using a consecutive sampling technique. Data on sociodemographic and other risk factors were collected using an interviewer-based pretested questionnaire by trained data collectors. Anti-hepatitis C virus and hepatitis B surface antigen were determined in serum using enzyme-linked immunosorbent assay. Data were entered and analyzed using SPSS version 22. Logistic regression analysis was computed, and then variables with a p value <0.05 were considered as statistically significant.

Result

The overall hepatitis virus infection among human immunodeficiency virus-positive and human immunodeficiency virus-negative tuberculosis patients was 14.03% and 8.14%, respectively. The prevalence of hepatitis B virus infection in human immunodeficiency virus positives and human immunodeficiency virus negatives was 10.5% and 6.4% and hepatitis C virus infection in human immunodeficiency virus positives and human immunodeficiency virus negatives was 3.5% and 1.75%, respectively. Hepatitis B virus and hepatitis C virus coinfections were not observed. Older age, history of problematic alcohol use, history of blood transfusion, ear-noise piercing, and history of multiple heterosexual partners were predictors for the hepatitis virus infection.

Conclusion

Hepatitis virus infection increases morbidity and mortality of tuberculosis patients. Therefore, screening tuberculosis patients for hepatitis virus infection is necessary to reduce the risk of antituberculosis complications.

Survival pattern of colorectal cancer in Sub-Saharan Africa: A systematic review and meta-analysis

Cancer incidence is relatively low in sub-Saharan Africa (SSA), however, prognosis is expected to be poor in comparison with high-income countries. Comprehensive evidence is limited on the survival pattern of colorectal cancer patients in the region. We conducted a systematic review and meta-analysis to investigate the pattern of colorectal cancer survival in the region and to identify variation across countries and over time. We searched international databases MEDLINE, Scopus, Embase, Web of Science, ProQuest, CINAHL, and Google Scholar to retrieve studies that estimated survival from colorectal cancer in SSA countries from inception to December 31, 2021 without language restriction. Due to between-study heterogeneity, we performed a random-effects meta-analysis to pool survival rates. To identify study-level sources of variation, we performed subgroup analysis and meta-regression. Results are reported in line with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 2020 guideline and the protocol was registered in PROSPERO database (CRD42021246935). 23 studies involving 10,031 patients were included in the review, of which, 20 were included in the meta-analysis. The meta-analysis results showed that the pooled 1-, 2-, 3-, 4-, and 5-year survival rates in SSA were 0.74 (95% CI, 0.66-0.81), 0.50 (95% CI, 0.41-0.58), 0.36 (95% CI, 0.27-0.47), 0.31 (95% CI, 0.22-0.42), and 0.28 (95% CI, 0.19-0.38) respectively. Subgroup analyses indicated that the survival rate varied according to year of study, in which those conducted in recent decades showed relatively better survival. The 5-year survival was higher in middle-income SSA countries (0.31; 95%CI: 0.17-0.49) than low-income countries (0.20; 95%CI: 0.11-0.35), however, the difference was not statistically significant. In conclusion, survival from colorectal cancer is low in sub-Saharan Africa compared to other regions. Thus, intervention strategies to improve screening, early diagnosis and treatment of colorectal cancer should be developed and implemented to improve survival in the region.

Identification of PTK2 as an adverse prognostic biomarker in breast cancer by integrated bioinformatics and experimental analyses

PTK2 is highly expressed in many cancers and is involved in cell growth, survival, migration, and invasion. However, the prognostic value of PTK2 and its potential function remain unclear in breast cancer. Therefore, we performed a comprehensive analysis of multiple public databases to explore the roles of PTK2. By integrating multiple datasets, we found that PTK2 mRNA expression in breast cancer tissue was higher than that in normal breast tissue or adjacent tissue. High PTK2 expression was associated with lymph node metastasis stage, tumor stage, breast cancer type, age, TP53 mutation, and gender and significantly predicted a poor survival outcome in breast cancer patients. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) results suggested that PTK2 and co-expressed genes participated in the cell cycle. Immune infiltration analysis clarified that high PTK2 expression was positively correlated with infiltrating levels of CD8+ T cells, CD4+ T cells, macrophages, neutrophils, and dendritic cells. The DNA methylation of PTK2 in breast cancer tissues was higher than that in normal tissues, and high PTK2 methylation was correlated with poor prognosis in breast cancer patients. Furthermore, 16 possible ceRNA networks related to PTK2 were constructed for breast cancer. Additionally, PTK2 knockdown could suppress the proliferation and migration ability of MCF-7 cells. These results suggest that PTK2 can be used as a prognostic biomarker for breast cancer.

Diagnostic accuracy of cervical cancer screening strategies for high-grade cervical intraepithelial neoplasia (CIN2+/CIN3+) among women living with HIV: A systematic review and meta-analysis

BACKGROUND

We systematically reviewed the diagnostic accuracy of cervical cancer screening and triage strategies in women living with HIV (WLHIV).

METHODS

Cochrane Library, Embase, Global Health and Medline were searched for randomised controlled trials, prospective or cross-sectional studies published from database inception to 15 July 2022 reporting diagnostic accuracy of tests in cervical cancer screening and triage of screen-positive WLHIV. Studies were included if they reported the diagnostic accuracy of any cervical cancer screening or triage strategies for the detection of histologically-confirmed high-grade cervical intraepithelial neoplasia (CIN2+/CIN3+) among WLHIV. Summary data were extracted from published reports. Authors were contacted for missing data where applicable. Sensitivity and specificity estimates for CIN2/3+ were pooled using models for meta-analysis of diagnostic accuracy data. Study quality was assessed using the QUADAS-2 tool for the quality assessment of diagnostic accuracy studies. PROSPERO registration:CRD42020189031.

FINDINGS

In 38 studies among 18,737 WLHIV, the majority (n=19) were conducted in sub-Saharan Africa. The pooled prevalence was 12.0% (95%CI:9.8-14.1) for CIN2+ and 6.7% (95%CI:5.0-8.4) for CIN3+. The proportion of screen-positive ranged from 3-31% (visual inspection using acetic acid[VIA]); 2-46% (high-grade squamous intraepithelial lesions, and greater [HSIL+] cytology); 20-64% (high-risk[HR]-HPV DNA). In 14 studies, sensitivity and specificity of VIA were variable limiting the reliability of pooled estimates. In 5 studies where majority had histology-confirmed CIN2+, pooled sensitivity was 56.0% (95%CI:45.4-66.1; I²=65%) for CIN2+ and 65.0% (95%CI:52.9-75.4; I² =42%) for CIN3+; specificity for <CIN2 was 73.8% (95%CI:59.8-84.2, I²=94%). Cytology was similarly variable (sensitivity of ASCUS+ for CIN2+ range: 58-100%; specificity: 9-96%). In 28 studies, sensitivity of tests targeting 14-HR-HPV types was high (91.6%, 95%CI:88.1-94.1; I²=45% for CIN2+ and 92.5%, 95%CI:88.4-95.2; I²=32%) for CIN3+); but specificity for <CIN2 was low (62.2% (95%CI:57.9-66.4;I²=92%). Restriction to 8-HR-HPV increased specificity (65.8%; Relative specificity[RSpec] vs. 14-HR-HPV=1.17; 95%CI:1.10-1.24) with no significant change in sensitivity (CIN2+:85.5%; Relative Sensitivity[RSens]=0.94, 95%CI: 0.89-1.00; CIN3+:90%; RSens=0.96, 95%CI:0.89-1.03). VIA triage of 14-HR-HPV positive women decreased sensitivity for CIN2+ compared to HPV-DNA test alone (64.4% vs. 91.6%; RSens=0.68, 95%CI:0.62-0.75).

INTERPRETATION

HPV-DNA based approaches consistently showed superior sensitivity for CIN2+/CIN3+ compared to VIA or cytology. The low specificity of HPV-DNA based methods targeting up to 14-HR-HPV could be improved significantly by restricting to 8-HR-HPV with only minor losses in sensitivity, limiting requirement for triage for which optimal approaches are less clear.

FUNDING

World Health Organisation; National Cancer Institute; European Union's Horizon 2020 and Marie Skłodowska-Curie Actions programme.

Prevalence of multimorbidity in men of African descent with and without prostate cancer in Soweto, South Africa

OBJECTIVE

With increases in chronic disease, men with prostate cancer are likely to have at least one other chronic health condition. The burden and complexity of each additional chronic disease may complicate prostate cancer treatment and reduce survival. In this paper, we describe the frequency of multimorbid chronic diseases, HIV and depression among men in Soweto, South Africa (SA) with and without prostate cancer and determine whether the presence of multimorbid diseases is associated with metastatic and high-risk, non-metastatic prostate cancer.

METHODS

A population-based case-control study on prostate cancer was conducted among black men in Soweto. All participants completed a baseline survey on sociodemographics, lifestyle, and comorbid medical conditions. All participants completed a depression screening survey and HIV testing at enrolment. Blood pressure measurements and blood testing for fasting glucose, total cholesterol, and high-density lipoprotein were performed on a subset of randomly selected cases and controls. For men with prostate cancer, clinical T staging was assessed with the digital rectal examination, the diagnosis was confirmed with a biopsy and PSA levels were assessed at presentation. The metastatic staging was assessed by bone scans, and this was confirmed with PSMA PET scans, CT scans and X-rays, standard for our resource-constrained setting. Normal PSA scores were used as an inclusion criterion for controls.

RESULTS

Of the 2136 men (1095 with prostate cancer and 1041 controls) included in the analysis, 43.0% reported at least one chronic metabolic disease; 24.1% reported two metabolic diseases; 5.3% reported three metabolic diseases; and 0.3% reported four metabolic diseases. Men with prostate cancer were more likely to report a multimorbid chronic metabolic disease compared to controls (p<0.001) and more likely to test positive for HIV (p = 0.05). The majority of men (66.2%) reported at least one metabolic disease, tested negative for HIV and had a negative depression screen. The clinical characteristics of men with prostate cancer, were as follows: 396 (36.2%) had a Gleason score of 8 and above; 552 (51.3%) had a PSA score of >20ng/ml; 233 (21.7%) had confirmed metastatic prostate cancer at diagnosis. Older age was associated with metastatic prostate cancer (OR = 1.043 95% CI:1.02-1.07) and NCCN defined high-risk non-metastatic prostate cancer (OR = 1.03 95% CI:1.01-1.05), whilst being hypertensive was protective (OR = 0.63 95% CI:0.47-0.84 and OR = 0.55 95% CI:0.37-0.83) respectively for metastatic and high-risk, non-metastatic prostate cancer.

CONCLUSION

The high prevalence of multimorbid metabolic diseases and HIV among men with prostate cancer represents a public health concern in South Africa. There is a need to effectively address multiple chronic diseases among men with prostate cancer by incorporating coordinated care models.

Global trends and regional differences in the burden of cancer attributable to secondhand smoke in 204 countries and territories, 1990–2019

Background

To describe the status quo and trends in the global burden of all cancers caused by secondhand smoke during 1990–2019.

Methods

Data on cancer associated with secondhand smoke were extracted from the Global Heath Data Exchange. Cancer burden was measured by cancer-related deaths, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs).

Results

In 2019, age-standardized rates of death, DALYs and YLLs among the cancer population globally caused by secondhand smoke were 1.60, 38.54 and 37.77, respectively. The proportions of these in the total cancer burden for all risk factors combined decreased slightly from 1990 to 2003 and then increased from 2004 to 2019. In 2019, >50% of the cancer burden was concentrated in men aged 55–75 years and women aged 50–70 years. Between 1990 and 2019, there was an increase in age-standardized rates of death, DALYs, YLDs and YLLs among those aged ≥70 years. The age-standardized YLDs rate attributable to secondhand smoke was higher among women; it decreased in men but increased in women, causing a wider gap between the sexes. A greater cancer burden was mainly seen in North America in 1990 and Europe in 2019. Reductions in the annual rate change of cancer burden were found mainly in North America and Oceania, while increases were found in Africa and Asia. In 2019, high–middle- and middle-SDI countries had higher age-standardized rates of deaths, DALYs, YLDs and YLLs than the global level. During 1990 and 2019, the largest decline in cancer burden was seen in high-SDI countries, while middle- or low-SDI countries experienced increases in all age-standardized rates.

Conclusions

Cancer burden attributable to secondhand smoke is concerning given the increasing health loss and differences in distribution of cancer burden worldwide. Further studies are needed to investigate the causes of disparities in cancer burden attributable to secondhand smoke and to improve understanding of the contribution of secondhand smoke to the burden of different types of cancer.

How a Digital Case Management Platform Affects Community-Based Palliative Care of Sub-Saharan African Cancer Patients: Clinician-Users' Perspectives

BACKGROUND

Symptom control among cancer patients is a Tanzanian public health priority impacted by limited access to palliative care (PC) specialists and resources. Mobile Palliative Care Link (mPCL), a mobile/web application, aims to extend specialist access via shared care with local health workers (LHWs) with the African Palliative care Outcome Scale (POS) adapted for regular, automated symptom assessment as a core feature.

OBJECTIVE

The aim of the study is to assess clinicians' attitudes, beliefs, and perceptions regarding mPCL usability and utility with their patients within a government-supported, urban Tanzanian cancer hospital setting.

METHODS

We used a mixed methods approach including surveys, qualitative interviews, and system usage data to assess clinicians' experience with mPCL in a field study where discharged, untreatable cancer patients were randomized to mPCL or phone-contact POS collection.

RESULTS

All six specialists and 10 LHWs expressed overall satisfaction with mPCL among 49 intervention arm patients. They perceived mPCL as a way to stay connected with patients and support remote symptom control. Timely access to POS responses and medical records were identified as key benefits. Some differences in perceptions of mPCL use and utility were seen between clinician groups; however, both expressed strong interest in continuing app use, recommending it to colleagues, and extending use throughout Tanzania. Primary use was for clinical status communication and care coordination. Pain and other symptom progression were the most frequently reported reasons for provider-patient interactions accounting for 34% (n = 44) and 12% (n = 15) of reasons, respectively. Usage barriers included time required to create a new clinical record, perceived need for response to non-urgent reminders or alerts, and training. necessary for competent use. System-level implementation barriers included variable patient access to smartphones and SIM cards and unreliable Internet access.

CONCLUSION

This work demonstrates broad clinician desire for digital health tools to support remote community-based PC among cancer patients, particularly pain management.

Distribution of Cancer and Cancer Screening and Treatment Services in Lagos: A 10-Year Review of Hospital Records

PURPOSE

In Lagos State, Nigeria, the population distribution of cancers is poorly described because studies are conducted at a few tertiary hospitals. Therefore, this study aims to map all health facilities where cancer screening takes place and describe the cases of cancer screened for and treated.

METHODS

A cross-sectional survey to identify facilities involved in screening and management of cancers was performed followed by extraction of data on individual cases of cancer screened for and treated at these facilities from 2011 to 2020. All health care facilities in the state were visited, and the survey was performed using standardized national tools modified to capture additional information on cancer screening and treatment. Data analysis was performed using STATA version 14 and R version 3.6.3.

RESULTS

Cervical cancer was the commonest cancer, accounting for 55% of 2,420 cancers screened, followed by breast (41%), prostate (4%), and colorectal cancers (0.2%). Of the 7,682 cancers treated among Lagos residents, the top five were breast (45%), colorectal (8%), cervical (8%), prostate (5%), and ovarian (4%). The female:male ratio of cancer cases was 3:1. The peak age for cancer among females and males was in the 40- to 49-year age group and 60- to 69-year age group, respectively. The Ikorodu local government area had the highest rate of reported cancer per million population.

CONCLUSION

Cancer screening is poor with a significant gap in screening for breast cancer since it is the commonest cancer in the state. The findings indicate the urgent need for the establishment of organized screening programs for the predominant cancers in the state and the prioritization of cancer research that addresses key policy and program questions.

Post-recurrence survival analysis of patients with pulmonary recurrence from gynaecologic cancers: a multi-institutional analysis of 122 patients

In this retrospective study, patients with epithelial gynaecologic cancer with pulmonary recurrence (PR) were evaluated from five national gynaecologic oncology clinics. Patients with a diagnosis of primary endometrial, ovarian/fallopian tube/peritoneal, cervical or vaginal/vulvar tumours who developed an initial PR were included in the study A total of 122 patients were included in the study. The median follow-up time after recurrence was 7.5 (range, 1-84) months. The 2-year PRS was 48% in the main cohort. The risk of death was more than seven times higher in patients who did not receive salvage chemotherapy compared with those who did (hazard ratio: 7.6, 95% CI: 3.0-18.9; p < .001). When squamous cell carcinoma was compared with the other tumour types, the risk of death increased more than three times (hazard ratio: 3.7, 95% CI: 1.4-9.6; p = .007).IMPACT STATEMENTWhat is already known on this subject? Pulmonary recurrence (PR) from gynaecologic malignancies is rare and can cause major clinical problem. Therefore, defining the clinical and pathologic characteristics and recurrence patterns are essential.What the results of this study add? This study demonstrates non-squamous subtype and salvage chemotherapy at PR were associated with improved survival.What of these findings for clinical practice and/or further research? To the best of our knowledge, our study is the largest study to investigate the clinico-pathologic characteristics, recurrence patterns, treatment options, and post-recurrence survival (PRS) in patients with PR from epithelial gynaecologic cancers. Future research should examine the underlying causes of these findings.

Risk factors of oesophageal cancer at health facilities in Addis Ababa, Ethiopia: Unmatched case control study

Background

Oesophageal carcinoma is one of the most common cancers in Ethiopia. Its occurrences vary among regional states of the country. The identification of local risk factors of oesophageal cancer will make it simple to design a focused intervention. On local risk factors, there is, however, a shortage of empirical evidence. Therefore, the aim of study was to identify local risk factors.

Methods

An unmatched case control study design was employed. From February 2019 to August 2020, 338 histologically confirmed cases and 338 controls were recruited consecutively from six health facilities in Addis Ababa, Ethiopia’s capital city. To collect data from the cases and the controls, face to face interviews were conducted. Epi-info version 7 was used to enter and cleaned data, and SPSS version 23 was used to analyze it. The odds ratio was calculated based on hierarchal model multivariable logistic regression, and statistically significance was declared at p-value of <0.05.

Results

The mean (SD) age of the cases and the controls was 54.3 ± 12.5 years old and 40.2 ± 13.7 years old, respectively. The odds of oesophageal cancer was significantly higher among older ages (OR =11.0, 95% CI [6.60, 20.91]), rural residents (OR = 4.2, 95% CI [1.04, 16.80]), and those who had history of smoking (OR =1.3, 95% CI [1.12, 1.60]), khat chewing (OR = 4.0, 95% CI [2.50, 6.60]), raw meat consumers (OR = 2.6, 95% CI [1.75, 3.90]). Increasing monthly income (OR = 0.2, CI 95% [0.09, 0.49]) and a habit of eating fruits or vegetables (OR = 0.49, 95% CI [0.32, 0.76]) were associated with lower risks.

Conclusions

Tobacco smoking, khat chewing, age, residency, and red raw meat consumption were discovered to be positive predictors of oesophageal cancer, whereas fruit or vegetable consumption and higher monthly income were discovered to be inversely associated. It is advised to avoid the use of khat and tobacco, as well as to avail fruits and vegetables in dish.

Mycotoxin Exposure and Renal Cell Carcinoma Risk: An Association Study in the EPIC European Cohort

BACKGROUND

Mycotoxins have been suggested to contribute to a spectrum of adverse health effects in humans, including at low concentrations. The recognition of these food contaminants being carcinogenic, as co-occurring rather than as singularly present, has emerged from recent research. The aim of this study was to assess the potential associations of single and multiple mycotoxin exposures with renal cell carcinoma risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort.

METHODS

Food questionnaire data from the EPIC cohort were matched to mycotoxin food occurrence data compiled by the European Food Safety Authority (EFSA) from European Member States to assess long-term dietary mycotoxin exposures, and to associate these with the risk of renal cell carcinoma (RCC, n = 911 cases) in 450,112 EPIC participants. Potential confounding factors were taken into account. Analyses were conducted using Cox's proportional hazards regression models to compute hazard ratios (HRs) and 95% confidence intervals (95% CIs) with mycotoxin exposures expressed as µg/kg body weight/day.

RESULTS

Demographic characteristics differed between the RCC cases and non-cases for body mass index, age, alcohol intake at recruitment, and other dietary factors. In addition, the mycotoxin exposure distributions showed that a large proportion of the EPIC population was exposed to some of the main mycotoxins present in European foods such as deoxynivalenol (DON) and derivatives, fumonisins, Fusarium toxins, Alternaria toxins, and total mycotoxins. Nevertheless, no statistically significant associations were observed between the studied mycotoxins and mycotoxin groups, and the risk of RCC development.

CONCLUSIONS

These results show an absence of statistically significant associations between long-term dietary mycotoxin exposures and RCC risk. However, these results need to be validated in other cohorts and preferably using repeated dietary exposure measurements. In addition, more occurrence data of, e.g., citrinin and fumonisins in different food commodities and countries in the EFSA database are a prerequisite to establish a greater degree of certainty.

Understanding Diagnostic Delays for Kaposi Sarcoma in Kenya: A Qualitative Study

BACKGROUND

Although HIV-associated Kaposi sarcoma (KS) is frequently diagnosed at an advanced stage in sub-Saharan Africa, reasons for diagnostic delays have not been well described.

METHODS

We enrolled patients >18 years with newly diagnosed KS between 2016 and 2019 into the parent study, based in western Kenya. We then purposively selected 30 participants with diversity of disease severity and geographic locations to participate in semistructured interviews. We used 2 behavioral models in developing the codebook for this analysis: situated Information, Motivation, and Behavior framework and Andersen model of total patient delay. We then analyzed the interviews using framework analysis.

RESULTS

The most common patient factors that delayed diagnosis were lack of KS awareness, seeking traditional treatments, lack of personal efficacy, lack of social support, and fear of cancer, skin biopsy, amputation, and HIV diagnosis. Health system factors that delayed diagnosis included previous negative health care interactions, incorrect diagnoses, lack of physical examination, delayed referral, and lack of tissue biopsy availability. Financial constraints were prominent barriers for patients to access and receive care. Facilitators for diagnosis included being part of an HIV care network, living near health facilities, trust in the health care system, desire to treat painful or disfiguring lesions, and social support.

CONCLUSIONS

Lack of KS awareness among patients and providers, stigma surrounding diagnoses, and health system referral delays were barriers in reaching KS diagnosis. Improved public health campaigns, increased availability of biopsy and pathology facilities, and health provider training about KS are needed to improve early diagnosis of KS.

Evaluating the geographic distribution of cervical cancer patients presenting to a multidisciplinary gynecologic oncology clinic in Gaborone, Botswana

OBJECTIVE

In Botswana, cervical cancer is the leading cause of cancer death for females. With limited resources, Botswana is challenged to ensure equitable access to advanced cancer care. Botswana's capital city, Gaborone, houses the only gynecologic oncology multi-disciplinary team (MDT) and the one chemoradiation facility in the country. We aimed to identify areas where fewer women were presenting to the MDT clinic for care.

METHODS

This cross-sectional study examined cervical cancer patients presenting to the MDT clinic between January 2015 and March 2020. Patients were geocoded to residential sub-districts to estimate age-standardized presentation rates. Global Moran's I and Anselin Local Moran's I tested the null hypothesis that presentation rates occurred randomly in Botswana. Community- and individual-level factors of patients living in sub-districts identified with higher (HH) and lower (LL) clusters of presentation rates were examined using ordinary least squares with a spatial weights matrix and multivariable logistic regression, respectively, with α level 0.05.

RESULTS

We studied 990 patients aged 22-95 (mean: 50.6). Presentation rates were found to be geographically clustered across the country (p = 0.01). Five sub-districts were identified as clusters, two high (HH) sub-district clusters and three low (LL) sub-district clusters (mean presentation rate: 35.5 and 11.3, respectively). Presentation rates decreased with increased travel distance (p = 0.033). Patients residing in LL sub-districts more often reported abnormal vaginal bleeding (aOR: 5.62, 95% CI: 1.31-24.15) compared to patients not residing in LL sub-districts. Patients in HH sub-districts were less likely to be living with HIV (aOR: 0.59; 95% CI: 0.38-0.90) and more likely to present with late-stage cancer (aOR: 1.78; 95%CI: 1.20-2.63) compared to patients not in HH sub-districts.

CONCLUSIONS

This study identified geographic clustering of cervical cancer patients presenting for care in Botswana and highlighted sub-districts with disproportionately lower presentation rates. Identified community- and individual level-factors associated with low presentation rates can inform strategies aimed at improving equitable access to cervical cancer care.

Time to death from cervical cancer and predictors among cervical cancer patients in Felege Hiwot Comprehensive Specialized Hospital, North West Ethiopia: Facility-based retrospective follow-up study

Introduction

A sexually transmitted virus called the Human Papillomavirus is responsible for more than 99% of cervical cancer cases and its precursors. In 2019, the median survival time of cervical cancer patients at 5 years was 37 months. The survival time and predictors of death from cervical cancer vary in different study settings. This study was aimed to assess the time to death and to identify the major predictors of death of cervical cancer patients in Felege Hiwot Comprehensive Specialized Hospital.

Methods

A facility-based retrospective follow-up study was conducted among 422 randomly selected cervical cancer patients in Felege Hiwot Comprehensive Specialized Hospital from 25^th June 2017 to 31^st March 2021. Data were extracted from the sampled patient charts by using a structured checklist which was prepared in an English version. Data were coded and then entered, edited, and cleaned using EPI-data 3.1 and exported to STATA14.2 statistical software for analysis. Frequencies and proportions were used to describe the study population with relevant variables and were presented using tables, pie charts, and graphs. Kaplan Meier and life table were used to describe the restricted mean survival time and the overall survival rates. Differences in survival among different variables were compared using the log-rank test. The assumption of proportional hazard was checked using Schoenfeld residual test. Variables having a P-value > 0.05 were considered as fulfilling the assumption. Variables with a significance level below 0.2 in the bivariable Cox regression model were included in a multivariable Cox regression model analysis, where Variables with a p-value < 0.05 were considered to be statistically significant at a 95% confidence interval. Model fitness was checked by Cox-Snell residual.

Results

The mean follow up time of this cohort was 27.66 (CI: 26.96, 28.36) months, and the restricted mean survival time of cervical cancer patients in this study was 40.21 (95% CI: 38.95, 41.47) months. Being FIGO stage IV [AHR = 6.10, 95% CI: 2.18, 16.90)], having adenocarcinoma [AHR = 3.12, 95% CI: 1.34, 7.28)], having co-morbidity [AHR = 2.57, 95% CI: 1.29, 5.11)], and being initiated with radiotherapy [AHR = 4.57, 95% CI: 1.60, 13.06)] were a significant predictors of death from cervical cancer.

Conclusion

The restricted mean survival time of cervical cancer patients in this study was 40.21 months. Marital status, type of tumor histology, stage of disease, type of treatment initiated, and presence of co-morbidity were significant predictors of death for cervical cancer. Treatment of comorbidities in the early stage of cervical cancer plays a key role in maximizing the survival time of cervical cancer patients.

Ultrasonographic findings in patients with abdominal symptoms or trauma presenting to an emergency room in rural Tanzania

Background

Frequencies of ultrasonographic findings and diagnoses in emergency departments in sub-Saharan Africa are unknown. This study aimed to describe the frequencies of different sonographic findings and diagnoses found in patients with abdominal symptoms or trauma presenting to a rural referral hospital in Tanzania.

Methods

In this prospective observational study, we consecutively enrolled patients with abdominal symptoms or trauma triaged to the emergency room of the Saint Francis Referral Hospital, Ifakara. Patients with abdominal symptoms received an abdominal ultrasound. Patients with an abdominal or thoracic trauma received an Extended Focused Assessment with Ultrasound in Trauma (eFAST).

Results

From July 1st 2020 to June 30th 2021, a total of 88838 patients attended the emergency department, of which 7590 patients were triaged as ‘very urgent’ and were seen at the emergency room. A total of 1130 patients with abdominal symptoms received an ultrasound. The most frequent findings were abnormalities of the uterus or adnexa in 409/754 females (54.2%) and abdominal free fluid in 368 (32.6%) patients; no abnormality was found in 150 (13.5%) patients. A tumour in the abdomen or pelvis was found in 183 (16.2%) patients, an intrauterine pregnancy in 129/754 (17.1%) females, complete or incomplete abortion in 96 (12.7%), and a ruptured ectopic pregnancy in 32 (4.2%) females. In males, most common diagnosis was intestinal obstruction in 54/376 (14.4%), and splenomegaly in 42 (11.2%). Of 1556 trauma patients, 283 (18.1%) received an eFAST, and 53 (18.7%) had positive findings. A total of 27 (9.4%) trauma patients and 51 (4.5%) non-trauma patients were sent directly to the operating theatre.

Conclusion

In this study, ultrasound examination revealed abnormal findings for the majority of patients with non-traumatic abdominal symptoms. Building up capacity to provide diagnostic ultrasound is a promising strategy to improve emergency services, especially in a setting where diagnostic modalities are limited.

Prostate Cancer Patterns and Trends in the Eastern Cape Province of South Africa; 1998-2017

Background

Globally, prostate cancer is rated the second most common cancer and the sixth leading cause of death. In South Africa, it is ranked as leading cancer among men. This study describes prostate cancer patterns and trends in the rural Eastern Cape Province population.

Methodology

Secondary data were used from which a sample of 723 prostate cancer (C61) patients was extracted from the database into STATA version 14.0 for descriptive analysis. A direct standardization method was used to estimate age-specific and age-standardized incidence rates. Keyfitz method was used to calculate the standard error and confidence interval, whereas the Joinpoint program the annual percentage change.

Results

The mean age was 64 years, with a standard deviation of 9.9. Trends in prostate cancer incidence increased significantly (p = 0.026) from 7.4% in 2010 to 12.6% in 2017. Incidence rates varied across the region, with the lowest of 4.5 per 100,000 in 1998 to the highest of 21.4 per 100,000 in 2017 period. Lusikisiki had the highest incidence rates of 53.4 per 100,000 population (95% CI 0.8–61.4), while Centane with 21.7 per 100,000 (95% CI 2.3–27.6) rated the second. Other magisterial areas showed a constant increase (p > 0.05) throughout the observation period except for Idutywa and Willowvale, with no apparent increase. Conversely, in Butterworth, incidence rates decreased from 15.2 per 100 000 (95% CI 8.6–21.9) to 11.5 per 100,000 (95% CI 6.2–16.7).

Conclusion

As experienced globally and regionally, prostate cancer has become a public health concern in this population. Incidence variations across the surveillance area in the Eastern Cape were noted with hotspots.

Building Modern Cancer Care Services in Sub-Saharan Africa Based on a Clinical-Research Care Model

Cancer is as old as humankind; there are examples of cancer treatment in ancient Egyptian civilizations. Globally, there has been rapid evolution of oncologic practices over many decades using different modalities, their complexities notwithstanding. These developments have resulted in visible improvements in outcomes for a complex medical condition.

Clinical utility of the 'Determine HBsAg' Point-of-Care Test for Diagnosis of Hepatitis B Surface Antigen in Africa

INTRODUCTION

Chronic infection with hepatitis B virus (HBV) is a leading cause of morbidity and death, especially in sub-Saharan Africa (sSSA), where approximately 60 million adults are infected. More than 90% of these patients are unaware of their HBV status.

AREAS COVERED

Scaling-up of HBV screening programs in SSA are essential to increase diagnosis, linkage to care and access to treatment, and will ultimately reduce HBV disease burden to achieve WHO hepatitis elimination targets. Such scale up will rely on inexpensive rapid point-of-care (POC) tests, especially in remote areas where gold standard serological assays are not routinely available. This review discusses the diagnostic performance and clinical utility of the Determine™ (Abbott, USA) hepatitis B surface Antigen (HBsAg) POC test for improving HBV screening in SSA, in light with others available HBsAg rapid tests.

EXPERT OPINION

The Determine™ HBsAg POC test has demonstrated relatively good diagnostic accuracy at the low cost, in the African field and laboratory and should be used for large scale mass screening of HBV infection in Africa.

A protocol to clinically evaluate liquid biopsies as a tool to speed up diagnosis of children and young adults with aggressive infection-related lymphoma in East Africa "(AI-REAL)"

Background

The capacity for invasive tissue biopsies followed by histopathology diagnosis in sub-Saharan Africa is severely limited. Consequently, many cancer patients are diagnosed late and outcomes are poor. Here, we propose to evaluate circulating tumour (ct) DNA analysis (“liquid biopsy”), a less invasive and faster approach to diagnose endemic EBV-driven lymphomas (EBVL) in East Africa.

Methods

We will evaluate the clinical utility of an already validated ctDNA test prospectively in a head-to-head comparison against histopathology. The primary endpoint is the time from presentation to the specialist centre to a final diagnosis of EBV- Lymphoma. Secondary endpoints include the sensitivity and specificity of liquid biopsy and health economic benefits over histopathology. One hundred forty-six patients will be recruited over 18 months. Patients will be eligible if they are 3–30 years of age and have provided written consent or assent as per IRB guidelines. Tissue and venous blood samples will be processed as per established protocols. Clinical data will be captured securely and in real-time into a REDCap database. The time from presentation to diagnosis will be documented. The sensitivity and specificity of the methods can be estimated within 5% error margin with 95% confidence level using 73 cases and 73 controls. Health-economic assessment will include micro-costing of ctDNA test and histopathology. All results will be reviewed in a multidisciplinary tumour board.

Discussion

The study evaluates the clinical utility of ctDNA in improving the speed of diagnostic pathways for EBVL in sub-Saharan Africa. Our results would provide proof-of-principle that ctDNA can be used as a diagnostic tool in areas without access to regular pathology, that transfer of the tool is feasible, and that it leads to an earlier and faster diagnosis. The potential clinical and economic impact of this proposal is thus significant. If successful, this study will provide appropriate, and cost-effective diagnostic tools that will promote earlier diagnosis of EBVL and potentially other cancers in countries with restricted healthcare resources.

Trial registration

Pan African Clinical Trials Registry: PACTR202204822312651, registered on 14th-April-2022.

Oncology Training Needs Assessment Among Health Care Professionals in Nigeria

PURPOSE

This study investigated the status of training and preparedness for oncology practice and research and degree of interprofessional collaboration among health care professionals in the six geopolitical regions of Nigeria.

METHODS

A convergent parallel mixed methods design was used. Three hundred seventeen respondents completed a three-part, online questionnaire. Self-rated competencies in oncology research (26 items), oncology practice (16 items), and interprofessional collaboration (nine items) were assessed with a one- to five-point Likert scale. Six key informant and 24 in-depth interviews were conducted. Descriptive statistics, analysis of variance, and pairwise t-test were used to analyze the quantitative data, whereas thematic analysis was used for the qualitative data.

RESULTS

Respondents were mostly female (65.6%) with a mean age of 40.5 ± 8.3 years. Respondents include 178 nurses (56.2%), 93 medical doctors (29.3%), and 46 pharmacists (14.5%). Self-assessed competencies in oncology practice differed significantly across the three groups of health care professionals (F = 4.789, P = .009). However, there was no significant difference across professions for competency in oncology research (F = 1.256, P = .286) and interprofessional collaboration (F = 1.120, P = .327). The majority of respondents (267, 82.4%) felt that educational opportunities in oncology-associated research in the country are inadequate and that this has implications for practice. Key training gaps reported include poor preparedness in data analysis and bioinformatics (138, 43.5%), writing clinical trials (119, 37.5%), and writing grant/research proposals (105, 33.1%). Challenges contributing to gaps in cancer research include few trained oncology specialists, low funding for research, and inadequate interprofessional collaboration.

CONCLUSION

This study highlights gaps in oncology training and practice and an urgent need for interventions to enhance interprofessional training to improve quality of cancer care in Nigeria. These would accelerate progress toward strengthening the health care system and reducing global disparities in cancer outcomes.

Mapping Cancer in Africa: A Comprehensive and Comparable Characterization of 34 Cancer Types Using Estimates From GLOBOCAN 2020

Objective

Cancer incidence and mortality rates in Africa are increasing, yet their geographic distribution and determinants are incompletely characterized. The present study aims to establish the spatial epidemiology of cancer burden in Africa and delineate the association between cancer burden and the country-level socioeconomic status. The study also examines the forecasts of the cancer burden for 2040 and evaluates infrastructure availability across all African countries.

Methods

The estimates of age, sex, and country-specific incidence and mortality of 34 neoplasms in 54 African countries, were procured from GLOBOCAN 2020. Mortality-to-incidence ratio (MIR) was employed as a proxy indicator of 5-year survival rates, and the socioeconomic development of each country was measured using its human development index (HDI). We regressed age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and MIR on HDI using linear regression model to determine the relationship between cancer burden and HDI. Maps were generated for each cancer group for each country in Africa. The data about the cancer infrastructure of African countries were extracted from the WHO Cancer Country Profiles.

Results

In Africa, an estimated 1.1 million new cases [95% uncertainty intervals (UIs) 1.0 - 1.3 million] and 711,429 [611,604 - 827,547] deaths occurred due to neoplasms in 2020. The ASIR was estimated to be 132.1/100,000, varying from 78.4/100,000 (Niger) to 212.5/100,000 (La Réunion) in 2020. The ASMR was 88.8/100,000 in Africa, ranging from 56.6/100,000 in the Republic of the Congo to 139.4/100,000 in Zimbabwe. The MIR of all cancer combined was 0.64 in Africa, varying from 0.49 in Mauritius to 0.78 in The Gambia. HDI had a significant negative correlation with MIR of all cancer groups combined and main cancer groups (prostate, breast, cervical and colorectal). HDI explained 75% of the variation in overall 5-year cancer survival (MIR). By 2040, the burden of all neoplasms combined is forecasted to increase to 2.1 million new cases and 1.4 million deaths in Africa.

Conclusion

High cancer mortality rates in Africa demand a holistic approach toward cancer control and management, including, but not limited to, boosting cancer awareness, adopting primary and secondary prevention, mitigating risk factors, improving cancer infrastructure and timely treatment.

Mapping Cancer in Africa: A Comprehensive and Comparable Characterization of 34 Cancer Types Using Estimates From GLOBOCAN 2020

Objective

Cancer incidence and mortality rates in Africa are increasing, yet their geographic distribution and determinants are incompletely characterized. The present study aims to establish the spatial epidemiology of cancer burden in Africa and delineate the association between cancer burden and the country-level socioeconomic status. The study also examines the forecasts of the cancer burden for 2040 and evaluates infrastructure availability across all African countries.

Methods

The estimates of age, sex, and country-specific incidence and mortality of 34 neoplasms in 54 African countries, were procured from GLOBOCAN 2020. Mortality-to-incidence ratio (MIR) was employed as a proxy indicator of 5-year survival rates, and the socioeconomic development of each country was measured using its human development index (HDI). We regressed age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and MIR on HDI using linear regression model to determine the relationship between cancer burden and HDI. Maps were generated for each cancer group for each country in Africa. The data about the cancer infrastructure of African countries were extracted from the WHO Cancer Country Profiles.

Results

In Africa, an estimated 1.1 million new cases [95% uncertainty intervals (UIs) 1.0 - 1.3 million] and 711,429 [611,604 - 827,547] deaths occurred due to neoplasms in 2020. The ASIR was estimated to be 132.1/100,000, varying from 78.4/100,000 (Niger) to 212.5/100,000 (La Réunion) in 2020. The ASMR was 88.8/100,000 in Africa, ranging from 56.6/100,000 in the Republic of the Congo to 139.4/100,000 in Zimbabwe. The MIR of all cancer combined was 0.64 in Africa, varying from 0.49 in Mauritius to 0.78 in The Gambia. HDI had a significant negative correlation with MIR of all cancer groups combined and main cancer groups (prostate, breast, cervical and colorectal). HDI explained 75% of the variation in overall 5-year cancer survival (MIR). By 2040, the burden of all neoplasms combined is forecasted to increase to 2.1 million new cases and 1.4 million deaths in Africa.

Conclusion

High cancer mortality rates in Africa demand a holistic approach toward cancer control and management, including, but not limited to, boosting cancer awareness, adopting primary and secondary prevention, mitigating risk factors, improving cancer infrastructure and timely treatment.

Mapping Cancer in Africa: A Comprehensive and Comparable Characterization of 34 Cancer Types Using Estimates From GLOBOCAN 2020

OBJECTIVE

Cancer incidence and mortality rates in Africa are increasing, yet their geographic distribution and determinants are incompletely characterized. The present study aims to establish the spatial epidemiology of cancer burden in Africa and delineate the association between cancer burden and the country-level socioeconomic status. The study also examines the forecasts of the cancer burden for 2040 and evaluates infrastructure availability across all African countries.

METHODS

The estimates of age, sex, and country-specific incidence and mortality of 34 neoplasms in 54 African countries, were procured from GLOBOCAN 2020. Mortality-to-incidence ratio (MIR) was employed as a proxy indicator of 5-year survival rates, and the socioeconomic development of each country was measured using its human development index (HDI). We regressed age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and MIR on HDI using linear regression model to determine the relationship between cancer burden and HDI. Maps were generated for each cancer group for each country in Africa. The data about the cancer infrastructure of African countries were extracted from the WHO Cancer Country Profiles.

RESULTS

In Africa, an estimated 1.1 million new cases [95% uncertainty intervals (UIs) 1.0 - 1.3 million] and 711,429 [611,604 - 827,547] deaths occurred due to neoplasms in 2020. The ASIR was estimated to be 132.1/100,000, varying from 78.4/100,000 (Niger) to 212.5/100,000 (La Réunion) in 2020. The ASMR was 88.8/100,000 in Africa, ranging from 56.6/100,000 in the Republic of the Congo to 139.4/100,000 in Zimbabwe. The MIR of all cancer combined was 0.64 in Africa, varying from 0.49 in Mauritius to 0.78 in The Gambia. HDI had a significant negative correlation with MIR of all cancer groups combined and main cancer groups (prostate, breast, cervical and colorectal). HDI explained 75% of the variation in overall 5-year cancer survival (MIR). By 2040, the burden of all neoplasms combined is forecasted to increase to 2.1 million new cases and 1.4 million deaths in Africa.

CONCLUSION

High cancer mortality rates in Africa demand a holistic approach toward cancer control and management, including, but not limited to, boosting cancer awareness, adopting primary and secondary prevention, mitigating risk factors, improving cancer infrastructure and timely treatment.