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Dare AJ, Olatoke SA, Okereke CE, Abdulkareem FB, Adeyeye A, Badejo O, Du M, Fayenuwo OJ, Gali BM, Kahn R, Knapp G, Ntiamoah P, Olcese C, Oludara MA, Omisore A, Omoyiola OZ, Owoade IA, Brennan MF, Kingham TP, Alatise OI. The African Research Group for Oncology: A decade fostering colorectal cancer research in Nigeria. J Surg Oncol 2023; 128:1011-1020. [PMID: 37818907 DOI: 10.1002/jso.27444] [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: 09/01/2023] [Accepted: 09/02/2023] [Indexed: 10/13/2023]
Abstract
The African Research Group for Oncology (ARGO) was formed in 2013 to undertake methodologically rigorous cancer research in Nigeria, and to strengthen cancer research capacity in the country through training and mentorship of physicians, scientists, and other healthcare workers. Here, we describe how ARGO's work in colorectal cancer (CRC) has evolved over the past decade. This includes the consortium's scientific contributions to the understanding of CRC in Nigeria and globally and its research capacity-building program.
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Affiliation(s)
- Anna J Dare
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Samuel A Olatoke
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | | | - Fatimah B Abdulkareem
- Department of Anatomic and Molecular Pathology, Faculty of Basic Medical Sciences, University of Lagos, Lagos, Nigeria
| | - Ademola Adeyeye
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Kwara State, Nigeria
| | - Olawale Badejo
- Department of Surgery, National Hospital Abuja, Abuja, Nigeria
| | - Mengmeng Du
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | | | - Bata M Gali
- Department of Surgery, University of Maiduguri, Maiduguri, Nigeria
| | - Rivka Kahn
- Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Gregory Knapp
- Department of Surgery, Division of General Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Peter Ntiamoah
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Cristina Olcese
- Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Mobolaji A Oludara
- Department of Surgery, Lagos State University Teaching Hospital, Ikeja, Lagos State, Nigeria
| | - Adeleye Omisore
- Department of Radiology, College of Health Sciences, Obafemi Awolowo University, Ile Ife, Osun State, Nigeria
| | - Oluwatosin Z Omoyiola
- Department of Morbid Anatomy, College of Health Sciences, Obafemi Awolowo University, Ile Ife, Osun State, Nigeria
| | - Israel A Owoade
- African Research Group for Oncology, Ile Ife, Osun State, Nigeria
| | - Murray F Brennan
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - T Peter Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Olusegun I Alatise
- Department of Surgery, College of Health Sciences, Obafemi Awolowo University, Ile Ife, Osun State, Nigeria
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Watermeyer G, Katsidzira L, Nsokolo B, Isaac Alatise O, Duduyemi BM, Kassianides C, Hodges P. Challenges in the diagnosis and management of IBD: a sub-Saharan African perspective. Therap Adv Gastroenterol 2023; 16:17562848231184986. [PMID: 37457138 PMCID: PMC10345935 DOI: 10.1177/17562848231184986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
With the exception of South Africa, inflammatory bowel disease (IBD) has long been considered uncommon in sub-Saharan Africa (SSA) with a dearth of peer-reviewed publications from the subcontinent. This most likely reflects underreporting as some cases may be missed due to the high burden of infectious diseases which may closely mimic IBD. In addition, many countries in SSA have limited endoscopic capacity, inadequate access to diagnostic imaging and a notable scarcity of histopathologists, radiologists and gastroenterologists. Beyond these obstacles, which significantly impact patient care, there are many other challenges in SSA, particularly the unavailability of key IBD therapies. In this review, we discuss barriers in diagnosing and managing IBD in SSA, as well as some of the initiatives currently in place to address these short comings.
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Affiliation(s)
| | - Leolin Katsidzira
- Internal Medicine Unit, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Bright Nsokolo
- School of Medicine and Clinical Sciences, Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Olusegun Isaac Alatise
- Division of Gastrointestinal/Surgical Oncology, Department of Surgery, Obafemi Awolowo University/Teaching Hospitals Complex, Ile-Ife, Osun, Nigeria
| | - Babatunde M. Duduyemi
- Department of Pathology, College of Medicine and Allied Health Sciences/Teaching Hospitals Complex Highest University of Sierra Leone, Freetown, Sierra Leone
| | - Chris Kassianides
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Phoebe Hodges
- Barts and the London School of Medicine and Dentistry, Blizard Institute, Queen Mary University of London, London, UK
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Olajide TO, Balogun OS, Bode CO, Atoyebi OA. Challenges and Prospects of Laser Haemorrhoidoplasty in a Low Resource Setting: The LUTH Experience. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2023; 13:96-100. [PMID: 37538221 PMCID: PMC10395859 DOI: 10.4103/jwas.jwas_42_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/06/2023] [Indexed: 08/05/2023]
Abstract
Background Haemorrhoids are the most common condition of the anal canal causing significant disability. Traditional excisional haemorrhoidectomy and its various modifications, while effective, may be attended by severe postoperative pain and other complications. Laser haemorrhoidoplasty is reported to be effective with fewer complications and shorter hospital stay. Objectives The aim of this study was to report the outcome of intrahaemorrhoidal coagulation with 1470-nm diode laser at the Lagos University Teaching Hospital. Patients and Methods The procedures were performed with a radially emitting laser fibre from Biolitec AG-CeramOptec (Bonn, Germany). The duration of symptoms, grade of the haemorrhoids, duration of the procedures, and postoperative complications were evaluated. Results Eleven patients had laser haemorrhoidoplasty. There were seven males and four females. The age range was 23-71 years, with a median age of 47 years and an interquartile range (IQR) of 28-57 years. Duration of surgery ranged from 20 to 90 min, with a median of 33 min and IQR of 25-53 min. Postoperative pain was mild in eight patients and moderate in three. Ten patients were discharged as day cases and one 3 days later due to spinal anaesthesia-related headache and acute urinary retention. One patient later had an anal ulcer probably due to too much energy delivered during the procedure, this was managed conservatively. There was no postoperative wound infection, anal incontinence, anal stenosis, subcutaneous abscess, and fistula or recurrence. Conclusion The advantages of laser haemorrhoidoplasty make it a readily acceptable form of treatment for haemorrhoids in our setting.
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Affiliation(s)
- Thomas Olagboyega Olajide
- General Surgery Unit, Department of Surgery, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Olanrewaju Samuel Balogun
- General Surgery Unit, Department of Surgery, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Christopher O. Bode
- Paediatric Surgery Unit, Department of Surgery, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Oluwole Ayoola Atoyebi
- General Surgery Unit, Department of Surgery, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
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Elshami M, Ayyad M, Hamdan FK, Alser M, Al-Slaibi I, Naji SA, Mohamad BM, Isleem WS, Shurrab A, Yaghi B, Qabaja YA, Dwikat MF, Sweity RR, Jneed RT, Assaf KA, Albandak ME, Hmaid MM, Awwad II, Alhabil BK, Alarda MN, Alsattari AS, Aboyousef MS, Aljbour OA, AlSharif R, Giacaman CT, Alnaga AY, Nemer RMA, Almadhoun NM, Skaik SM, Abu-El-Noor N, Bottcher B. Perceived barriers to early presentation and symptom-specific time to seek medical advice for possible colorectal cancer symptoms among Palestinians. Sci Rep 2023; 13:6871. [PMID: 37105988 PMCID: PMC10140026 DOI: 10.1038/s41598-023-34136-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/25/2023] [Indexed: 04/29/2023] Open
Abstract
This study explored the anticipated time to seek medical advice for possible colorectal cancer (CRC) signs/symptoms and its association with CRC symptom awareness. In addition, it examined perceived barriers that may delay seeking medical advice. Palestinian adults were recruited from hospitals, primary healthcare centers, and public spaces in 11 governorates. A modified, translated-into-Arabic version of the validated Bowel Cancer Awareness Measure was used. The questionnaire comprised three sections: sociodemographics, assessment of CRC symptom awareness and time to seek medical advice, and barriers to early presentation. A total of 4623 participants were included. The proportion that reported seeking immediate medical advice for possible CRC signs/symptoms with blood or mass ranged from 47.1% for 'blood in stools' to 59.5% for 'bleeding from back passage'. Less than half of the participants reported immediate seeking of medical advice for non-specific symptoms (ranging from 5.4% for 'loss of appetite' to 42.0% for 'anemia') and other gastrointestinal symptoms (ranging from 7.7% for 'feeling persistently full' to 35.7% for 'change in bowel habits'). Good CRC symptom awareness was associated with higher likelihood of seeking medical advice within a week from recognizing a CRC symptom. About 13.0% reported a delay to visit their doctor after recognizing a CRC symptom. The most reported barriers were practical with 'would try some herbs first' (50.9%) as the leading barrier. CRC symptoms with blood or mass prompted earlier help seeking. Participants with good CRC awareness were more likely to seek medical advice within a week.
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Affiliation(s)
- Mohamedraed Elshami
- Division of Surgical Oncology, Department of Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside 7100, Cleveland, OH, 44106, USA.
- Ministry of Health, Gaza, Palestine.
| | - Mohammed Ayyad
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | - Mohammed Alser
- The United Nations Relief and Works Agency for Palestine Refugees in The Near East (UNRWA), Amman, Jordan
| | | | | | | | | | | | - Bashar Yaghi
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | | | | | | | - Khayria Ali Assaf
- Faculty of Medicine, An-Najah National University, Nablus, Palestine
| | | | | | - Iyas Imad Awwad
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | | | | | | | | | - Rinad AlSharif
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | | | | | | | - Sondos Mahmoud Skaik
- Faculty of Medicine, Al-Quds Abu Dis University Al-Azhar Branch of Gaza, Gaza, Palestine
| | | | - Bettina Bottcher
- Faculty of Medicine, Islamic University of Gaza, Gaza, Palestine
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Lombe DC, Mwamba M, Msadabwe S, Bond V, Simwinga M, Ssemata AS, Muhumuza R, Seeley J, Mwaka AD, Aggarwal A. Delays in seeking, reaching and access to quality cancer care in sub-Saharan Africa: a systematic review. BMJ Open 2023; 13:e067715. [PMID: 37055211 PMCID: PMC10106057 DOI: 10.1136/bmjopen-2022-067715] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023] Open
Abstract
OBJECTIVES Late presentation and delays in diagnosis and treatment consistently translate into poor outcomes in sub-Saharan Africa (SSA). The aim of this study was to collate and appraise the factors influencing diagnostic and treatment delays of adult solid tumours in SSA. DESIGN Systematic review with assessment of bias using Risk of Bias in Non-randomised Studies of Exposures (ROBINS-E) tool. DATA SOURCES PubMed and Embase, for publications from January 1995 to March 2021. ELIGIBILITY CRITERIA Inclusion criteria: quantitative or mixed-method research, publications in English, on solid cancers in SSA countries. EXCLUSION CRITERIA paediatric populations, haematologic malignancies, and assessments of public perceptions and awareness of cancer (since the focus was on patients with a cancer diagnosis and treatment pathways). DATA EXTRACTION AND SYNTHESIS Two reviewers extracted and validated the studies. Data included year of publication; country; demographic characteristics; country-level setting; disease subsite; study design; type of delay, reasons for delay and primary outcomes. RESULTS 57 out of 193 full-text reviews were included. 40% were from Nigeria or Ethiopia. 70% focused on breast or cervical cancer. 43 studies had a high risk of bias at preliminary stages of quality assessment. 14 studies met the criteria for full assessment and all totaled to either high or very high risk of bias across seven domains. Reasons for delays included high costs of diagnostic and treatment services; lack of coordination between primary, secondary and tertiary healthcare sectors; inadequate staffing; and continued reliance on traditional healers and complimentary medicines. CONCLUSIONS Robust research to inform policy on the barriers to quality cancer care in SSA is absent. The focus of most research is on breast and cervical cancers. Research outputs are from few countries. It is imperative that we investigate the complex interaction of these factors to build resilient and effective cancer control programmes.
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Affiliation(s)
| | | | - Susan Msadabwe
- Department of Radiation Oncology, Cancer Diseases Hospital, Lusaka, Zambia
| | - Virginia Bond
- Social Science, London School of Hygiene & Tropical Medicine and ZAMBART, Lusaka, Zambia
| | | | - Andrew Sentoogo Ssemata
- The Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Kampala, Uganda
| | - Richard Muhumuza
- The Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Kampala, Uganda
| | - Janet Seeley
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, UK
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Alatise OI, Dare AJ, Kingham TP. Colorectal cancer screening with fecal immunochemical testing in Nigeria - Authors' reply. Lancet Glob Health 2022; 10:e1562. [PMID: 36240821 DOI: 10.1016/s2214-109x(22)00404-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/01/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Olusegun I Alatise
- Department of Surgery, College of Health Sciences, Obafemi Awolowo University, Osun, Nigeria; African Research Group for Oncology, Osun, Nigeria
| | - Anna J Dare
- African Research Group for Oncology, Osun, Nigeria; Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - T Peter Kingham
- African Research Group for Oncology, Osun, Nigeria; Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Global Cancer Disparities Initiative, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
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Sharma A, Alatise OI, O'Connell K, Ogunleye SG, Aderounmu AA, Samson ML, Wuraola F, Olasehinde O, Kingham TP, Du M. Healthcare utilisation, cancer screening and potential barriers to accessing cancer care in rural South West Nigeria: a cross-sectional study. BMJ Open 2021; 11:e040352. [PMID: 34312189 PMCID: PMC8314695 DOI: 10.1136/bmjopen-2020-040352] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND/AIMS Cancer burden is predicted to double by 2030 in sub-Saharan Africa; access to healthcare services for cancer management is a priority in the region. In Nigeria, National Cancer Control Plan aims to ensure >50% cancer screening of eligible populations by 2022 for all Nigerians. We describe healthcare utilisation, cancer screening activities and potential barriers to accessing cancer care within an understudied rural community-based adult population in South West Nigeria. METHODS In April 2018, we conducted a cross-sectional study of community-based adults (>18 years) ~130 km east of Ibadan, 250 km from Lagos in Osun State, South West Nigeria. Participants completed a face-to-face survey in local dialect. We used a questionnaire to assess demographics, health status, income, medical expenditures, doctor visits and cancer screening history. RESULTS We enrolled 346 individuals: with median age of 52 years and 75% women. Of the entire cohort, 4% had medical insurance. 46% reported a major medical cost in the last year. Cancer screening activities were infrequent in eligible participants: 1.5% reported having had cervical cancer screening, 3.3% mammogram and 5% colonoscopy screening. Cancer screening assessment was less frequent in those with less income and lower education levels. Using a multivariable logistic regression model including personal income, insurance status and education, higher personal income was associated with more cancer screening activity (OR 2.7, 95% CI 1.3 to 5.7, p<0.01). Despite this, most individuals had contact with a primary healthcare doctor (52% in the last year), and over 70% access to radio and TV suggesting the opportunity to expand community-based screening interventions and awareness exists. CONCLUSIONS Despite national increases in cancer cases, we highlight a deficiency in cancer screening and universal healthcare coverage within a community-based adult Nigerian population. Subject to availability of governmental resources, increasing financial risk protection, awareness and targeted resource allocation may help expand access in Nigeria.
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Affiliation(s)
- Avinash Sharma
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Olusegun Isaac Alatise
- Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Kelli O'Connell
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Samson Gbenga Ogunleye
- Surgery, Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun State, Nigeria
| | | | - Marquerite L Samson
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Funmilola Wuraola
- Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - Olalekan Olasehinde
- Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria
| | - T Peter Kingham
- Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Mengmeng Du
- Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Martins T, Merriel SWD, Hamilton W. Routes to diagnosis of symptomatic cancer in sub-Saharan Africa: systematic review. BMJ Open 2020; 10:e038605. [PMID: 33444186 PMCID: PMC7678384 DOI: 10.1136/bmjopen-2020-038605] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 10/02/2020] [Accepted: 10/17/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Most cancers in sub-Saharan Africa (SSA) are diagnosed at advanced stages, with limited treatment options and poor outcomes. Part of this may be linked to various events occurring in patients' journey to diagnosis. Using the model of pathways to treatment, we examined the evidence regarding the routes to cancer diagnosis in SSA. DESIGN AND SETTINGS A systematic review of available literature was performed. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Between 30 September and 30 November 2019, seven electronic databases were searched using terms relating to SSA countries, cancer and routes to diagnosis comprising the population, exposure and outcomes, respectively. Citation lists of included studies were manually searched to identify relevant studies. Furthermore, ProQuest Dissertations & Theses Global was searched to identify appropriate grey literature on the subject. RESULTS 18 of 5083 references identified met the inclusion criteria: eight focused on breast cancer; three focused on cervical cancer; two each focused on lymphoma, Kaposi's sarcoma and childhood cancers; and one focused on colorectal cancer. With the exception of Kaposi's sarcoma, definitive diagnoses were made in tertiary healthcare centres, including teaching and regional hospitals. The majority of participants initially consulted within primary care, although a considerable proportion first used complementary medicine before seeking conventional medical help. The quality of included studies was a major concern, but their findings provided important insight into the pathways to cancer diagnosis in the region. CONCLUSION The proportion of patients who initially use complementary medicine in their cancer journey may explain a fraction of advanced-stage diagnosis and poor survival of cancer in SSA. However, further research would be necessary to fully understand the exact role (or activities) of primary care and alternative care providers in patient cancer journeys.
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Affiliation(s)
- Tanimola Martins
- College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - William Hamilton
- College of Medicine and Health, University of Exeter, Exeter, UK
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Knapp GC, Alatise OI, Olasehinde OO, Adeyeye A, Ayandipo OO, Weiser MR, Kingham TP. Is Colorectal Cancer Screening Appropriate in Nigeria? J Glob Oncol 2020; 5:1-10. [PMID: 31170018 PMCID: PMC6613663 DOI: 10.1200/jgo.19.00035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The global burden of colorectal cancer (CRC) will continue to increase for the foreseeable future, largely driven by increasing incidence and mortality in low- and middle-income countries (LMICs) such as Nigeria. METHODS We used the Wilson-Jungner framework (1968) to review the literature relevant to CRC screening in Nigeria and propose areas for future research and investment. RESULTS Screening is effective when the condition sought is both important and treatable within the system under evaluation. The incidence of CRC is likely increasing, although the exact burden of disease in Nigeria remains poorly understood and access to definitive diagnosis and treatment has not been systematically quantified. In high-income countries (HICs), CRC screening builds on a well-known natural history. In Nigeria, a higher proportion of CRC seems to demonstrate microsatellite instability, which is dissimilar to the molecular profile in HICs. Prospective trials, tissue banking, and next-generation sequencing should be leveraged to better understand these potential differences and the implications for screening. Fecal immunochemical test for hemoglobin (FIT) is recommended for LMICs that are considering CRC screening. However, FIT has not been validated in Nigeria, and questions about the impact of high ambient temperature, endemic parasitic infection, and feasibility remain unanswered. Prospective trials are needed to validate the efficacy of stool-based screening, and these trials should consider concomitant ova and parasite testing. CONCLUSION Using the Wilson-Jungner framework, additional work is needed before organized CRC screening will be effective in Nigeria. These deficits can be addressed without missing the window to mitigate the increasing burden of CRC in the medium to long term.
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Sharma A, Alatise OI, Adisa AO, Arowolo OA, Olasehinde O, Famurewa OC, Omisore AD, Komolafe AO, Olaofe O, Katung IA, Ibikunle DA, Egberongbe AA, Olatoke SA, Agodirin SO, Adesiyun AO, Adeyeye A, Ibrahim K, Kolawole OA, Idris OL, Adejumobi MO, Ajayi IA, Olakanmi A, Constable JC, Seier K, Gonen M, Brennan M, Kingham T. Treatment of colorectal cancer in Sub-Saharan Africa: Results from a prospective Nigerian hospital registry. J Surg Oncol 2020; 121:342-349. [PMID: 31742699 PMCID: PMC7405945 DOI: 10.1002/jso.25768] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 11/02/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) is the third most common cancer worldwide. Mortality for CRC is improving in high income countries, but in low and middle income countries, rates of disease and death from disease are rising. In Sub-Saharan Africa, the ratio of CRC mortality to incidence is the highest in the world. This study investigated the nature of CRC treatment currently being offered and received in Nigeria. METHODS Between April 2013 and October 2017, a prospective study of consecutively diagnosed cases of CRC was conducted. Patient demographics, clinical features, and treatment recommended and received was recorded for each case. Patients were followed during the study period every 3 months or until death. RESULTS Three hundred patients were included in our analysis. Seventy-one percent of patients received a recommended surgical operation. Of those that didn't undergo surgery as recommended, 37% cited cost as the main reason, 30% declined due to personal reasons, and less than 5% absconded or were lost to follow up. Approximately half of patients (50.5%) received a chemotherapy regimen when it was recommended, and 4.1% received radiotherapy when this was advised as optimal treatment. With therapy, the median overall survival for patients diagnosed with stage III and stage IV CRC was 24 and 10.5 months respectively. Overall, we found significantly better median survival for patients that received the recommended treatment (25 vs 7 months; P < .01). CONCLUSIONS A number of patients were unable to receive the recommended treatment, reflecting some of the burden of untreated CRC in the region. Receiving the recommended treatment was associated with a significant difference in outcome. Improved healthcare financing, literacy, training, access, and a better understanding of tumor biology will be necessary to address this discrepancy.
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Affiliation(s)
- A. Sharma
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - A. O. Adisa
- Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | | | | | | | | | - O. Olaofe
- Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | | | | | | | | | | | - A. Adeyeye
- University Teaching Hospital, Ilorin, Nigeria
| | - K. Ibrahim
- University Teaching Hospital, Ilorin, Nigeria
| | | | - O. L. Idris
- Lautech University Hospital, Osogbo, Nigeria
| | | | - I. A. Ajayi
- Lautech University Hospital, Osogbo, Nigeria
| | - A.O. Olakanmi
- Department of Surgery, University of Medical Sciences Teaching Hospitals’ Complex, Ondo, Nigeria
| | - J. C. Constable
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - K. Seier
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - M. Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - M.F Brennan
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - T.P Kingham
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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11
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Deliana M, Suza DE, Tarigan R. Advanced Stage Cancer Patients Experience in Seeking Treatment in Medan, Indonesia. Open Access Maced J Med Sci 2019; 7:2194-2203. [PMID: 31456851 PMCID: PMC6698112 DOI: 10.3889/oamjms.2019.590] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Proper treatment of cancer can make it easier for the healing process. Delay in patients seeking treatment is a problem that often occurs today. Handling of complementary and alternative therapies, which is not appropriate is one of the causes of delay in seeking treatment, which worsens the patient's condition. Patients usually come to health services already diagnosed with advanced cancer. AIM The purpose of this study is to explore the experience of advanced cancer patients in seeking treatment. METHODS This study is qualitative research with descriptive phenomenology approach. Participants in this study were 15 advanced cancer patients who were treated in the chemotherapy room at Adam Malik General Hospital Medan and Murni Teguh Hospital using purposive sampling technique. Data collection was done with in-depth interviews. All interviews were first recorded and then transcribed. This study was analysed using the Colaizzi approach method. RESULTS The six main themes indicated that advanced-stage cancer patients for seeking treatment. Themes such as 1) choose the complementary and alternative treatment rather than medical treatment, 2) seek medical treatment as a final decision, 3) integrating complementary treatment as supportive therapy in addition to medical treatment, 4) external sources influence patient decisions, 5) reduce negative feelings by surrendering to God, and 6) lack of involvement of basic health services. CONCLUSION Advanced cancer patients have experience using complementary and alternative therapies, which are not appropriate before using a medical treatment on the grounds of distrust of medical treatment and advice from the environment around patients. The importance of nurses in providing appropriate education related to complementary and alternative treatment to cancer patients according to the stage of the disease.
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Affiliation(s)
- Muthia Deliana
- Master Student of Medical-Surgical Nursing, Universitas Sumatra Utara, Medan, Indonesia
| | - Dewi Elizadiani Suza
- Faculty of Nursing, Universitas Sumatera Utara, Jl. Prof. T. Ma’as No 3, Kampus USU, Medan, Indonesia
| | - Rosina Tarigan
- Faculty of Nursing, Universitas Sumatera Utara, Jl. Prof. T. Ma’as No 3, Kampus USU, Medan, Indonesia
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Nwachukwu CR, Mudasiru O, Million L, Sheth S, Qamoos H, Onah JO, Okemini A, Rhodes M, Barry M, Banjo AA, Habeebu M, Olasinde TA, Bhatt AS. Evaluating Barriers and Opportunities in Delivering High-Quality Oncology Care in a Resource-Limited Setting Using a Comprehensive Needs Assessment Tool. J Glob Oncol 2018; 4:1-9. [PMID: 30532992 PMCID: PMC6818301 DOI: 10.1200/jgo.18.00125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Despite recognition of both the growing cancer burden in low- and
middle-income countries and the disproportionately high mortality rates in
these settings, delivery of high-quality cancer care remains a challenge.
The disparities in cancer care outcomes for many geographic regions result
from barriers that are likely complex and understudied. This study describes
the development and use of a streamlined needs assessment questionnaire
(NAQ) to understand the barriers to providing quality cancer care,
identifies areas for improvement, and formulates recommendations for
implementation. Methods Using a comprehensive NAQ, in-depth interviews were conducted with 17
hospital staff involved in cancer care at two teaching hospitals in Nigeria.
Data were analyzed using content analysis and organized into a framework
with preset codes and emergent codes, where applicable. Results Data from the interviews were organized into six broad themes: staff, stuff,
system, space, lack of palliative care, and provider bias, with key barriers
within themes including: financial, infrastructural, lack of awareness,
limited human capacity resources, lack of palliative care, and provider
perspective on patient-related barriers to cancer care. Specific solutions
based on ability to reasonably implement were subcategorized into short-,
medium-, and long-term goals. Conclusion This study provides a framework for a streamlined initial needs assessment
and a unique discussion on the barriers to high-quality oncology care that
are prevalent in resource-constrained settings. We report the feasibility of
collecting and organizing data using a streamlined NAQ and provide a
thorough and in-depth understanding of the challenges in this setting.
Knowledge gained from the assessments will inform steps to improve oncology
cancer in these settings.
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Affiliation(s)
- Chika R Nwachukwu
- Chika R. Nwachukwu, Lynn Million, Shruti Sheth, Hope Qamoos, and Ami S. Bhatt, Stanford University School of Medicine; Michele Barry, Center for Innovation in Global Health, Stanford University, Stanford; Omobola Mudasiru, University of California Berkley, Berkeley, CA; Joseph O. Onah, Anita Okemini, and Mojisola Rhodes, Clinton Health Access Initiative, Nigeria Country Office; Adekunbiola A. Banjo and Muhameed Habeebu, Lagos University Teaching Hospital, Lagos; Anita Okemini, ONE Campaign, Nigeria Country Office, Abuja; and Tajudeen A. Olasinde, Amadu Bello University Teaching Hospital, Zaira, Nigeria
| | - Omobola Mudasiru
- Chika R. Nwachukwu, Lynn Million, Shruti Sheth, Hope Qamoos, and Ami S. Bhatt, Stanford University School of Medicine; Michele Barry, Center for Innovation in Global Health, Stanford University, Stanford; Omobola Mudasiru, University of California Berkley, Berkeley, CA; Joseph O. Onah, Anita Okemini, and Mojisola Rhodes, Clinton Health Access Initiative, Nigeria Country Office; Adekunbiola A. Banjo and Muhameed Habeebu, Lagos University Teaching Hospital, Lagos; Anita Okemini, ONE Campaign, Nigeria Country Office, Abuja; and Tajudeen A. Olasinde, Amadu Bello University Teaching Hospital, Zaira, Nigeria
| | - Lynn Million
- Chika R. Nwachukwu, Lynn Million, Shruti Sheth, Hope Qamoos, and Ami S. Bhatt, Stanford University School of Medicine; Michele Barry, Center for Innovation in Global Health, Stanford University, Stanford; Omobola Mudasiru, University of California Berkley, Berkeley, CA; Joseph O. Onah, Anita Okemini, and Mojisola Rhodes, Clinton Health Access Initiative, Nigeria Country Office; Adekunbiola A. Banjo and Muhameed Habeebu, Lagos University Teaching Hospital, Lagos; Anita Okemini, ONE Campaign, Nigeria Country Office, Abuja; and Tajudeen A. Olasinde, Amadu Bello University Teaching Hospital, Zaira, Nigeria
| | - Shruti Sheth
- Chika R. Nwachukwu, Lynn Million, Shruti Sheth, Hope Qamoos, and Ami S. Bhatt, Stanford University School of Medicine; Michele Barry, Center for Innovation in Global Health, Stanford University, Stanford; Omobola Mudasiru, University of California Berkley, Berkeley, CA; Joseph O. Onah, Anita Okemini, and Mojisola Rhodes, Clinton Health Access Initiative, Nigeria Country Office; Adekunbiola A. Banjo and Muhameed Habeebu, Lagos University Teaching Hospital, Lagos; Anita Okemini, ONE Campaign, Nigeria Country Office, Abuja; and Tajudeen A. Olasinde, Amadu Bello University Teaching Hospital, Zaira, Nigeria
| | - Hope Qamoos
- Chika R. Nwachukwu, Lynn Million, Shruti Sheth, Hope Qamoos, and Ami S. Bhatt, Stanford University School of Medicine; Michele Barry, Center for Innovation in Global Health, Stanford University, Stanford; Omobola Mudasiru, University of California Berkley, Berkeley, CA; Joseph O. Onah, Anita Okemini, and Mojisola Rhodes, Clinton Health Access Initiative, Nigeria Country Office; Adekunbiola A. Banjo and Muhameed Habeebu, Lagos University Teaching Hospital, Lagos; Anita Okemini, ONE Campaign, Nigeria Country Office, Abuja; and Tajudeen A. Olasinde, Amadu Bello University Teaching Hospital, Zaira, Nigeria
| | - Joseph O Onah
- Chika R. Nwachukwu, Lynn Million, Shruti Sheth, Hope Qamoos, and Ami S. Bhatt, Stanford University School of Medicine; Michele Barry, Center for Innovation in Global Health, Stanford University, Stanford; Omobola Mudasiru, University of California Berkley, Berkeley, CA; Joseph O. Onah, Anita Okemini, and Mojisola Rhodes, Clinton Health Access Initiative, Nigeria Country Office; Adekunbiola A. Banjo and Muhameed Habeebu, Lagos University Teaching Hospital, Lagos; Anita Okemini, ONE Campaign, Nigeria Country Office, Abuja; and Tajudeen A. Olasinde, Amadu Bello University Teaching Hospital, Zaira, Nigeria
| | - Anita Okemini
- Chika R. Nwachukwu, Lynn Million, Shruti Sheth, Hope Qamoos, and Ami S. Bhatt, Stanford University School of Medicine; Michele Barry, Center for Innovation in Global Health, Stanford University, Stanford; Omobola Mudasiru, University of California Berkley, Berkeley, CA; Joseph O. Onah, Anita Okemini, and Mojisola Rhodes, Clinton Health Access Initiative, Nigeria Country Office; Adekunbiola A. Banjo and Muhameed Habeebu, Lagos University Teaching Hospital, Lagos; Anita Okemini, ONE Campaign, Nigeria Country Office, Abuja; and Tajudeen A. Olasinde, Amadu Bello University Teaching Hospital, Zaira, Nigeria
| | - Mojisola Rhodes
- Chika R. Nwachukwu, Lynn Million, Shruti Sheth, Hope Qamoos, and Ami S. Bhatt, Stanford University School of Medicine; Michele Barry, Center for Innovation in Global Health, Stanford University, Stanford; Omobola Mudasiru, University of California Berkley, Berkeley, CA; Joseph O. Onah, Anita Okemini, and Mojisola Rhodes, Clinton Health Access Initiative, Nigeria Country Office; Adekunbiola A. Banjo and Muhameed Habeebu, Lagos University Teaching Hospital, Lagos; Anita Okemini, ONE Campaign, Nigeria Country Office, Abuja; and Tajudeen A. Olasinde, Amadu Bello University Teaching Hospital, Zaira, Nigeria
| | - Michele Barry
- Chika R. Nwachukwu, Lynn Million, Shruti Sheth, Hope Qamoos, and Ami S. Bhatt, Stanford University School of Medicine; Michele Barry, Center for Innovation in Global Health, Stanford University, Stanford; Omobola Mudasiru, University of California Berkley, Berkeley, CA; Joseph O. Onah, Anita Okemini, and Mojisola Rhodes, Clinton Health Access Initiative, Nigeria Country Office; Adekunbiola A. Banjo and Muhameed Habeebu, Lagos University Teaching Hospital, Lagos; Anita Okemini, ONE Campaign, Nigeria Country Office, Abuja; and Tajudeen A. Olasinde, Amadu Bello University Teaching Hospital, Zaira, Nigeria
| | - Adekunbiola A Banjo
- Chika R. Nwachukwu, Lynn Million, Shruti Sheth, Hope Qamoos, and Ami S. Bhatt, Stanford University School of Medicine; Michele Barry, Center for Innovation in Global Health, Stanford University, Stanford; Omobola Mudasiru, University of California Berkley, Berkeley, CA; Joseph O. Onah, Anita Okemini, and Mojisola Rhodes, Clinton Health Access Initiative, Nigeria Country Office; Adekunbiola A. Banjo and Muhameed Habeebu, Lagos University Teaching Hospital, Lagos; Anita Okemini, ONE Campaign, Nigeria Country Office, Abuja; and Tajudeen A. Olasinde, Amadu Bello University Teaching Hospital, Zaira, Nigeria
| | - Muhameed Habeebu
- Chika R. Nwachukwu, Lynn Million, Shruti Sheth, Hope Qamoos, and Ami S. Bhatt, Stanford University School of Medicine; Michele Barry, Center for Innovation in Global Health, Stanford University, Stanford; Omobola Mudasiru, University of California Berkley, Berkeley, CA; Joseph O. Onah, Anita Okemini, and Mojisola Rhodes, Clinton Health Access Initiative, Nigeria Country Office; Adekunbiola A. Banjo and Muhameed Habeebu, Lagos University Teaching Hospital, Lagos; Anita Okemini, ONE Campaign, Nigeria Country Office, Abuja; and Tajudeen A. Olasinde, Amadu Bello University Teaching Hospital, Zaira, Nigeria
| | - Tajudeen A Olasinde
- Chika R. Nwachukwu, Lynn Million, Shruti Sheth, Hope Qamoos, and Ami S. Bhatt, Stanford University School of Medicine; Michele Barry, Center for Innovation in Global Health, Stanford University, Stanford; Omobola Mudasiru, University of California Berkley, Berkeley, CA; Joseph O. Onah, Anita Okemini, and Mojisola Rhodes, Clinton Health Access Initiative, Nigeria Country Office; Adekunbiola A. Banjo and Muhameed Habeebu, Lagos University Teaching Hospital, Lagos; Anita Okemini, ONE Campaign, Nigeria Country Office, Abuja; and Tajudeen A. Olasinde, Amadu Bello University Teaching Hospital, Zaira, Nigeria
| | - Ami S Bhatt
- Chika R. Nwachukwu, Lynn Million, Shruti Sheth, Hope Qamoos, and Ami S. Bhatt, Stanford University School of Medicine; Michele Barry, Center for Innovation in Global Health, Stanford University, Stanford; Omobola Mudasiru, University of California Berkley, Berkeley, CA; Joseph O. Onah, Anita Okemini, and Mojisola Rhodes, Clinton Health Access Initiative, Nigeria Country Office; Adekunbiola A. Banjo and Muhameed Habeebu, Lagos University Teaching Hospital, Lagos; Anita Okemini, ONE Campaign, Nigeria Country Office, Abuja; and Tajudeen A. Olasinde, Amadu Bello University Teaching Hospital, Zaira, Nigeria
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13
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Alatise OI, Ayandipo OO, Adeyeye A, Seier K, Komolafe AO, Bojuwoye MO, Afuwape OO, Zauber A, Omisore A, Olatoke S, Akere A, Famurewa O, Gonen M, Irabor DO, Kingham TP. A symptom-based model to predict colorectal cancer in low-resource countries: Results from a prospective study of patients at high risk for colorectal cancer. Cancer 2018; 124:2766-2773. [PMID: 29645077 DOI: 10.1002/cncr.31399] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 03/16/2018] [Accepted: 03/20/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) rates in low-resource countries, which typically lack CRC screening programs, are rising. This study determined whether a risk model for patients with rectal bleeding could identify patients with curable CRC. METHODS This prospective, cross-sectional study evaluated a model constructed from data from 1 hospital and validated at 2 other hospitals. The primary endpoint was the ability of the model to predict CRC, as diagnosed by colonoscopy, from clinical characteristics. The secondary endpoint was to determine the percentage of patients who had CRC. RESULTS Consecutive patients who were 45 years old or older and had self-reported rectal bleeding for more than 1 week were evaluated. From January 2014 to July 2016, 362 patients answered a questionnaire and underwent colonoscopy. In the validation cohort, 56% of patients with rectal bleeding, weight loss, and changes in bowel habits had CRC, whereas 2% of patients with bleeding alone did. Overall, 18.2% of the patients had CRC, and 8.6% had adenomas. The proportion of CRC patients with potentially curable stage II or III disease was 74%, whereas the historical rate was 36%. The combination of rectal bleeding with both symptoms significantly predicted CRC in the validation set (odds ratio, 12.8; 95% confidence interval, 4.6-35.4; P < .001). CONCLUSIONS In low-resource settings, patients with rectal bleeding, weight loss, and changes in bowel habits should be classified as high risk for CRC. Patients with a high risk score should be prioritized for colonoscopy to increase the number of patients diagnosed with potentially curable CRC. Cancer 2018;124:2766-2773. © 2018 American Cancer Society.
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Affiliation(s)
- Olusegun Isaac Alatise
- Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.,Surgeons OverSeas, New York, New York
| | | | | | - Ken Seier
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Akinwunmi O Komolafe
- Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | | | | | - Ann Zauber
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Adeleye Omisore
- Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | | | | | - Olusola Famurewa
- Faculty of Clinical Sciences, College of Health Sciences, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Mithat Gonen
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - T Peter Kingham
- Surgeons OverSeas, New York, New York.,Memorial Sloan Kettering Cancer Center, New York, New York
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