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Meghani K, Puri P, Bazzett-Matabele L, Vuylsteke P, Luckett R, Monare B, Chiyapo S, Ketlametswe R, Ralefala TB, Bvochora-Nsingo M, Zetola N, Ramogola-Masire D, Grover S. Significance of HIV status in cervical cancer patients receiving curative chemoradiation therapy, definitive radiation alone, or palliative radiation in Botswana. Cancer 2024; 130:2462-2471. [PMID: 38529676 DOI: 10.1002/cncr.35289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/10/2024] [Accepted: 02/13/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Cervical cancer associated with human papillomavirus has the highest cancer incidence and mortality for women in Botswana because of a high HIV prevalence and limited screening. This study investigates the significance of HIV on the overall survival (OS) of patients with locally advanced cervical cancer by various treatment categories (curative chemoradiation, definitive radiation [RT] alone, or palliative RT alone). METHODS This study included patients diagnosed with cervical cancer between 2013 and 2020, prospectively enrolled in the Botswana Prospective Cancer Cohort. OS based on HIV status and completion of planned treatment regimen was estimated by the Kaplan-Meier method. Comparisons of 2-year OS by HIV status was performed by the log-rank test, univariate and multivariable Cox analyses adjusting for cancer stage, RT dose, number of chemotherapy cycles, and baseline hemoglobin levels. RESULTS Of 1131 patients diagnosed with stage IB-IVB cervical cancer, 69.8% were women living with HIV (n = 789). For patients receiving curative chemoradiation, HIV status was not significantly associated with OS in unadjusted (p = .987) and adjusted (p = .578) analyses. For RT only treatment and definitive (high-dose) RT alone, HIV status was significantly associated with OS in unadjusted analysis (HR = 1.77, p = .002; HR = 1.95, p = .014), but not in adjusted analysis (p = .227, p = .73). For patients receiving palliative (low-dose) RT, HIV status was not associated with OS in unadjusted (p = .835) or adjusted analysis (p = .359). CONCLUSIONS In Botswana, a resource-limited setting, HIV status had no significant effect on 2-year OS in patients with cervical cancer with well-managed HIV receiving chemoradiation, RT alone, or palliative RT. This demonstrates that patients living with HIV receiving antiretroviral treatment can receive clinically appropriate treatment with no evidence that HIV may lead to poorer outcomes.
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Affiliation(s)
- Kinza Meghani
- School of Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | - Priya Puri
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Peter Vuylsteke
- Department of Oncology, Gaborone Private Hospital, Gaborone, Botswana
| | - Rebecca Luckett
- Department of Obstetrics and Gynecology, University of Botswana, Gaborone, Botswana
| | - Barati Monare
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | - Sebathu Chiyapo
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | | | - Tlotlo B Ralefala
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
- Department of Oncology, Princess Marina Hospital, Gaborone, Botswana
| | - Memory Bvochora-Nsingo
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
- Department of Oncology, Princess Marina Hospital, Gaborone, Botswana
| | - Nicola Zetola
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Oncology, Princess Marina Hospital, Gaborone, Botswana
| | - Doreen Ramogola-Masire
- Department of Obstetrics and Gynecology, University of Botswana, Gaborone, Botswana
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
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BONI SP, HORO A, DIDI-KOUKO-COULIBALY J, TANON A, TCHOUNGA BK, COFFIE PA, COMOE JC, MOH RD, DABIS F, ADOUBI I, JAQUET A. Impact of HIV infection on access to cancer care and survival among women with invasive cervical cancer in Côte d'Ivoire: A prospective cohort study. Int J Gynaecol Obstet 2023; 163:392-401. [PMID: 37350012 PMCID: PMC10592570 DOI: 10.1002/ijgo.14925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE To assess the impact of HIV on access to invasive cervical cancer (ICC) care and overall survival (OS) in a time of universal access to antiretroviral therapy (ART). METHODS A cohort of women prospectively diagnosed with ICC was consecutively recruited from 2018 to 2020 in public/private cancer centers in Côte d'Ivoire. Follow-up data were collected through facility- and phone-based approaches. Logistic and Cox regression models allowed analysis of factors associated with access to cancer care and OS, respectively. RESULTS Overall, 294 women with ICC aged 50 years (interquartile range [IQR] 43-60) were enrolled, including 21.4% of women living with HIV (WLHIV), 87% being on ART. An advanced ICC clinical stage (III-IV) was less frequent in WLHIV (63.5% vs. 77.1% in HIV-uninfected women; P = 0.029). Cancer care was initiated in 124 (42.2%) women (54.0% in WLHIV; 39.0% in HIV-uninfected; P = 0.030). Factors independently associated with access to cancer care were International Federation of Gynecology and Obstetrics (FIGO) stage I-II (adjusted odds ratio [aOR] 3.58, 95% CI 2.01-6.38) and no treatment by traditional healers prior to ICC diagnosis (aOR 3.69, 95% CI 1.96-6.96). The 2-year OS was 37.9% (95% CI 30.0-47.9). HIV status was not predictive of mortality (adjusted hazard ratio [aHR] 0.98, 95% CI 0.60-1.69). An advanced clinical stage was the only measured predictor of death (aHR 1.59, 95% CI 1.02-2.47). CONCLUSION In a time of universal access to ART, HIV infection was not associated with OS among women with ICC in Côte d'Ivoire. Higher access to cancer care in WLHIV might be mediated by enhanced access to ICC screening services, supporting the need to expand these services to other types of healthcare facilities.
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Affiliation(s)
- Simon P. BONI
- Programme PAC-CI, Treichville, Abidjan, Côte d’Ivoire
- National Cancer Control Program, Côte d’Ivoire
| | - Apollinaire HORO
- Gynecology and obstetrics department, Felix Houphouët Boigny University, University Hospital of Yopougon, Abidjan; Côte d’Ivoire
| | | | - Aristophane TANON
- Infectious and tropical diseases department, University Hospital of Treichville, Abidjan; Côte d’Ivoire
| | | | | | | | - Raoul D. MOH
- Programme PAC-CI, Treichville, Abidjan, Côte d’Ivoire
| | - François DABIS
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
| | - Innocent ADOUBI
- National Cancer Control Program, Côte d’Ivoire
- Oncology department, Felix Houphouët Boigny University, University hospital of Treichville, Côte d’Ivoire
| | - Antoine JAQUET
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
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Castle PE, Einstein MH, Sahasrabuddhe VV. Cervical cancer prevention and control in women living with human immunodeficiency virus. CA Cancer J Clin 2021; 71:505-526. [PMID: 34499351 PMCID: PMC10054840 DOI: 10.3322/caac.21696] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/07/2021] [Accepted: 08/10/2021] [Indexed: 12/16/2022] Open
Abstract
Despite being highly preventable, cervical cancer is the fourth most common cancer and cause of cancer death in women globally. In low-income countries, cervical cancer is often the leading cause of cancer-related morbidity and mortality. Women living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome are at a particularly high risk of cervical cancer because of an impaired immune response to human papillomavirus, the obligate cause of virtually all cervical cancers. Globally, approximately 1 in 20 cervical cancers is attributable to HIV; in sub-Saharan Africa, approximately 1 in 5 cervical cancers is due to HIV. Here, the authors provide a critical appraisal of the evidence to date on the impact of HIV disease on cervical cancer risk, describe key methodologic issues, and frame the key outstanding research questions, especially as they apply to ongoing global efforts for prevention and control of cervical cancer. Expanded efforts to integrate HIV care with cervical cancer prevention and control, and vice versa, could assist the global effort to eliminate cervical cancer as a public health problem.
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Affiliation(s)
- Philip E Castle
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, Maryland
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Mark H Einstein
- Department of Obstetrics, Gynecology, and Reproductive Health, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Vikrant V Sahasrabuddhe
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, Maryland
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MacDuffie E, Sakamuri S, Luckett R, Wang Q, Bvochara-Nsingo M, Monare B, Bazzett-Matabele L, Moloi T, Ralefala T, Ramogola-Masire D, Shin SS, Zetola NM, Grover S. Vulvar cancer in Botswana in women with and without HIV infection: patterns of treatment and survival outcomes. Int J Gynecol Cancer 2021; 31:1328-1334. [PMID: 34493586 DOI: 10.1136/ijgc-2021-002728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/28/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Vulvar cancer is a rare gynecological malignancy. However, the incidence of human papillomavirus (HPV)-associated vulvar disease is increasing, particularly in low- and middle-income countries. HIV infection is associated with an increased risk of HPV-associated vulvar cancer. We evaluated treatment patterns and survival outcomes in a cohort of vulvar cancer patients in Botswana. The primary objective of this study was to determine overall survival and the impact of treatment modality, stage, and HIV status on overall survival. METHODS Women with vulvar cancer who presented to oncology care in Botswana from January 2015 through August 2019 were prospectively enrolled in this observational cohort study. Demographics, clinical characteristics, treatment, and survival data were collected. Factors associated with survival including age, HIV status, stage, and treatment were evaluated. RESULTS Our cohort included 120 women with vulvar cancer. Median age was 42 (IQR 38-47) years. The majority of patients were living with HIV (89%, n=107) that was well-controlled on antiretroviral treatment. Among women with HIV, 54.2% (n=58) were early stage (FIGO stage I/II). In those without HIV, 46.2% (n=6) were early stage (stage I/II). Of the 95 (79%) patients who received treatment, 20.8% (n=25) received surgery, 67.5% (n=81) received radiation therapy, and 24.2% (n=29) received chemotherapy, either alone or in combination. Median follow-up time of all patients was 24.7 (IQR 14.2-39.1) months and 2- year overall survival for all patients was 74%. Multivariate analysis demonstrated improved survival for those who received surgery (HR 0.26; 95% CI 0.08 to 0.86) and poor survival was associated with advanced stage (HR 2.56; 95% CI 1.30 to 5.02). Survival was not associated with HIV status. CONCLUSIONS The majority of women with vulvar cancer in Botswana are young and living with HIV infection. Just under half of patients present with advanced stage, which was associated with worse survival. Improved survival was seen for those who received surgery.
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Affiliation(s)
- Emily MacDuffie
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sruthi Sakamuri
- Department of Obstetrics and Gynecology, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rebecca Luckett
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Department of Obstetrics and Gynecology, University of Botswana, Gaborone, Botswana.,Princess Marina Hospital, Gaborone, Botswana
| | - Qiao Wang
- Sue and Bill Gross School of Nursing, University of California, Irvine, California, USA
| | | | | | - Lisa Bazzett-Matabele
- Department of Obstetrics and Gynecology, University of Botswana, Gaborone, Botswana.,Princess Marina Hospital, Gaborone, Botswana.,Department of Obstetrics and Gynecology, Yale University, New Haven, Connecticut, USA
| | - Thabo Moloi
- Princess Marina Hospital, Gaborone, Botswana
| | | | - Doreen Ramogola-Masire
- Department of Obstetrics and Gynecology, Pennsylvania Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Obstetrics and Gynecology, University of Botswana, Gaborone, Botswana
| | - Sanghyuk S Shin
- Sue and Bill Gross School of Nursing, University of California, Irvine, California, USA
| | - Nicola M Zetola
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Botswana-UPenn Partnership, Gaborone, Botswana
| | - Surbhi Grover
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA .,Princess Marina Hospital, Gaborone, Botswana.,Botswana-UPenn Partnership, Gaborone, Botswana.,Department of Medicine, University of Botswana, Gaborone, Botswana
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Mohanty S, Gurram L, Chopra S, Mahantshetty U, Grover S. Cervical Cancer Treatment in HIV-Positive Patients: A Survey of Treatment Practices in India. JCO Glob Oncol 2021; 7:843-848. [PMID: 34101485 PMCID: PMC8457850 DOI: 10.1200/go.21.00081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Chemoradiation remains a challenge in women living with HIV (WLWH) and cervical cancer primarily because of concerns regarding immune status. With limited literature available to help guide the management of these patients, clinical practices among oncologists are variable across India. Hence, we conducted a survey among radiation oncologists in India to assess the patterns of current practices of treating cervical cancer with chemoradiation in WLWH.
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Affiliation(s)
- Samarpita Mohanty
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Lavanya Gurram
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Supriya Chopra
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | | | - Surbhi Grover
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Five-year overall survival following chemoradiation therapy for locally advanced cervical carcinoma in women living with and without HIV infection in Botswana. Infect Agent Cancer 2021; 16:55. [PMID: 34344430 PMCID: PMC8330031 DOI: 10.1186/s13027-021-00389-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/16/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose To compare updated prospective 5-year survival outcomes of cervical cancer patients living with and without human immunodeficiency virus (HIV) infection who initiated curative chemoradiation therapy (CRT) in a resource-limited setting. Methods & Materials Women in Botswana with locally advanced cervical cancer were enrolled in a prospective, observational, cohort study from July 2013 through January 2015. Survival outcomes were analyzed after 5 years of follow-up. Results This cohort included 143 women initiating curative CRT. Sixty-seven percent (n = 96) of cohort were women living with HIV (WLWH), all of whom were receiving antiretroviral therapy (ART) at the time of treatment initiation and boasted a median CD4 count of 481 cells/μL (IQR, 351-579 μL). The 5-year overall survival (OS) rates were 56.8% (95% CI, 40.0–70.5%) for patients without HIV infection and 55.1% (95% CI, 44.2–64.7%) for WLWH (p = 0.732). Factors associated with superior 5-year OS on multivariate analyses included baseline hemoglobin > 10 g/dL (hazard ratio (HR) 0.90, 95% CI, 0.83–0.98, p = 0.015), lower stage at diagnosis (stage I and II vs. III and IV) (HR 1.39, 95% CI 1.09–1.76, p = 0.007), and higher EQD2 (HR 0.98, 95% CI 0.97–0.99, p = 0.001). Conclusions Five-year OS was not impacted by HIV status in this population of WLWH with well-managed infection who initiated curative treatment for cervical cancer in Botswana. Regardless of HIV status, hemoglobin levels and stage at diagnosis were associated with survival. These findings suggest that treatment for cervical cancer in WLWH with well-controlled infection need not be altered solely due to HIV status.
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Clinical and sociodemographic factors associated with late stage cervical cancer diagnosis in Botswana. BMC WOMENS HEALTH 2021; 21:267. [PMID: 34229672 PMCID: PMC8259023 DOI: 10.1186/s12905-021-01402-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/22/2021] [Indexed: 01/22/2023]
Abstract
Background Cervical cancer is the leading cause of female cancer mortality in Botswana with the majority of cervical cancer patients presenting with late-stage disease. The identification of factors associated with late-stage disease could reduce the cervical cancer burden. This study aims to identify potential patient level clinical and sociodemographic factors associated with a late-stage diagnosis of cervical cancer in Botswana in order to help inform future interventions at the community and individual levels to decrease cervical cancer morbidity and mortality. Results There were 984 women diagnosed with cervical cancer from January 2015 to March 2020 at two tertiary hospitals in Gaborone, Botswana. Four hundred forty women (44.7%) presented with late-stage cervical cancer, and 674 women (69.7%) were living with HIV. The mean age at diagnosis was 50.5 years. The association between late-stage (III/IV) cervical cancer at diagnosis and patient clinical and sociodemographic factors was evaluated using multivariable logistic regression with multiple imputation. Women who reported undergoing cervical cancer screening had lower odds of late-stage disease at diagnosis (OR: 0.63, 95% CI 0.47–0.84) compared to those who did not report screening. Women who had never been married had increased odds of late-stage disease at diagnosis (OR: 1.35, 95% CI 1.02–1.86) compared to women who had been married. Women with abnormal vaginal bleeding had higher odds of late-stage disease at diagnosis (OR: 2.32, 95% CI 1.70–3.16) compared to those without abnormal vaginal bleeding. HIV was not associated with a diagnosis of late-stage cervical cancer. Rural women who consulted a traditional healer had increased odds of late-stage disease at diagnosis compared to rural women who had never consulted a traditional healer (OR: 1.61, 95% CI 1.02–2.55). Conclusion Increasing education and awareness among women, regardless of their HIV status, and among providers, including traditional healers, about the benefits of cervical cancer screening and about the importance of seeking prompt medical care for abnormal vaginal bleeding, while also developing support systems for unmarried women, may help reduce cervical cancer morbidity and mortality in Botswana.
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McGinnis GJ, Ning MS, Bvochora-Nsingo M, Chiyapo S, Balang D, Ralefala T, Lin A, Zetola NM, Grover S. Management of Head and Neck Cancers With or Without Comorbid HIV Infection in Botswana. Laryngoscope 2021; 131:E1558-E1566. [PMID: 33098322 PMCID: PMC8046722 DOI: 10.1002/lary.29206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/24/2020] [Accepted: 10/13/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVES/HYPOTHESIS Head and neck cancer (HNC) is the fifth most common malignancy in sub-Saharan Africa, a region with hyperendemic human immunodeficiency virus (HIV)-infection. HIV patients have higher rates of HNC, yet the effect of HIV-infection on oncologic outcomes and treatment toxicity is poorly characterized. STUDY DESIGN Prospective observational cohort study. METHODS HNC patients attending a government-funded oncology clinic in Botswana were prospectively enrolled in an observational cohort registry from 2015 to 2019. Clinical characteristics were analyzed via Cox proportional hazards and logistic regression followed by secondary analysis by HIV-status. Overall survival (OS) was evaluated via Kaplan-Meier. RESULTS The study enrolled 149 patients with a median follow-up of 23 months. Patients presented with advanced disease (60% with T4-primaries), received limited treatment (19% chemotherapy, 8% surgery, 29% definitive radiation [RT]), and had delayed care (median time from diagnosis to RT of 2.5 months). Median OS was 36.2 months. Anemia was associated with worse survival (HR 2.74, P = .001). Grade ≥ 3 toxicity rate with RT was 30% and associated with mucosal subsite (OR 4.04, P = .03) and BMI < 20 kg/m2 (OR 6.04, P = .012). Forty percent of patients (n = 59) were HIV-infected; most (85%) were on antiretroviral therapy, had suppressed viral loads (90% with ≤400 copies/mL), and had immunocompetent CD4 counts (median 400 cells/mm3 ). HIV-status was not associated with decreased receipt or delays of definitive RT, worse survival, or increased toxicity. CONCLUSIONS Despite access to government-funded care, HNC patients in Botswana present late and have delays in care, which likely contributes to suboptimal survival outcomes. While a disproportionate number has comorbid HIV infection, HIV-status does not adversely affect outcomes. LEVEL OF EVIDENCE 2c Laryngoscope, 131:E1558-E1566, 2021.
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Affiliation(s)
- Gwendolyn J McGinnis
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Matthew S Ning
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, U.S.A
| | | | - Sebathu Chiyapo
- Department of Oncology, Gaborone Private Hospital, Gaborone, Botswana
| | - Dawn Balang
- Department of Oncology, Gaborone Private Hospital, Gaborone, Botswana
| | - Tlotlo Ralefala
- School of Medicine, University of Botswana, Gaborone, Botswana
- Princess Marina Hospital, Gaborone, Botswana
| | - Alexander Lin
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Nicola M Zetola
- School of Medicine, University of Botswana, Gaborone, Botswana
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Surbhi Grover
- School of Medicine, University of Botswana, Gaborone, Botswana
- Princess Marina Hospital, Gaborone, Botswana
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Botswana University of Pennsylvania Partnership, Gaborone, Botswana
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9
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Little RF. Tearing down the false walls to HIV cancer care. Cancer 2019; 125:1597-1599. [DOI: 10.1002/cncr.31974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 12/24/2022]
Affiliation(s)
- Richard F. Little
- Division of Cancer Treatment and Diagnosis National Cancer Institute, National Institutes of Health Bethesda Maryland
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