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Obayo S, Mulumba Y, Thompson CL, Gibson MK, Cooney MM, Orem J. Clinicopathological characteristics and treatment outcomes of oesophageal cancer patients in Uganda. Ecancermedicalscience 2023; 17:1576. [PMID: 37533943 PMCID: PMC10393309 DOI: 10.3332/ecancer.2023.1576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Indexed: 08/04/2023] Open
Abstract
Background Oesophageal cancer is the seventh most common cancer and the sixth leading cause of cancer death worldwide, and its incidence varies globally. In Uganda, the incidence and trend are on the increase. However, there is a paucity of published data regarding this population's oesophageal cancer clinicopathologic characterisation and treatment outcomes. Objectives To study the patients' clinicopathologic characteristics and treatment outcomes of oesophageal cancer over 10 years at the Uganda Cancer Institute. Methods Patients' charts with histologically confirmed diagnoses of oesophageal cancer for 2009-2019 were identified. Case information, which included patient demographics, history of alcohol use or smoking, tumour location, histological type, tumour grade, clinical TNM (Tumour, Node, Metastasis) staging treatment exposure and treatment outcomes, was evaluated retrospectively. The median survival time was estimated with the Kaplan-Meier method and the median follow-up period was estimated using the reverse Kaplan-Meier. Results 1,965 oesophageal cancer patients were identified; 1,380(70.23%) were males and 585(29.77 %) females, their mean age was 60.20 years (±12.66). Most males had a history of both alcohol consumption and smoking 640(46.38%). The lower third of the oesophagus was the most common anatomical location 771(39.24%). The majority had squamous cell carcinoma histological type 1,783(90.74%) followed by adenocarcinomas 182(9.26%) in the distal oesophagus. Poorly differentiated tumour grade 743(37.81%) was predominant. The majority of the patients were in stage IVB, 733(37.30%), and most patients were planned for the best supportive care, 731(37.20%). Radiation alone was offered to 621(31.60%) and feeding gastrostomy to 249(12.70%). Treatment outcomes: at the time of the current analysis, 58.68% had died, 1.48% were alive and 39.84% were lost to follow-up. The median follow-up period was 65 months (IQR:35.83-83.30) with a median survival time of 4.47 months (95% CI: 4.17-4.80). Conclusion Treatment outcomes of Ugandan oesophageal cancer patients seeking care are poor as most patients present with advanced disease. There is a significant loss of follow-up after treatment initiation. Therefore, reduction in exposure to known modifiable risk factors, early detection and timely referral for treatment strategies are needed to improve outcomes of these patients in our population. Designing interventions to improve treatment adherence is necessary.
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Affiliation(s)
- Siraji Obayo
- Uganda Cancer Institute, Upper Mulago Hill Road PO Box 3935, Kampala, Uganda
| | - Yusuf Mulumba
- Uganda Cancer Institute, Upper Mulago Hill Road PO Box 3935, Kampala, Uganda
| | - Cheryl L Thompson
- Case Western Reserve University, Case Comprehensive Cancer Centre, Cleveland, OH 44106, USA
- Case Western Reserve University, University Hospitals Seidman Cancer Center, Cleveland, OH 44106, USA
| | - Michael K Gibson
- Vanderbilt University Medical Centre, Vanderbilt-Ingram Cancer Center, Nashville, TN 37232, USA
| | - Matthew M Cooney
- Case Western Reserve University, Case Comprehensive Cancer Centre, Cleveland, OH 44106, USA
- Case Western Reserve University, University Hospitals Seidman Cancer Center, Cleveland, OH 44106, USA
| | - Jackson Orem
- Uganda Cancer Institute, Upper Mulago Hill Road PO Box 3935, Kampala, Uganda
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Chen J, Liu H, Santhekadur PK. Editorial: Chemotherapy in esophageal cancer. Front Oncol 2022; 12:1098838. [PMID: 36605431 PMCID: PMC9809285 DOI: 10.3389/fonc.2022.1098838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/08/2022] [Indexed: 01/07/2023] Open
Affiliation(s)
- Jiang Chen
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Hao Liu
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Prasanna K. Santhekadur
- Department of Biochemistry, Center of Excellence in Molecular Biology & Regenerative Medicine, Jagadguru Sri Shivarathreeshwara (JSS) Medical College, Jagadguru Sri Shivarathreeshwara (JSS) Academy of Higher Education and Research, Mysore, Karnataka, India,*Correspondence: Prasanna K. Santhekadur,
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Masukume G, Mmbaga BT, Dzamalala CP, Mlombe YB, Finch P, Nyakunga-Maro G, Mremi A, Middleton DRS, Narh CT, Chasimpha SJD, Abedi-Ardekani B, Menya D, Schüz J, McCormack V. A very-hot food and beverage thermal exposure index and esophageal cancer risk in Malawi and Tanzania: findings from the ESCCAPE case-control studies. Br J Cancer 2022; 127:1106-1115. [PMID: 35768549 PMCID: PMC9470732 DOI: 10.1038/s41416-022-01890-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 05/30/2022] [Accepted: 06/08/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Consumption of very-hot beverages/food is a probable carcinogen. In East Africa, we investigated esophageal squamous cell carcinoma (ESCC) risk in relation to four thermal exposure metrics separately and in a combined score. METHODS From the ESCCAPE case-control studies in Blantyre, Malawi (2017-20) and Kilimanjaro, Tanzania (2015-19), we used logistic regression models adjusted for country, age, sex, alcohol and tobacco, to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for self-reported thermal exposures whilst consuming tea, coffee and/or porridge. RESULTS The study included 849 cases and 906 controls. All metrics were positively associated with ESCC: temperature of drink/food (OR 1.92 (95% CI: 1.50, 2.46) for 'very hot' vs 'hot'), waiting time before drinking/eating (1.76 (1.37, 2.26) for <2 vs 2-5 minutes), consumption speed (2.23 (1.78, 2.79) for 'normal' vs 'slow') and mouth burning (1.90 (1.19, 3.01) for ≥6 burns per month vs none). Amongst consumers, the composite score ranged from 1 to 12, and ESCC risk increased with higher scores, reaching an OR of 4.6 (2.1, 10.0) for scores of ≥9 vs 3. CONCLUSIONS Thermal exposure metrics were strongly associated with ESCC risk. Avoidance of very-hot food/beverage consumption may contribute to the prevention of ESCC in East Africa.
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Affiliation(s)
- Gwinyai Masukume
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France.
| | - Blandina T Mmbaga
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre and Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | | | - Peter Finch
- Malawi College of Medicine, Blantyre, Malawi
| | - Gissela Nyakunga-Maro
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre and Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Alex Mremi
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre and Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Daniel R S Middleton
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Clement T Narh
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France
- School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Steady J D Chasimpha
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Behnoush Abedi-Ardekani
- Genomic Epidemiology Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Diana Menya
- School of Public Health, Moi University, Eldoret, Kenya
| | - Joachim Schüz
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Valerie McCormack
- Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France.
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Ismail M, Mondlane L, Loforte M, Dimande L, Machatine S, Carrilho C, Sacarlal J. Demographic, endoscopic and histological profile of esophageal cancer at the Gastroenterology Department of Maputo Central Hospital from January 2016 to December 2018. Pan Afr Med J 2022; 41:100. [PMID: 35465369 PMCID: PMC8994464 DOI: 10.11604/pamj.2022.41.100.30941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/14/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION esophageal cancer is a major public health problem in Mozambique. It is the nineth most common cancer worldwide in terms of incidence (604.000 new cases/year), and sixth in overall mortality (544.076 deaths/year). In Mozambique esophageal cancer was the seventh most common cancer in males and the fifth in females between 1991 and 2008. METHODS it was done a cross-sectional hospital-based epidemiological study, using secondary demographics endoscopic and pathologic features data. A retrospective analysis of the existing information of patients classified as esophageal cancer diagnosed with upper gastrointestinal endoscopy observed from January 1st, 2016 to December 31st, 2018 at the Gastroenterology Service of Maputo Central Hospital. A coding sheet was created a priori, and data analysed in SPSS version 20. RESULTS of the 205 cases with complete records where included in the analysis, there was a higher frequency of females with 56.6% (116/205). The average age was 59.5 years with standard deviation of ± 12.9 years. Most of the patients were native of southern Mozambique, with 92.7% (190/205), of which Maputo made up 53.2% (109/205). Regarding race, 99.5% (204/205) were black. The most affected endoscopic location was the middle third with 48.8% (100/205), followed by the lower third with 29.8% (61/205) and the upper third with 21.5% (44/205). Squamous cell carcinoma was the most frequent, with 92.7% (190/205), followed by adenocarcinoma with 4.9% (10/205). CONCLUSION due to the high number of observed cases of esophageal cancer, a high degree of clinical suspicion is needed for timely diagnosis and more effective treatment. Updated prevalent studies are needed throughout the country to understand the true impact of esophageal cancer on the Mozambican population.
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Affiliation(s)
- Muhammad Ismail
- Serviço de Gastroenterologia, Hospital Central de Maputo, Maputo, Mozambique,,Corresponding author: Muhammad Ismail, Serviço de Gastroenterologia, Hospital Central de Maputo, Maputo, Mozambique.
| | - Liana Mondlane
- Serviço de Gastroenterologia, Hospital Central de Maputo, Maputo, Mozambique
| | - Michella Loforte
- Serviço de Gastroenterologia, Hospital Central de Maputo, Maputo, Mozambique
| | - Luzmira Dimande
- Serviço de Gastroenterologia, Hospital Central de Maputo, Maputo, Mozambique
| | - Sheila Machatine
- Serviço de Gastroenterologia, Hospital Central de Maputo, Maputo, Mozambique
| | - Carla Carrilho
- Serviço de Anatomia Patológica, Hospital Central de Maputo, Maputo, Mozambique,,Departamento de Patologia, Faculdade de Medicina, UEM, Maputo, Mozambique
| | - Jahit Sacarlal
- Departamento de Patologia, Faculdade de Medicina, UEM, Maputo, Mozambique
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Buckle GC, Mrema A, Mwachiro M, Ringo Y, Selekwa M, Mulima G, Some FF, Mmbaga BT, Mody GN, Zhang L, Paciorek A, Akoko L, Ayuo P, Burgert S, Bukusi E, Charles A, Chepkemoi W, Chesumbai G, Kaimila B, Kenseko A, Kibwana KS, Koech D, Macharia C, Moirana EN, Mushi BP, Mremi A, Mwaiselage J, Mwanga A, Ndumbalo J, Nvakunga G, Ngoma M, Oduor M, Oloo M, Opakas J, Parker R, Seno S, Salima A, Servent F, Wandera A, Westmoreland KD, White RE, Williams B, Mmbaga EJ, Van Loon K. Treatment outcomes of esophageal cancer in Eastern Africa: protocol of a multi-center, prospective, observational, open cohort study. BMC Cancer 2022; 22:82. [PMID: 35045815 PMCID: PMC8772224 DOI: 10.1186/s12885-021-09124-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 12/18/2021] [Indexed: 11/19/2022] Open
Abstract
Background Esophageal squamous cell carcinoma (ESCC) is a major cause of cancer morbidity and mortality in Eastern Africa. The majority of patients with ESCC in Eastern Africa present with advanced disease at the time of diagnosis. Several palliative interventions for ESCC are currently in use within the region, including chemotherapy, radiation therapy with and without chemotherapy, and esophageal stenting with self-expandable metallic stents; however, the comparative effectiveness of these interventions in a low resource setting has yet to be examined. Methods This prospective, observational, multi-center, open cohort study aims to describe the therapeutic landscape of ESCC in Eastern Africa and investigate the outcomes of different treatment strategies within the region. The 4.5-year study will recruit at a total of six sites in Kenya, Malawi and Tanzania (Ocean Road Cancer Institute and Muhimbili National Hospital in Dar es Salaam, Tanzania; Kilimanjaro Christian Medical Center in Moshi, Tanzania; Tenwek Hospital in Bomet, Kenya; Moi Teaching and Referral Hospital in Eldoret, Kenya; and Kamuzu Central Hospital in Lilongwe, Malawi). Treatment outcomes that will be evaluated include overall survival, quality of life (QOL) and safety. All patients (≥18 years old) who present to participating sites with a histopathologically-confirmed or presumptive clinical diagnosis of ESCC based on endoscopy or barium swallow will be recruited to participate. Key clinical and treatment-related data including standardized QOL metrics will be collected at study enrollment, 1 month following treatment, 3 months following treatment, and thereafter at 3-month intervals until death. Vital status and QOL data will be collected through mobile phone outreach. Discussion This study will be the first study to prospectively compare ESCC treatment strategies in Eastern Africa, and the first to investigate QOL benefits associated with different treatments in sub-Saharan Africa. Findings from this study will help define optimal management strategies for ESCC in Eastern Africa and other resource-limited settings and will serve as a benchmark for future research. Trial registration This study was retrospectively registered with the ClinicalTrials.gov database on December 15, 2021, NCT05177393. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-09124-5.
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Affiliation(s)
- Geoffrey C Buckle
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 505 Parnassus Ave, M1296, San Francsico, CA, 94143, USA.
| | - Alita Mrema
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | | | - Yona Ringo
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Msiba Selekwa
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Fatma F Some
- Moi University School of Medicine, Eldoret, Kenya
| | - Blandina T Mmbaga
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Gita N Mody
- University of North Carolina, Chapel Hill, USA
| | - Li Zhang
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 505 Parnassus Ave, M1296, San Francsico, CA, 94143, USA
| | - Alan Paciorek
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 505 Parnassus Ave, M1296, San Francsico, CA, 94143, USA
| | - Larry Akoko
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Paul Ayuo
- Moi University School of Medicine, Eldoret, Kenya
| | | | | | | | | | | | | | - Aida Kenseko
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | - David Koech
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | | | | | - Alex Mremi
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | - Ally Mwanga
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Gissela Nvakunga
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Mamsau Ngoma
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | | | - Mark Oloo
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Jesse Opakas
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Robert Parker
- Tenwek Hospital, Bomet, Kenya.,Warren Alpert School of Medicine at Brown University, Providence, RI, USA
| | - Saruni Seno
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | - Furaha Servent
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | - Kate D Westmoreland
- University of North Carolina, Chapel Hill, USA.,UNC-Project Malawi, Lilongwe, Malawi
| | - Russell E White
- Tenwek Hospital, Bomet, Kenya.,Warren Alpert School of Medicine at Brown University, Providence, RI, USA
| | | | - Elia J Mmbaga
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Katherine Van Loon
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 505 Parnassus Ave, M1296, San Francsico, CA, 94143, USA
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Asombang AW, Kasongo N, Muyutu J, Montiero JFG, Chishinga N, Chipaila J, Banda L. Descriptive analysis of esophageal cancer in Zambia using the cancer disease hospital database: young age, late stage at presentation. Pan Afr Med J 2021; 39:12. [PMID: 34394803 PMCID: PMC8348283 DOI: 10.11604/pamj.2021.39.12.23357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 03/22/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION published data on oesophageal cancer (EC) in Zambia is limited and our study is the only study in Zambia evaluating the demographics and clinicopathologic features of patients presenting with EC at time of diagnosis. METHODS a retrospective analysis of data from Cancer Diseases Hospital (CDH) database was conducted on EC patients diagnosed between 2007 and December 2018. Medical records of EC patients were manually retrieved and reviewed using medical record numbers identified from the CDH database. Demographics, clinicopathologic features and modes of treatment were extracted. A coding sheet was created a priori, and data analysed in SAS version 9.3. RESULTS two hundred and seventy eight (278) complete EC medical records were included in the analysis, 183 (66%) were males, mean age was 55 years (range 21-89). One hundred and fifty six (156) (56%) resided in Lusaka, the location of CDH. The age-standardized incidence for EC was 5.5 per 100,000 people (95% CI, 4.3-6.6). The commonest symptom was dysphagia (83%), 97% were diagnosed endoscopically, squamous cell carcinoma and adenocarcinoma accounted for 90% and 8.3% respectively, 65% received treatment. One hundred and twenty four (124) medical records had missing cancer staging. Of 154 medical records with complete cancer staging, 98 (35%) were diagnosed at stage 4 of which 33% were between 40 and 49 years. CONCLUSION the age-standardized incidence for EC is high at CDH. Patients with EC are predominantly male, reside in Lusaka and present with late stage EC at time of diagnosis; mostly between the ages of 40-49 years. Robust prospective research and improved data recording is needed.
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Affiliation(s)
- Akwi Wasi Asombang
- Division of Gastroenterology, Hepatology, Warren Alpert Medical School of Brown University, Rhode Island 02903, United States
| | - Nancy Kasongo
- School of Medicine, Copperbelt University, Ndola, Zambia
| | - John Muyutu
- School of Medicine, Copperbelt University, Ndola, Zambia
| | | | | | - Jackson Chipaila
- Department of Surgery, University Teaching Hospital - Adult Hospital, Lusaka, Zambia
| | - Lewis Banda
- Hematology, Oncology, Cancer Disease Hospital, Lusaka, Zambia
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Understanding health-seeking and adherence to treatment by patients with esophageal cancer at the Uganda cancer Institute: a qualitative study. BMC Health Serv Res 2021; 21:159. [PMID: 33602201 PMCID: PMC7890846 DOI: 10.1186/s12913-021-06163-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 02/09/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In the low- and middle-income countries, most patients with esophageal cancer present with advanced stage disease and experience poor survival. There is inadequate understanding of the factors that influence decisions to and actual health-seeking, and adherence to treatment regimens among esophageal cancer patients in Uganda, yet this knowledge is critical in informing interventions to promote prompt health-seeking, diagnosis at early stage and access to appropriate cancer therapy to improve survival. We explored health-seeking experiences and adherence to treatment among esophageal cancer patients attending the Uganda Cancer Institute. METHODS We conducted an interview based qualitative study at the Uganda Cancer Institute (UCI). Participants included patients with established histology diagnosis of esophageal cancer and healthcare professionals involved in the care of these patients. We used purposive sampling approach to select study participants. In-depth and key informant interviews were used in data collection. Data collection was conducted till point of data saturation was reached. Thematic content analysis approach was used in data analyses and interpretations. Themes and subthemes were identified deductively. RESULTS Sixteen patients and 17 healthcare professionals were included in the study. Delayed health-seeking and poor adherence to treatment were related to (i) emotional and psychosocial factors including stress of cancer diagnosis, stigma related to esophageal cancer symptoms, and fear of loss of jobs and livelihood, (ii) limited knowledge and recognition of esophageal cancer symptoms by both patients and primary healthcare professionals, and (iii) limited access to specialized cancer care, mainly because of long distance to the facility and associated high transport cost. Patients were generally enthused with patient - provider relationships at the UCI. While inadequate communication and some degree of incivility were reported, majority of patients thought the healthcare professionals were empathetic and supportive. CONCLUSION Health system and individual patient factors influence health-seeking for symptoms of esophageal cancer and adherence to treatment schedule for the disease. Interventions to improve access to and acceptability of esophageal cancer services, as well as increase public awareness of esophageal cancer risk factors and symptoms could lead to earlier diagnosis and potentially better survival from the disease in Uganda.
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Hassen HY, Teka MA, Addisse A. Survival Status of Esophageal Cancer Patients and its Determinants in Ethiopia: A Facility Based Retrospective Cohort Study. Front Oncol 2021; 10:594342. [PMID: 33659206 PMCID: PMC7917207 DOI: 10.3389/fonc.2020.594342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 12/18/2020] [Indexed: 12/17/2022] Open
Abstract
Background Globally, the incidence and mortality due to esophageal cancer are increasing, particularly in low- and middle-income countries. Cancer of the esophagus is the eighth in incidence and seventh in cancer mortality in Ethiopia. A few studies have shown an increasing burden, however, little is known about the survival pattern and its determinants among esophageal cancer patients in Ethiopia. Therefore, we assessed the survival pattern and its determinants among esophageal cancer patients. Methods We conducted a retrospective cohort study among 349 esophageal cancer patients who were diagnosed at or referred to Tikur Anbessa Specialized Hospital, Ethiopia from January 2010 to May 2017. Using an abstraction form, nurses who were working at the oncology department extracted the data from patient charts. To estimate and compare the probability of survival among covariate categories, we performed a Kaplan-Meier survival analysis with the log-rank test. To identify the prognostic determinants of survival, we performed a multivariable Cox proportional regression analysis. Results The median follow-up time was 32 months with interquartile range of 15 to 42. Overall, the median survival time after diagnosis with esophageal cancer was 4 months with one-, two- and three-year survival of 14.4, 6.3, and 2.4% respectively. In the multivariable Cox proportional hazards model, receiving chemotherapy [Adjusted Hazard Ratio (AHR)=0.36, 95%CI: 0.27-0.49], radiotherapy [AHR=0.38, 95%CI: 0.23-0.63] and surgery [AHR=0.70, 95%CI: 0.54-0.89] were statistically significant. Conclusions In Ethiopia, esophageal cancer patients have a very low one-, two- and three-year survival. Despite a very low overall survival, patients who received either chemotherapy, radiotherapy or surgery showed a better survival compared with those who did not receive any treatment. Hence, it is essential to improve the survival of patients with esophageal cancer through early detection and timely initiation of the available treatment options.
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Affiliation(s)
- Hamid Yimam Hassen
- Department of Public Health, Faculty of Medicine and Health Sciences, Mizan Tepi University, Mizan Teferi, Ethiopia.,Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Mohammed Ahmed Teka
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adamu Addisse
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Come J, Pereira JB, Pinto R, Carrilho C, Pereira L, Lara Santos L. The Upper Digestive Tract Microbiome and Oesophageal Squamous Cell Carcinoma: Epidemiology, Pathogenesis, and Clinical Implications in Africa. Pathobiology 2020; 88:141-155. [PMID: 33291118 DOI: 10.1159/000511422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 09/07/2020] [Indexed: 12/24/2022] Open
Abstract
The study of the microbiome has significantly contributed to our understanding of complex diseases including cancer, with a profound influence of the microbiota on clinical prognosis and the efficacy of cancer treatments. Oesophageal cancer is positioned amongst the most aggressive malignant diseases, resulting from a complex interaction between anthropometric, genetic, immune response, and environmental factors. Oesophageal squamous cell carcinoma (OSCC) is the most common type of oesophageal cancer and is a serious burden in Eastern Africa, in the area known as the African oesophageal cancer corridor (AOCC). OSCC is often diagnosed at a late stage, with patients already suffering from severe malnutrition and dehydration due to swallowing difficulties, leading to high mortality rates. So far, aetiological factors have been individually analysed with an inappropriate contextualisation. The upper digestive tract microbiome has been proposed to contribute to the onset and progression of OSCC but with limited understanding of the mechanisms behind this interaction. Data on African populations are limited, and the aetiology of AOCC is still poorly understood. This review discusses the current knowledge of the aetiology of OSCC in Africa, with special focus on the probable influence of the upper digestive tract microbiota.
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Affiliation(s)
- Jotamo Come
- Departamento de Cirurgia, Hospital Central de Maputo, Maputo, Mozambique
| | - Joana Barbosa Pereira
- i3S, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,IPATIMUP, Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal
| | - Ricardo Pinto
- i3S, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,IPATIMUP, Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal
| | - Carla Carrilho
- Departamento de Patologia, Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique.,Departamento de Patologia, Hospital Central de Maputo, Maputo, Mozambique
| | - Luisa Pereira
- i3S, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,IPATIMUP, Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Porto, Portugal
| | - Lúcio Lara Santos
- Grupo de Patologia e Terapêutica Experimental e Departamento de Oncologia do Instituto Português de Oncologia do Porto, Porto, Portugal, .,ONCOCIR - Education and Care in Oncology, PALOP - Lusophone Africa, Porto, Portugal,
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Asombang AW, Chishinga N, Nkhoma A, Chipaila J, Nsokolo B, Manda-Mapalo M, Montiero JFG, Banda L, Dua KS. Systematic review and meta-analysis of esophageal cancer in Africa: Epidemiology, risk factors, management and outcomes. World J Gastroenterol 2019; 25:4512-4533. [PMID: 31496629 PMCID: PMC6710188 DOI: 10.3748/wjg.v25.i31.4512] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/05/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Esophageal cancer (EC) is associated with a poor prognosis, particularly so in Africa where an alarmingly high mortality to incidence ratio prevails for this disease. AIM To provide further understanding of EC in the context of the unique cultural and genetic diversity, and socio-economic challenges faced on the African continent. METHODS We performed a systematic review of studies from Africa to obtain data on epidemiology, risk factors, management and outcomes of EC. A non-systematic review was used to obtain incidence data from the International Agency for Research on Cancer, and the Cancer in Sub-Saharan reports. We searched EMBASE, PubMed, Web of Science, and Cochrane Central from inception to March 2019 and reviewed the list of articles retrieved. Random effects meta-analyses were used to assess heterogeneity between studies and to obtain odds ratio (OR) of the associations between EC and risk factors; and incidence rate ratios for EC between sexes with their respective 95% confidence intervals (CI). RESULTS The incidence of EC is higher in males than females, except in North Africa where it is similar for both sexes. The highest age-standardized rate is from Malawi (30.3 and 19.4 cases/year/100000 population for males and females, respectively) followed by Kenya (28.7 cases/year/100000 population for both sexes). The incidence of EC rises sharply after the age of 40 years and reaches a peak at 75 years old. Meta-analysis shows a strong association with tobacco (OR 3.15, 95%CI: 2.83-3.50). There was significant heterogeneity between studies on alcohol consumption (OR 2.28, 95%CI: 1.94-2.65) and on low socioeconomic status (OR 139, 95%CI: 1.25-1.54) as risk factors, but these could also contribute to increasing the incidence of EC. The best treatment outcomes were with esophagectomy with survival rates of 76.6% at 3 years, and chemo-radiotherapy with an overall combined survival time of 267.50 d. CONCLUSION Africa has high incidence and mortality rates of EC, with preventable and non-modifiable risk factors. Men in this setting are at increased risk due to their higher prevalence of tobacco and alcohol consumption. Management requires a multidisciplinary approach, and survival is significantly improved in the setting of esophagectomy and chemoradiation therapy.
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Affiliation(s)
- Akwi W Asombang
- Division of Gastroenterology/Hepatology, Warren Alpert Medical School of Brown University, Providence, RI 02903, United States
| | - Nathaniel Chishinga
- Department for HIV Elimination, Fulton County Government, Atlanta, GA 30303, United States
| | - Alick Nkhoma
- Department of Gastroenterology, Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Staffordshire ST4 6QG, United Kingdom
| | - Jackson Chipaila
- Department of Surgery, University Teaching Hospital-Adult Hospital, Lusaka 10101, Zambia
| | - Bright Nsokolo
- Department of Medicine, Levy Mwanawasa University Teaching Hospital, Tropical Gastroenterology and Nutrition Group (TROPGAN), Lusaka 10101, Zambia
| | - Martha Manda-Mapalo
- Department of Medicine, The University of New Mexico, Albuquerque, NM 87106, United States
| | | | - Lewis Banda
- Hematology/Oncology, Cancer Disease Hospital, Lusaka 10101, Zambia
| | - Kulwinder S Dua
- Department of Medicine and Pediatrics, Medical College of Wisconsin, Milwaukee, WI 53226, United States
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Come J, Cambaza E, Ferreira R, da Costa JMC, Carrilho C, Santos LL. Esophageal cancer in Mozambique: should mycotoxins be a concern? Pan Afr Med J 2019; 33:187. [PMID: 31565147 PMCID: PMC6756822 DOI: 10.11604/pamj.2019.33.187.18295] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 05/04/2019] [Indexed: 01/01/2023] Open
Abstract
Fumonisin B1 (FB1) is a mycotoxin frequently found in agricultural commodities. The toxin poses a considerable risk for human and animal health. FB1 is among several mycotoxins produced by Fusarium spp. contaminating virtually any cereal and other Poaceae. Their intracellular action includes the promotion of oxidative stress through the generation of reactive oxygen species (ROS) that damage biomolecules such as DNA. These toxic effects were observed in vivo and in vitro. However, the association between esophageal lesions and oxidative stress induced by FB1. Studies in China, Iran and South Africa showed higher exposure to fumonisins in areas with higher risk of esophageal cancer (EC). Exposure to mycotoxins may be inevitable in Mozambique. How mycotoxins, particularly fumonisins from the contaminated food, can be associated with the emergence of EC in Mozambique? Herein, we revise the literature and present some pieces of evidence in order to highlight the burden of mycotoxins and to provide evidence-based considerations for the stakeholders involved in the management of the EC agenda in Mozambique. The information presented herein supports the need to implement novel and/or to revisit the existent detoxification methods to reduce the global burden of mycotoxins and its outcomes in health management.
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Affiliation(s)
- Jotamo Come
- Department of Surgery, Maputo Central Hospital, Maputo, Mozambique
| | - Edgar Cambaza
- Department of Biological Sciences, Faculty of Sciences, Eduardo Mondlane University, Maputo, Mozambique
| | - Rita Ferreira
- QOPNA-Química Orgânica, Produtos Naturais e Agroalimentares, Departamento de Química, Aveiro University, Aveiro, Portugal
| | - José Manuel Correia da Costa
- Center for the Study of Animal Science, ICETA, University of Porto and INSA-National Health Institute Dr. Ricardo Jorge, Porto, Portugal
| | - Carla Carrilho
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo Central Hospital, Maputo, Mozambique
| | - Lúcio Lara Santos
- Experimental Pathology and Therapeutics Research Group, Surgical Oncology Department, Portuguese Oncology Institute, Porto, Portugal
- ONCOCIR, Education and Care in Oncology, Lusophone Africa
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Ebigbo A, Karstensen JG, Aabakken L, Dinis-Ribeiro M, Spaander M, Le Moine O, Vilmann P, Ijoma U, Osuagwu C, Anigbo G, Afiheni M, Duduyemi B, Desalegn H, Ponchon T, Hassan C. Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Cascade Guideline. Endosc Int Open 2019; 7:E833-E836. [PMID: 31198848 PMCID: PMC6561763 DOI: 10.1055/a-0898-3523] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 02/02/2019] [Indexed: 02/07/2023] Open
Affiliation(s)
- Alanna Ebigbo
- Department of Gastroenterology, Klinikum Augsburg, Augsburg, Germany
| | - John Gásdal Karstensen
- Gastro Unit, Division of Endoscopy, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Lars Aabakken
- Endoscopy, Oslo University Hospital – Rikshospitalet, Oslo, Norway
| | | | - Manon Spaander
- Department of Gastroenterology and Hepatology, Erasmus Medical Centre Rotterdam
| | - Olivier Le Moine
- Gastroenterology Department, Erasme University Hospital, Brussels, Belgium
| | - Peter Vilmann
- Gastro Unit, Division of Endoscopy, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Uchenna Ijoma
- Department of Gastroenterology, University of Nigeria Teaching Hospital, Ituku-Ozala, Nigeria
| | - Chukwuemeka Osuagwu
- Department of Gastroenterology, University of Nigeria Teaching Hospital, Ituku-Ozala, Nigeria
| | - Gideon Anigbo
- Department of Medicine, Enugu State University Teaching Hospital, Enugu, Nigeria
| | - Mary Afiheni
- Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Babatunde Duduyemi
- Department of Pathology, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Hailemichael Desalegn
- Department of Internal Medicine, St. Paul’s Hospital Millenium Medical College, Ethiopia
| | - Thierry Ponchon
- Gastroenterology and Endoscopy, Edouard Herriot Hospital, Lyon, France
| | - Cesare Hassan
- Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy,Corresponding author Cesare Hassan, MD Endoscopy UnitNuovo Regina Margherita HospitalVia Morosini 30Rome 00153Italy+39-06-58446533
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13
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Morais A, Come J, Selemane C, Pires G, Tivane A, Cossa M, Tulsidás S, Antunes L, Costa MJ, Sidat M, Martins MDR, Carrilho C, Santos LL. Understanding the bricks to build better surgical oncology unit at Maputo Central Hospital: prevalent surgical cancers and residents knowledge. Pan Afr Med J 2019; 32:83. [PMID: 31223374 PMCID: PMC6560991 DOI: 10.11604/pamj.2019.32.83.18126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 01/27/2019] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Cancer is a growing concern in Mozambique. However, the country has limited facilities and few oncologists. Surgical oncologists are an unmet need. The aim of this study was to assess residents' knowledge in prevalent cancer domains and to identify and characterize prevalent cancers treated by surgery at Maputo Central Hospital, the largest hospital in Mozambique. The expectations were that the findings shall inform the development of a comprehensive curriculum in surgical oncology fellowship fit for the Hospital. METHODS To identify and characterize prevalent cancers, we performed a retrospective analysis of individual cancer patient registries of Maputo Central Hospital (MCH), Mozambique. Information was recorded into data collection sheets and analyzed with SPSS® 21. To assess MCH residents oncologic knowledge, we invited Twenty-six junior residents (49% of all residents) of different specialties to take a 30 item multiple choice written test used elsewhere in previous studies. The test focused on the domains of Basis of oncology, Radiotherapy, Pathology, Chemotherapy, Pain management, Surgical oncology and Clinical Pathway. The test was administered anonymously and without prior notice. We analyzed the overall test and topic performance of residents. RESULTS The study covered a period of 3 years and 203 patients. The most prevalent malignant tumors treated by general and thoracic surgery in MCH cancer registry were esophageal (7%), female breast (6.5%) and colorectal cancer (2.8%). Globally these malignancies were diagnosed at an advanced stage of the disease and required a multimodal treatment. The mean percent correct score of residents was 37.3%. The dimension with the highest percent correct score were clinical management (46%) and surgical oncology (28%) showed the lowest correct score. CONCLUSION In Maputo, Mozambique esophageal, breast and colorectal cancer were the most prevalent malignancies treated, with surgery, by thoracic or general surgery in MCH. The test scores suggest that, among residents, the knowledge in oncology needs to be improved, rendering support to the need of a surgical oncology training tailored to suit the local needs. Specific training should take into account local cancer prevalence, resources, their quality and the support of surgical oncology services with volume and experience.
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Affiliation(s)
- Atílio Morais
- Surgical Department, Maputo Central Hospital, Maputo, Mozambique
- Department of Surgery of Faculty of Medicine, University of Eduardo Mondlane, Maputo, Mozambique
| | - Jotamo Come
- Surgical Department, Maputo Central Hospital, Maputo, Mozambique
| | - Carlos Selemane
- Surgical Department, Maputo Central Hospital, Maputo, Mozambique
| | - Germano Pires
- Surgical Department, Maputo Central Hospital, Maputo, Mozambique
| | - Adriano Tivane
- Surgical Department, Maputo Central Hospital, Maputo, Mozambique
| | - Matchecane Cossa
- Surgical Department, Maputo Central Hospital, Maputo, Mozambique
| | - Satish Tulsidás
- Medical Oncology Department, Maputo Central Hospital, Maputo, Mozambique
| | - Luís Antunes
- Epidemiology Service, Portuguese Institute of Oncology, Porto, Portugal
| | - Manuel João Costa
- Medical Education Unit, School of Medicine University of Minho, Portugal
| | - Moshin Sidat
- Department of Community Health, University of Eduardo Mondlane, Maputo, Mozambique
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Portugal
| | - Maria do Rosário Martins
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Portugal
| | - Carla Carrilho
- Pathology Department, Maputo Central Hospital, Maputo, Mozambique
| | - Lúcio Lara Santos
- Surgical Oncology Department, Portuguese Institute of Oncology, Porto, Portugal
- Experimental Pathology and Therapeutics Research Group, Portuguese Institute of Oncology, Porto, Portugal
- ONCOCIR- Education and Care in Oncology, Lusophone, Africa
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Santos LL, Spencer HB, Miguel F, Tulsidás S, Rodrigues B, Lopes LV. Fight against cancer in Portuguese-speaking African countries: echoes from the last cancer meetings. Infect Agent Cancer 2019. [PMCID: PMC6377738 DOI: 10.1186/s13027-019-0222-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Portuguese-speaking countries in Africa include Angola, Mozambique, Guinea-Bissau, Cape Verde, São Tomé and Principe. These countries belong to an interstate organization known as PALOP. In June 2018, PALOP organized a cancer meeting in Praia, Cape Verde, entitled ‘Quality in cancer care, optimization of cancer units, cancer education and training.’ This meeting was supported by faculty from the African Organization for Research and Training in Cancer (AORTIC) and was dedicated to the improvement of cancer care in PALOP countries. The burden of non-communicable diseases, which includes cancer, is increasing rapidly in these countries.. During this meeting, a plan was developed to guide the future strategic actions in this community. The main points of action include to increase access to cancer care, boost HPV and hepatitis B vaccination, improve access to cancer treatment, including radiotherapy and palliative care, amongst others. Efforts will be made to ensure the participation of all of these countries at PALOP meetings, including Equatorial Guinea, a potential new member.
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