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Eren MF, Kilic SS, Eren AA, Kaplan SO, Teke F, Kutuk T, Bicakci BC, Hathout L, Moningi S, Orio P, Atalar B, Sayan M. Radiation therapy for prostate cancer in Syrian refugees: facing the need for change. Front Public Health 2023; 11:1172864. [PMID: 37325331 PMCID: PMC10264678 DOI: 10.3389/fpubh.2023.1172864] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/11/2023] [Indexed: 06/17/2023] Open
Abstract
Purpose To report the utilization of radiation therapy in Syrian refugee patients with prostate cancer residing in Turkey. Methods and materials A multi-institutional retrospective review including 14 cancer centers in Turkey was conducted to include 137 Syrian refugee patients with prostate cancer treated with radiation therapy (RT). Toxicity data was scored using the National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0. Noncompliance was defined as a patient missing two or more scheduled RT appointments. Results Advanced disease, defined as stage III or IV, was reported in 64.2% of patients while androgen deprivation therapy (ADT) was only administrated to 20% of patients. Conventionally fractionated RT with a median number of 44 fractions was delivered to all patients with curative intent (n = 61) while palliative RT (n = 76) was delivered with a median number of 10 fractions. The acute grade 3-4 toxicity rate for the entire cohort was 16%. Noncompliance rate was 42%. Conclusion Most Syrian refugee prostate cancer patients presented with advanced disease however ADT was seldom used. Despite the low treatment compliance rate, conventional fractionation was used in all patients. Interventions are critically needed to improve screening and increase the use of standard-of-care treatment paradigms, including hypofractionated RT and ADT.
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Affiliation(s)
- Mehmet Fuat Eren
- Marmara University Istanbul Pendik Education and Research Hospital, Istanbul, Türkiye
| | - Sarah S. Kilic
- Taussig Cancer Institute, Cancer Center, Cleveland Clinic, Cleveland, OH, United States
| | - Ayfer Ay Eren
- Istanbul Kartal Dr.Lutfi Kirdar Education and Research Hospital, Istanbul, Türkiye
| | | | | | - Tugce Kutuk
- Malatya Education and Research Hospital, Malatya, Türkiye
| | | | - Lara Hathout
- Rutgers Cancer Institute of New Jersey, The State University of New Jersey, New Brunswick, NJ, United States
| | - Shalini Moningi
- Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Peter Orio
- Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | | | - Mutlay Sayan
- Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
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Mushonga M, Nyakabau AM, Ndlovu N, Iyer HS, Bellon JR, Kanda C, Ndarukwa-Jambwa S, Chipidza F, Makunike-Mutasa R, Muchuweti D, Muguti EG, Cluff Elmore SN. Patterns of Palliative Radiotherapy Utilization for Patients With Metastatic Breast Cancer in Harare, Zimbabwe. JCO Glob Oncol 2021; 7:1212-1219. [PMID: 34343013 PMCID: PMC8457791 DOI: 10.1200/go.20.00656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In sub-Saharan Africa, radiotherapy (RT) utilization and delivery patterns have not been extensively studied in patients with metastatic breast cancer. METHODS A retrospective cohort study of female patients with metastatic breast cancer seen at Parirenyatwa Radiotherapy Centre in Zimbabwe from 2014 to 2018 was conducted. Demographics, pathology, staging, and treatment data were abstracted through chart review. Fisher's exact test and chi-squared test of independence were used to compare proportions, and independent two-sample t-tests were used to compare means. RESULTS Of 351 patients with breast cancer, 152 (43%) had metastatic disease, median age 51 years (interquartile range: 43-61 years). Of those with metastatic disease, 30 patients (20%) received radiation to various metastatic sites: 16 spine; three nonspine bone metastases; six whole brain; and five chest wall or supraclavicular. Patients who received radiation were younger (46 v 52 years; P = .019), but did not differ significantly by performance status than those who did not. The most common dose prescription was 30 Gy in 10 fractions (33%). Five (17%) patients had treatment interruption and two (7%) had treatment noncompletion. Province of origin and clinical tumor stage were significant predictors of RT receipt (P = .002; and P = .018, respectively). CONCLUSION A minority of patients with metastatic breast cancer received RT (20%), and these were likely to be younger, with advanced tumor stage, and resided in provinces where RT is available. Conventional courses were generally prescribed. There is a need to strongly consider palliative RT as an option for patients with metastatic breast cancer and use of hypofractionated courses (e.g. 8 Gy in one fraction) may support this goal.
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Affiliation(s)
| | - Anna Mary Nyakabau
- Parirenyatwa Hospital Radiotherapy Centre, Harare, Zimbabwe.,Department of Oncology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe.,Cancerserve Trust, Harare, Zimbabwe
| | - Ntokozo Ndlovu
- Parirenyatwa Hospital Radiotherapy Centre, Harare, Zimbabwe.,Department of Oncology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Hari Subramaniam Iyer
- Harvard T.H. Chan School of Public Health, Boston, MA.,Dana-Farber Cancer Institute, Boston, MA
| | | | - Caroline Kanda
- Parirenyatwa Hospital Radiotherapy Centre, Harare, Zimbabwe
| | - Sandra Ndarukwa-Jambwa
- Sally Mugabe Central Hospital, Harare, Zimbabwe.,Department of Oncology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Fallon Chipidza
- Dana-Farber Cancer Institute, Boston, MA.,Harvard Radiation Oncology Program, Boston, MA
| | - Rudo Makunike-Mutasa
- Department of Pathology, University of Zimbabwe, Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | - David Muchuweti
- Department of Surgery, University of Zimbabwe, Faculty of Medicine and Health Sciences, Harare, Zimbabwe
| | - Edwin G Muguti
- Department of Surgery, University of Zimbabwe, Faculty of Medicine and Health Sciences, Harare, Zimbabwe
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