Diagnosis and Risk Factors of Advantage Cancers in Ethiopia

The psychometric properties of the amharic version of EuroQoL five-dimensions-five level among Ethiopian cervical cancer patients

BACKGROUND

Despite being a widely used generic measure of health-related quality of life worldwide, there is limited evidence on the psychometric properties of the EuroQoL Five-dimensions five level (EQ-5D) among cervical cancer patients in Ethiopia.

OBJECTIVE

To evaluate psychometric properties of the Amharic version of EQ-5D among Ethiopian cervical cancer patients.

METHODS

A longitudinal survey of cervical cancer patients receiving treatment at two Ethiopian tertiary care facilities was conducted from March 2022 to July 2023. Participants completed the EQ-5D and the European Organization for Research and Therapy of Cancer (EORTC QLQ-C30) at baseline and after three months on treatment. Effect size and standardized response mean were used to assess responsiveness. Anchor-based and distribution-based methods were used to calculate the minimal clinically important difference (MCID). Minimal detectable change (MDC) ratios were computed at the individual and group levels. Statistical significance was determined at p < 0.05.

RESULTS

Three hundred seventy-one patients completed the survey at baseline and follow-up with a mean age of 49.72 (10.80) years. The majority (268,73%) of the patients had early-stage cancer. The EQ-5D index and EQ VAS scores respectively improved by 0.04 and 7.0 post-treatment.The physical domains of EORTC QLQ-C30 had showed high correlation with physical dimensions of EQ-5D (r > 0.6) and the instrument showed good discriminate validity between patients with different health states. The effect size ranged between - 0.12 and 0.60 for the EQ-5D index value and - 0.12 to 1.16 for the EQ VAS, indicating small to large responsiveness. The average (range) MCID value of the EQ-5D index was 0.10-0.15. The findings showed that MCID to MDC ratios at the group level were more clinically meaningful than the individual level.

CONCLUSION

The EQ-5D effectively detected changes and discriminate patients with different levels of health. While group-level MCIDs were established in this study, further studies are recommended to prove its usefulness at the individual-level.

Breast cancer and its determinants in Ethiopia: a systematic review and meta-analysis

OBJECTIVES

Breast cancer is the leading cause of cancer morbidity and mortality among women. Still, there is a paucity of studies to know the magnitude of the problem in Ethiopia. Hence, this review was intended to pool the prevalence and identify the determinants of breast cancer in Ethiopia.

DESIGN

A systematic review and meta-analysis was conducted.

DATA SOURCES

Databases like PubMed/MEDLINE, HINARI, Science Direct, and Google Scholar, as well as websites of organisationsI organizations,rewere searched between 25 February and 6 March 2023.

ELIGIBILITY CRITERIA

All observational studies in Ethiopia that reported either the magnitude and/or determinants of breast cancer regardless of publication status were included.

DATA EXTRACTION AND SYNTHESIS

Two authors independently assessed and extracted the data. The Joanna Briggs Institute meta-analysis of statistics assessment and review instrument quality appraisal tool was used to assess the quality of the articles. Effect estimates were done by using the random-effects model. The meta-analysis results were displayed by using forest plots.

RESULTS

Seventeen articles were reviewed with 24 435 total participants. The pooled proportion of breast cancer morbidity among patients with cancer was 20. 58% (95% CI 17.25%, 23.90%) in Ethiopia. Consuming packed foods (POR=2.12, 95% CI 1.41, 3.17), presence of high cholesterol (POR=4.08; 95% CI 2.75, 6.07), physical inactivity (POR=3.27; 95% CI 1.80, 5.94), high body mass index (BMI) (POR=2.27; 95% CI 0.85, 6.03), postmenopause (POR=2.25; 95% CI 1.63, 3.10), family history of cancer (POR=3.65; 95% CI 0.85, 15.71) and lack of breastfeeding (POR=2.76; 95% CI 0.90, 7.92) were the determinants of breast cancer.

CONCLUSIONS

One of five patients with cancer is diagnosed with breast cancer in Ethiopia. Furthermore, more than a quarter of women with cancer suffer from breast cancer. Processed food consumption, high cholesterol in the body, lack of physical activity, high BMI, postmenopause, family history of cancer and lack of breastfeeding were the risk factors for breast cancer. The use of healthy food sources such as fruits and vegetables, and homegrown varieties of crops rather than seeking processed foods would help.

PROSPERO REGISTRATION NUMBER

CRD42023417733.

Time to Diagnosis and Treatment for Ovarian Cancer and Associations with Outcomes: A Systematic Review

Background: Ovarian cancer is commonly diagnosed symptomatically at an advanced stage. Better survival for early disease suggests improving diagnostic pathways may increase survival. This study examines literature assessing diagnostic intervals and their association with clinical and psychological outcomes. Methods: Medline, EMBASE, and EmCare databases were searched for studies including quantitative measures of at least one interval, published between January 1, 2000 and August 9, 2022. Interval measures and associations (interval, outcomes, analytic strategy) were synthesized. Risk of bias of association studies was assessed using the Aarhus Checklist and ROBINS-E tool. Results: In total, 65 papers (20 association studies) were included and 26 unique intervals were identified. Interval estimates varied widely and were impacted by summary statistic used (mean or median) and group focused on. Of Aarhus-defined intervals, patient (symptom to presentation, n = 23; range [median]: 7-168 days) and diagnostic (presentation to diagnosis, n = 22; range [median]: 7-270 days) were most common. Nineteen association studies examined survival or stage outcomes with most, including five low risk-of-bias studies, finding no association. Conclusions: Studies reporting intervals for ovarian cancer diagnosis are limited by inconsistent definitions and reporting. Greater utilization of the Aarhus statement to define intervals and appropriate analytic methods is needed to strengthen findings from future studies.

Breast cancer preventive practices and associated factors among reproductive age women in Wadila District, North East Ethiopia: community based cross-sectional study

BACKGROUND

Cancer is one of the leading causes of morbidity and mortality worldwide. Among all cancer types, breast cancer stands out as the most common and is characterized by distinct molecular characteristics. This disease poses a growing public health concern, particularly in low and middle-income countries where it is associated with high mortality rates. Despite these challenges, there is a paucity of data on breast cancer preventive practices and associated factors among reproductive-age women in Wollo, Ethiopia. Hence, this study aimed to evaluate the level of breast cancer awareness, preventive practices, and associated factors among women of reproductive age residing in Wadila district, Wollo, Ethiopia in the year 2022.

METHOD

A cross-sectional community-based study involving 352 women of reproductive age in Wadila district was carried out between May and June 2022. Participants were selected using a systematic random sampling technique, and data analysis was conducted using Statistical Package for Social Science (SPSS) version 23 software. Logistic regression analysis was utilized to determine the odds ratio for variable associations, with statistical significance set at p < 0.05.

RESULT

The prevalence of breast-examination among women of reproductive age was determined to be 40.1% (95% Interval [CI]: 34.94-45.18). Factors such as educational status (Adjusted Odds Ratio [AOR]: 0.28, 95% CI: 0.13-0.6), income (AOR: 0.19, 95% CI: 0.11-0.33), and family history of breast conditions in reproductive-age women (AOR: 1.90, 95% CI: 1.08-3.34) were significantly linked to the practice of breast self-examination in this population.

CONCLUSION

The study highlighted a decline in regular breast self-examination among women of reproductive age. It revealed that the reduced frequency of regular breast self-examination was a prevalent concern among women in this age group and the broader community. Educational level, monthly income, and family history of cancer among women of reproductive age were identified as significant factors linked to the practice of regular breast examination.

Mortality rate and predictors of colorectal cancer patients in Ethiopia: a systematic review and meta-analysis

INTRODUCTION

The incidence of colorectal cancer (CRC) has been increasing in Sub-Saharan countries, including Ethiopia. However, the real mortality rate for CRC patients in Ethiopia has not been established. Therefore, this systematic review and meta-analysis aimed to determine the overall mortality rate and identify predictors among CRC patients in Ethiopia.

METHODS

PubMed, EMBASE, Web of Science, Scopus, Science Direct, and Google Scholar were searched to identify relevant articles. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) were followed. The quality of the included studies was assessed using the Newcastle-Ottawa Scale Critical Appraisal checklist. A random effect model was used to estimate the pooled mortality rate and adjusted hazard ratio (AHR). Publication bias was assessed using funnel plots and Egger's regression test, while heterogeneity was evaluated through the Cochran Q test and I2 statistics.

RESULTS

After reviewing 74 articles, only 7 studies met the criteria and were included in the analysis. The analysis revealed that the overall mortality rate among CRC patients in Ethiopia was 40.5% (95% confidence interval [CI]: 32.05, 48.87) while the survival rates at 1 year, 3 years, and 5 years were 82.3% (95% CI: 73.33, 91.31), 48.8% (95% CI: 43.35, 54.32), and 26.6% (95% CI: 21.26, 31.91) respectively. Subgroup analysis indicated that studies conducted after 2017 had higher mortality rates compared to those studied earlier (43.0% vs. 38.2%). Older age (AHR: 1.89, 95% CI: 1.27, 2.82); being married (AHR: 2.53, 95% CI: 1.79, 3.57); having comorbidities (AHR: 1.84, 95% CI: 1.45, 2.35); having high CEA levels (AHR: 2.06, CI: 1.35, 3.13); being in stage II (AHR: 4.13, 95% CI: 1.85, 9.22), III (AHR: 8.62, 95% CI: 3.88, 19.15), and IV (AHR: 8.06, CI: 2.89, 22.49) were the most important predictors.

CONCLUSION

In Ethiopia, the mortality rate among individuals diagnosed with CRC is high, with two out of five patients dying from this disease. Age, marital status, CEA level, comorbidities, and cancer stage were identified as predictors of mortality in CRC patients. Therefore, early detection and screening should be prioritized, particularly for older patients, those who are married, have comorbidities, elevated CEA levels, and advanced cancer stages.

Advanced-stage breast cancer diagnosis and its determinants in Ethiopia: a systematic review and meta-analysis

INTRODUCTION

Worldwide, breast cancer is the primary cause of illness and death. Unless early detected and treated breast cancer is a life-threatening tumor. Advanced-stage presentation is greatly linked with short survival time and increased mortality rates. In Ethiopia nationally summarized evidence on the level of advanced-stage breast cancer diagnosis is scarce. Therefore, this systematic review and meta-analysis aimed to determine the pooled prevalence of advanced-stage breast cancer diagnosis and its determinants in Ethiopia.

METHOD

By following PRISMA guidelines, a systematic review and meta-analysis were carried out. To include relevant publications, a broad literature search was conducted in the African Online Journal, PubMed, Google Scholar, and Embase which are published until last search date; June 15, 2023. To prevent further duplication this review was registered in PROSPERO database with ID no of CRD42023435096. To determine the pooled prevalence, a weighted inverse variance random effect model was applied. I2 statistics and the Cochrane Q-test were computed to determine heterogeneity. To evaluate publication bias, a funnel plot, and Egger's regression test were used.

RESULT

A total of 924 articles were sought and finally 20 articles were included in this review. The pooled prevalence of advanced-stage breast cancer diagnosis in Ethiopia was 72.56% (95%CI; 68.46-76.65%). Use of traditional medicine as first choice (AOR = 1.32, 95% CI: (1.13-1.55)), delay of > 3 months in seeking care (AOR = 1.24, 95% CI: (1.09-1.41)), diagnosis or health system delay of > 2 months (AOR = 1.27, 95% CI: (1.11-1.46)), rural residence (AOR = 2.04, 95% CI: (1.42 - 2.92)), and chief complaint of a painless breast lump (AOR = 2.67, 95% CI: (1.76-4.06)) were significantly associated to advanced-stage diagnosis.

CONCLUSION

In Ethiopia, more than two-thirds of breast cancer cases are diagnosed at an advanced stage. Use of traditional medicine before diagnostic confirmation, delay in seeking care, health system delay, rural residence, and chief complaint of painless breast lump were positively associated with an advanced-stage diagnosis. Policymakers and program designers give great focus to those delays so as to seek and access modern diagnosis and treatment as early as possible specifically focusing on those who are rurally residing.

Analyzing socio-environmental determinants of bone and soft tissue cancer in Indonesia

BACKGROUND

This study is designed to explore the potential impact of individual and environmental residential factors as risk determinants for bone and soft tissue cancers, with a particular focus on the Indonesian context. While it is widely recognized that our living environment can significantly influence cancer development, there has been a notable scarcity of research into how specific living environment characteristics relate to the risk of bone and soft tissue cancers.

METHODS

In a cross-sectional study, we analyzed the medical records of oncology patients treated at Prof. Suharso National Referral Orthopedic Hospital. The study aimed to assess tumor malignancy levels and explore the relationships with socio-environmental variables, including gender, distance from the sea, sunrise time, altitude, and population density. Data were gathered in 2020 from diverse sources, including medical records, Google Earth, and local statistical centers. The statistical analyses employed Chi-square and logistic regression techniques with the support of Predictive Analytics SoftWare (PASW) Statistics 18.

RESULTS

Both bivariate and multivariate analyses revealed two significant factors associated with the occurrence of bone and soft tissue cancer. Age exhibited a statistically significant influence (OR of 5.345 and a p-value of 0.000 < 0.05), indicating a robust connection between cancer development and age. Additionally, residing within a distance of less than 14 km from the sea significantly affected the likelihood of bone and soft tissue cancers OR 5.604 and p-value (0.001 < 0.05).

CONCLUSIONS

The study underscores the strong association between age and the development of these cancers, emphasizing the need for heightened vigilance and screening measures in older populations. Moreover, proximity to the sea emerges as another noteworthy factor influencing cancer risk, suggesting potential environmental factors at play. These results highlight the multifaceted nature of cancer causation and underscore the importance of considering socio-environmental variables when assessing cancer risk factors. Such insights can inform more targeted prevention and early detection strategies, ultimately contributing to improved cancer management and patient outcomes.

Determinants of late-stage cervical cancer presentation in Ethiopia: a systematic review and meta-analysis

INTRODUCTION

Behind breast, colorectal, and lung cancers, cervical cancer is the fourth most common cancer affecting females. Despite, it is a preventable form of cancer both the incidence and mortality figures reflect it as a major reproductive health problem. Late-stage cervical cancer diagnosis is associated with complicated clinical presentation which can result in short survival time and increased mortality. Several factors contribute to the late-stage presentation of cervical cancer patients. In Ethiopia nationally summarized evidence on the level and the factors contributing to late-stage cervical cancer diagnosis is scarce. Therefore, this systematic review and meta-analysis aimed to assess the pooled prevalence of late-stage cervical cancer diagnosis and its determinants in Ethiopia.

METHOD

A systematic review and meta-analysis were conducted using PRISMA guidelines. Comprehensive literature was searched in PubMed, Embase, Google Scholar, and African Online Journal to retrieve eligible articles. A weighted inverse variance random effect model was used to estimate pooled prevalence. Cochrane Q-test and I2 statistics were computed to assess heterogeneity among studies. Funnel plot and Egger's regression test were done to assess publication bias.

RESULT

Overall, 726 articles were retrieved and finally 10 articles were included in this review. The pooled prevalence of late-stage cervical cancer diagnosis in Ethiopia was 60.45% (95%CI; 53.04%-67.85%). Poor awareness about cervical cancer and its treatment (AOR = 1.55, 95% CI: (1.03 - 2.33, longer delay to seek care (AOR = 1.02, 95% CI: (1.01 - 1.03)) and rural residence (AOR = 2.07, 95% CI:( 1.56 - 2.75)) were significantly associated to late-stage diagnosis.

CONCLUSION

In Ethiopia, six in every ten cervical cancer cases are diagnosed at the late stage of the disease. Poor awareness about cervical cancer and its treatment, long patient delay to seek care, and rural residence were positively associated with late-stage diagnosis. Therefore intervention efforts should be made to improve public awareness about cervical cancer, minimize patient delay to seek care, and expand screening services specifically in the rural residing segment of the population to detect the disease early and improve survival.

Awareness of prostate cancer and its associated factors among male patients attending care in the urology unit at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

BACKGROUND

Globally, prostate cancer is the most common cancer among men. It is the second most common cause of cancer-related deaths in men. Symptoms may be non-specific and may not present until the cancer has progressed. Raising awareness, knowing risk factors and symptoms and seeking early medical attention is critical for prevention and detection. The objective of this study is to assess the level of awareness of prostate cancer among male patients attending care in a urology unit in Ethiopia.

METHODS

We conducted a cross-sectional study among 241 male patients at Tikur Anbessa Specialized Hospital from February to April 2021. Data were collected using an interviewer-administered questionnaire adapted from published studies and cancer awareness measurement tools. We used EpiData V.4.6.0 and SPSS V.26 for data entry and analysis. Descriptive statistics and linear regressions were used for analyses. Bivariate and multivariate linear regression analysis identified factors associated with prostate cancer awareness. Adjusted odd ratio (AOR) at 95% CI and p value<0.05 were considered statistically significant.

RESULTS

A total of 250 patients were approached, and 241 (96.4%) responded. The mean scores for awareness of prostate cancer risk factors, symptoms, screening and prevention were 41.2%, 43.8%, 44.7% and 49.5%, respectively. Families with an average monthly income of more than 8900 ETB (Ethiopian birr), having heard about prostate cancer, having a regular source of care every six months or more, having a history of hospitalisation and having healthcare providers as the main source of information were all significantly associated with awareness of prostate cancer.

CONCLUSION

The findings of this study indicate that male patients have a relatively low level of awareness of prostate cancer risk factors, symptoms, screening and prevention. There should be more public awareness initiatives to educate men in Ethiopia on the risk factors, symptoms, screening and prevention of prostate cancer.

Analysis of lung cancer risk factors from medical records in Ethiopia using machine learning

Cancer is a broad term that refers to a wide range of diseases that can affect any part of the human body. To minimize the number of cancer deaths and to prepare an appropriate health policy on cancer spread mitigation, scientifically supported knowledge of cancer causes is critical. As a result, in this study, we analyzed lung cancer risk factors that lead to a highly severe cancer case using a decision tree-based ranking algorithm. This feature relevance ranking algorithm computes the weight of each feature of the dataset by using split points to improve detection accuracy, and each risk factor is weighted based on the number of observations that occur for it on the decision tree. Coughing of blood, air pollution, and obesity are the most severe lung cancer risk factors out of nine, with a weight of 39%, 21%, and 14%, respectively. We also proposed a machine learning model that uses Extreme Gradient Boosting (XGBoost) to detect lung cancer severity levels in lung cancer patients. We used a dataset of 1000 lung cancer patients and 465 individuals free from lung cancer from Tikur Ambesa (Black Lion) Hospital in Addis Ababa, Ethiopia, to assess the performance of the proposed model. The proposed cancer severity level detection model achieved 98.9%, 99%, and 98.9% accuracy, precision, and recall, respectively, for the testing dataset. The findings can assist governments and non-governmental organizations in making lung cancer-related policy decisions.

High burden of diabetes and prediabetes among cancer patients at University of Gondar comprehensive specialized hospital, Northwest Ethiopia

Cancer and diabetes mellitus (DM) are diagnosed within the same individual more frequently and share common risk factors. Although diabetes among cancer patients may result in more aggressive clinical courses of cancer, there is limited evidence about its burden and associated factors. Hence, this study aimed to assess the burden of diabetes and prediabetes among cancer patients and its associated factors. Institution-based cross-sectional study was conducted at the University of Gondar comprehensive specialized hospital from 10 January to 10 March 2021. A systematic random sampling technique was used to select 423 cancer patients. The data was collected using a structured interviewer-administered questionnaire. Prediabetes and diabetes diagnosis was made based on World Health Organization (WHO) criteria. Bi-variable and multivariable binary logistic regression models were fitted to identify factors associated with the outcome. Adjusted Odds Ratio (AOR) with a 95% confidence interval was estimated to show the direction and strength of associations. Variables with a p-value less than 0.05 in the multivariable model were considered significantly associated with the outcome. The final analysis was based on 384 patients with cancer. The proportion of prediabetes and diabetes was 56.8% (95% CI 51.7, 61.7) and 16.7% (95% CI 13.3, 20.8), respectively. Alcohol consumption was found to increase the odds of elevated blood sugar among cancer patients (AOR: 1.96; 95%CI: 1.11, 3.46). The burden of prediabetes and diabetes is alarmingly high among cancer patients. Besides, alcohol consumption was found to increase the odds of having elevated blood sugar among cancer patients. Hence, it is essential to recognize cancer patients are at high risk of having elevated blood sugar and design strategies to integrate diabetes and cancer care.

Blood biomarkers as potential malnutrition screening alternatives among adult patients with cancer on treatment in oncology unit of jimma tertiary hospital: A cross-sectional analysis

BACKGROUND

Cancer is becoming the most common global public health concern. Early malnutrition detection and treatment in patients with cancer is an important aspect of cancer management. Although Subjective global assessment (SGA) is a gold standard nutritional assessment tool, it is not routinely utilized due to it is tedious and needs patient literacy. Thus, early detection of malnutrition necessitates alternative parameters comparable with SGA. Therefore this study aims to evaluate serum albumin, Total Protein (TP), and Hemoglobin (Hgb) and their correlation with malnutrition in patients with cancer at Jimma Medical Center (JMC).

METHODS

Facility based cross-sectional study was conducted from October 15 to December 15, 2021 G.C at JMC among a total of 176 adult patients with cancer selected via a systematic sampling technique. Nutritional status and behavioural data were collected using the SGA tool and a structured questionnaire. Five ml of venous blood was collected and the level of serum albumin, TP and Hgb were measured using Cobas®6000 chemistry analyzer and hematology analyzer UniCel DxH 800. Descriptive statistics, independent t-test, Pearson's correlation coefficient (r), and logistic regression analysis were implemented for analysis.

RESULT

From the total of 176 study participants, 69.3% were females and the mean age was 50.1 ± 13.7 years. Based on SGA, 61.4% of the patients were malnourished. There was a significant decrease in the mean level of serum albumin, TP and Hgb in malnourished as compared to well-nourished patients. Serum albumin(r=-0.491), TP(r=-0.270), and Hgb (r=-0.451) had a significant correlation with SGA tool. Stage IV cancer AOR = 4.98 (1.23-20.07), Gastrointestinal (GI) cancer AOR = 3.39(1.29-8.88) and malnutrition AOR = 3.9(1.81-8.4) were significantly associated with hypoalbuminemia. Similarly, age of > 64 years AOR = 6.44(1.55-26.67), GI cancer AOR = 2.92(1.01-6.29) and malnutrition AOR = 3.14(1.43-6.94) were significantly associated with hypoproteinemia; and stage-IV cancer AOR = 3.94(1.11-13.35) and malnutrition AOR = 3.8(1.82-8.2) were significantly associated with low Hgb level.

CONCLUSION AND RECOMMENDATION

Altered level of serum albumin, TP and Hgb was correlated with the SGA tool of malnutrition. Therefore, it is suggested to be used as an alternative or additional screening tool for prompt detection of malnutrition in adult patients with cancer.

Price, Availability and Affordability of Anti-Cancer Medicines in Addis Ababa, Ethiopia

Introduction

Cytotoxic drugs are essential treatments available for patients with cancer. There are concerns that unavailability and high prices of cancer medicines may limit patient access. Since information on availability, prices and affordability for cancer medicine is lacking for several countries, particularly for lower income countries like Ethiopia, it will be difficult to know the real situation of those medications' access.

Purpose

The purpose of this study was to assess availability, affordability and price of anti-cancer medications, in Addis Ababa, Ethiopia.

Methods

The study was cross-sectional using a modified form of the WHO/HAI methodology of measuring medicine price, availability and affordability in public, private, Kenema municipal and Red Cross Pharmacies found in Addis Ababa, Ethiopia. Data on the availability and price of 47 cytotoxic medications for both lowest priced generics and originator brands were collected in 3 public, 6 private and 2 NGO pharmacies which are expected to dispense cytotoxic medications in Addis Ababa. The data were entered and analyzed using WHO/HAI data entry and analysis form. Results were presented in tables and figures.

Results

The majority of the anti-cancer medications assessed were not available and the few available medicines were unaffordable. The lowest priced generic were relatively more available (34.8%) than the originator brand medications (2.8%) in the public sector. Generally, the availability of anti-cancer medicine differs when comparing the public, private and other sectors. The availability of cytotoxic medications was 18.8%, 5.3% and 8.8% in the public, private and other sectors. The prices of cytotoxic medications available in the private sector were higher than the public and other sectors. All of the medications except for anastrazole were unaffordable.

Conclusion

Medicines for cancer treatment are unavailable and the few available medicines are unaffordable in Addis Ababa, Ethiopia. Different interventions should be done to improve access to cytotoxic medications.

Patterns of cancer in Wolaita Sodo University Hospital: South Ethiopia

BACKGROUND

Variations in cancer occurrence between populations in different places are expected because of many factors. In Ethiopia there is no national cancer registry and here we are reporting the pattern of cancer in Wolaita Sodo University hospital located in Southern region of Ethiopia with catchment area of over ten million peoples.

METHODOLOGY

A retrospective record analysis of all pathologically confirmed malignancies from January 2021 up to June 2021. Data was filtered and descriptive analysis was done using IBM SPSS version 22 (Chicago IL USA).

RESULT

In the Wolaita Sodo University Teaching Referral Hospital during the first six months of 2021, out of 1,810 histopathologically tested samples 19.5% (354) were confirmed malignant cases. Among 354 patient samples, most of them (62.4%) were in females and the rest (37%) found to be in males. The age pattern shows occurrence of 336 (95%) cases in adults and 18 (5%) cases in children. Breast cancer, soft tissue sarcomas, cancer of uteri cervix, non melanomatous skin cancer, and non hodgkin lymphomas were the five top common cancers of all age groups. In adult population, breast cancer, soft tissue sarcomas, and cancer of uteri cervix are the most common. In children of age less than 14 years non hodgkin lymphomas, soft tissue sarcomas and bone sarcomas were the three top cancers. Breast cancer, cancer of uteri cervix and soft tissue sarcomas are found to be the commonest cancers in females. On the other hand, soft tissue sarcomas, non melanomatous skin cancers and Non Hodgkin lymphomas, are the three top commonest cancers in males.

CONCLUSION

Based on our current study cancer is one of the common finding from histopathology samples analyzed at the hospital and the pattern of cancer was similar to those reported in other regions of the country as well as neighboring countries. However, Comprehensive demographic and clinical data using population or facility-based cancer registry is required to get better information. Additionally, our finding of higher proportion of soft tissue sarcomas both in males and females of all age groups in this region is disparate and requires further investigation.

Influence of clone and nitrogen application level on quality of green tea in some selected tea (Camellia sinensis (L.)O. Kuntze) in Southwest Ethiopia

The biochemical constituents and organoleptic characteristics of Camellia sinensis (L.) O. Kuntze clones are not studied well in Ethiopia. The study aims to evaluate the polyphenols, caffeine, antioxidant content, and cup quality of clones at different nitrogen application rates and identify suitable clones and processes for daily consumable antioxidant-rich green tea. The experiment consisted of five clones (6/8, BB-35, 11/56, 11/4, and 12/38) and five nitrogen application rates (i.e., 0, 75, 150, 225, and 300 kg ha⁻¹) under a split-plot design and was replicated three times. The biochemical constituents and overall quality of green tea were examined using HPLC, chemical analysis, and a cup taster. The results indicate that the polyphenol content increased slightly (P < 0.018) as the nitrogen application rate increased, with a weak correlation (r = 0.387). The caffeine content varies from 1.82 to 3.06%. Clone BB-35 scored the highest (3.06%), and clone 6/8 scored the lowest caffeine content in all nitrogen treatments. The total nitrogen content varied between 2.27 and 4.01 mg g⁻¹ and slightly increased as the nitrogen application rate increased (r² = 0.798). The antioxidant activity showed a significant variation (P < 0.001) among clones, and the tested clones had a high antioxidant inhibition percent ranging from 51.9 to 66.5%. The cup quality, aroma, liquor color, and dry leaf appearances of green tea were positively correlated (r = 0.68, r = 0.70, r = 0.48, and r = 0.30), and the overall quality of green tea improved as the nitrogen application rate increased. Clones 6/8 and 11/4 recorded the highest overall quality above the total mean value, whereas clones BB-35, 12/38, and 11/56 scored below the total mean value (77.68%). Clone 6/8 produced an excellent full aroma, balanced bitterness, and a slightly sweeter cup in all nitrogen treatments than other clones. Moreover, this clone contains less caffeine and high polyphenol content in high nitrogen treatment. The second-best, clone 11/4, has a good marketable green liquor, aroma, and dry-made tea appearance, but it is slightly bitterer than clone 6/8. The research concluded that clone 6/8 can produce a more acceptable and high-quality green tea at 300 kg N ha⁻¹.

Breast Self-Examination Knowledge and its Determinants among Female Students at Addis Ababa University, Ethiopia: An Institution-Based Cross-Sectional Study

Introduction

Breast self-examination is a noninvasive, low-cost screening method for breast cancer detection. A thorough awareness of breast self-examination enables the early detection of breast abnormalities and dramatically lowers breast cancer complications and mortality. The purpose of this study was to investigate the level of knowledge about breast self-examination and its associated factors among female students at Addis Ababa University, Ethiopia.

Methods

An institution-based cross-sectional study design was employed. The final calculated sample size was 407, and participants were recruited using a proportionate stratified random sampling approach. For data entry and coding, EPI Data 3.1 statistical software was utilized, and for data analysis, SPSS version 18 was employed. The data was described using descriptive analysis. Bivariate and multivariate logistic regression analyses were performed to determine the strength of the association between the predictor and the outcome variables. A 95% confidence interval and a p-value of less than 0.05 were used to declare statistical significance.

Results

The findings of this study revealed that 49.9% of respondents possessed good breast self-examination knowledge. Previously, urban residents were about two times more likely to have good knowledge of BSE than their rural counterparts (AOR =2.16, 95% CI (1.18–39.91), p =0.011). The odds of having good BSE knowledge were about three times more likely among those who had a good attitude than those who had a poor attitude (AOR =3.17, 95% CI (2.02–4.74), p <0.001). Those who knew someone with a diagnosis of breast cancer were almost three times more likely to have good knowledge than those who did not know (AOR =2.95, 95% CI (1.77-4.91), p <0.001).

Conclusion

According to the findings of this survey, less than half of the students who participated had good knowledge of breast self-examination. This justifies raising awareness about breast self-examination among female students.

Traditional and Phytochemical Bases of Herbs, Shrubs, Climbers, and Trees from Ethiopia for Their Anticancer Response

Ethiopia is one of Africa's six plant-rich countries, with around 60% of the plants being indigenous and most of them having medicinal properties. 80% of people in the country use these plants as a primary health care system to tackle different diseases, including cancer. This review is aimed at summarizing the evidence gained from diverse MPs in Ethiopia that have been used ethnobotanically and ethnopharmacologically for treatment of cancer. The primary data sources were Google Scholar, Web of Science, Science Direct, Scopus, PubMed, and other electronic scientific databases. This literature review showed that there are around 200 MPs used as anticancer. Seventy-four herbs, 39 trees, 77 shrubs, and 17 weed/climbers belonging to 56 families have been identified for their ethnobotanical anticancer potential, and 31 species were recognized for their pharmaceutically anticancer activities. The reviewed data also indicated that many Ethiopian MPs had been used to treat breast, lung, blood, and skin cancers and other tumors. Besides, the collected data showed that the leaves (36.76%), roots (27.2%), bark (12.5%), stem (5.1%), and fruit (7.35%) of plants are commonly used for the preparation of anticancer remedies. Among the reported plant species, Euphorbiaceae (10.71%), Acanthaceae (7.14%), and Asteraceae (7.1%) are the most prominent plant families being used to treat cancer ethnobotanically. Phytochemicals such as flavonoids (like xanthone, indirubin, flavopiridol, and silybin), alkaloids (like taxol, vincristine, evodiamine, and berberine), and physalin B, D, and F steroids exhibited anticancer activity on various cancer cell lines. The crude extracts of Aerva javanica, Vernonia leopoldi, Withania somnifera, Kniphofia foliosa, and Catharanthus roseus were powerful anticancer agents with an IC₅₀ value below 10 μg/mL. Although several Ethiopian plants possess anticancer potential, only a limited number of plants are scientifically studied. Therefore, more scientific studies on anticancer MPs should be carried out; it may lead to discovering and isolating cost-effective and safe anticancer drugs.

Utilization of Rehabilitation Services and Associated Factors Among Adults with Cancer Diagnoses at Hawassa Comprehensive Specialized Hospital, Ethiopia

BACKGROUND

Rehabilitation is a type of treatment that focuses on improving a person's physical, social, cognitive, and emotional functioning. Currently, there is a significant unmet need for rehabilitation. Despite the expansion of rehabilitation services in Ethiopia, little is known about its utilization and associated factors.

OBJECTIVE

This study aimed to assess the utilization of rehabilitation services and associated factors among adults with cancer diagnoses at Hawassa Comprehensive Specialized Hospital, Ethiopia.

METHODS

An institutional-based cross-sectional study was employed among 325 participants selected using a systematic sampling technique. Data were collected using a pre-tested, interviewer-administered questionnaire and a review of medical records. Participants were considered as utilized if they attended at least one cancer rehabilitation service at the hospital in the last 1 year. The data were entered into EpiData version 4.6 and exported to Statistical Package for Social Science Version 23 for analysis. Binary logistic regression analysis was used to identify factors associated with the utilization of rehabilitation services. Variables with a P-value of < 0.05 were considered statistically significant.

RESULTS

Utilization of rehabilitation service among adults with cancer diagnoses in the last 1 year were found to be 33.2% (95% CI; 27.93-41.25). Being male (AOR=5.76; 95% CI: 2.60, 12.75), urban residence (AOR=2.56; 95% CI: 1.04, 6.26), ability to perform the activity of daily living independently (AOR=2.68; 95% CI: 1.20, 6.00), receiving education on cancer rehabilitation services (AOR=2.44; 95% CI: 1.21, having strong social support (AOR=2.10; 95% CI: 1.02, 4.87), 4.91) and satisfaction with cancer care (AOR=3.21; 95% CI: 1.42, 5.76) were factors associated with the utilization of rehabilitation services.

CONCLUSION

Only 33.2% of adults with cancer diagnoses at Hawassa Comprehensive Specialized Hospital utilized rehabilitation services. To improve the utilization of rehabilitation services, patients should receive adequate education on the benefits of rehabilitation.

Epidemiological Trends of Breast Cancer in Southern Ethiopia: A Seven-Year Retrospective Review

INTRODUCTION

African women are affected by cancer at an early age of their productivity. However, the exact prevalence and incidence of cancer, including breast cancer is not known in most sub-Saharan African countries, including Ethiopia because of lack of well-established cancer registry. This study aims to assess the epidemiology of breast cancer at Hawassa University Comprehensive Specialized Hospital (HUCSH), the biggest referral hospital with cancer treatment center serving the southern part of the country.

METHODS

Retrospective review of charts of all patients with a diagnosis of breast cancer between 2013 and 2019 at HUCSH was conducted. A standardized questionnaire was used to collect relevant data that include sociodemographic, symptoms, type of diagnosis, treatment, and outcomes. Data were entered using epidata version 3.1 and analyzed using MS Excel and SPSS version 20.

RESULTS

Five hundred fifty-nine (18.6%) breast cancer cases were retrieved in 7 years between 2013 and 2019. Of this, 548 (98%) were women. The median ages of the patents were 38 years. Invasive ductal carcinoma was the leading 309 (55.3%) histologic type followed by 185 (33.1%) lobular carcinoma. One hundred seventy-seven (31.7%) were moderately differentiated and 155 (27.7%) were poorly differentiated. Three hundred seventy-two (66.5%) were advanced breast cancer (Stages III and IV). Trends of breast cancer showed the case load is continuously increasing except with a slight reduction of cases in between 2015 and 2016. The majority were advanced breast cancer occurring at an early age by the time diagnosis made. Invasive ductal carcinomas were the predominant one. The trend also showed a continuous increment of cancer case load. Therefore, cancer registration center establishment, community awareness creation, and intensive early detection strategy are mandatory.

Breaking Bad News in Cancer Care: Ethiopian Patients Want More Information Than What Family and the Public Want Them to Have

PURPOSE

This study explores the preferences of patients with cancer, family caregivers, and the general public regarding breaking bad news in an Ethiopian oncology setting.

METHODS

The study was conducted at Tikur Anbessa (Black Lion) Specialized Hospital. The sample consists of patients with a confirmed cancer diagnosis, their family caregivers, and representatives from the general public with 150 subjects per cohort. The study used a comparative cross-sectional design and multivariable data analysis.

RESULTS

The patients would like to be informed, which contradicts the preferences of family caregivers. This creates an ethical dilemma for staff in terms of how much they involve their patients in clinical decision making. The patients also indicate that information should not be withheld from them. By contrast, the general public prefers information about poor life expectancy to be communicated to family only, which may reflect a widespread public perception of cancer as a deadly disease.

CONCLUSION

The findings indicate the complexity of communication-related preferences concerning breaking bad news in oncology care in Ethiopia. It requires oncologists to probe patient attitudes before information disclosure to find a balance between involving patients in communication at the same time as keeping a constructive alliance with family caregivers.

Awareness of Colorectal Cancer and Associated Factors Among Adult Patients in Jimma, South-West Ethiopia: An Institution-Based Cross-Sectional Study

Background

Colorectal cancer (CRC) is the first commonest diagnosed cancer in men and the fourth commonest in women in Ethiopia. Awareness of CRC and associated factors is crucial in the prevention of CRC. However, there have not been studies about the awareness of CRC and associated factors among adult patients in Ethiopia. Therefore, the study aimed to assess the awareness of CRC and associated factors among adult patients in Jimma, South-West Ethiopia, 2020.

Methods

This institution-based cross-sectional study design was conducted among 422 adult patients. The study respondents were recruited by a systematic random sampling method. The Cancer Awareness Measure questions were used to measure awareness of CRC of adult patients. Descriptive and logistic regression analyses were conducted.

Results

More than half (57.6%) of respondents had low-level awareness of CRC. Respondents who were females (adjusted odds ratio [AOR] = 1.86; 95% CI: 1.26, 2.75), who are residing in urban areas (AOR = .45; 95% CI: .30, .67), who had a monthly income of 3000 Ethiopian Birr and above (AOR = 4.72; 95% CI: 3.11, 7.15), who heard about CRC (AOR = 4.48; 95% CI: 2.90, 6.93), who get information through social media about CRC (AOR = 2.51; 95% CI: 1.18, 5.37), and who had a family history of CRC (AOR = 3.27; 95% CI: 1.45, 7.36) had a high level of awareness of CRC, while those who cannot read and write (AOR = 2.83; 95% CI: 1.49, 5.37) and learn elementary school (AOR = 2.12; 95% CI: 1.15, 3.93) had a low level of awareness of CRC.

Conclusion

This study indicated that awareness of CRC of adult patients was inadequate. Adult patients’ gender, residency, level of education, monthly income, heard about CRC, sources of information about CRC, and a family history of CRC were found to be independent predictors of the awareness of CRC. Therefore, there is a need for health education and awareness campaigns for promoting awareness of CRC of adult patients, and the government should develop policy on CRC prevention and screening program.

Investigation on the Direct and Bystander Effects in HeLa Cells Exposed to Very Low α-Radiation Using Electrical Impedance Measurement

The impact of radiation-induced bystander effect (RIBE) is still not well understood in radiotherapy. RIBEs are biological effects expressed by nonirradiated cells near or far from the irradiated cells. Most radiological studies on cancer cells have been based on biochemical characterization. However, biophysical investigation with label-free techniques to analyze and compare the direct irradiation effect and RIBE has lagged. In this work, we employed an electrical cell-indium tin oxide (ITO) substrate impedance system (ECIIS) as a bioimpedance sensor to evaluate the HeLa cells' response. The bioimpedance of untreated/nonirradiated HeLa (N-HeLa) cells, α-particle (Am-241)-irradiated HeLa (I-HeLa) cells, and bystander HeLa (B-HeLa) cells exposed to media from I-HeLa cells was monitored with a sampling interval of 8 s over a period of 24 h. Also, we imaged the cells at times where impedance changes were observed. Different radiation doses (0.5 cGy, 1.2 cGy, and 1.7 cGy) were used to investigate I-HeLa and B-HeLa cells' radiation-dose-dependence. By analyzing the changes in absolute impedance and cell size/number with time, compared to N-HeLa cells, B-HeLa cells mimicked the I-HeLa cells' damage and modification of proliferation rate. Contrary to the irradiated cells, the bystander cells' damage rate and proliferation rate enhancements have an inverse radiation-dose-response. Also, we report multiple RIBEs in HeLa cells in a single measurement and provide crucial insights into the RIBE mechanism without any labeling procedure. Unambiguously, our results have shown that the time-dependent control of RIBE is important during α-radiation-based radiotherapy of HeLa cells.

Person and Family Centeredness in Ethiopian Cancer Care: Proposal for a Project for Improving Communication, Ethics, Decision Making, and Health

Background

Cancer is a major burden in Ethiopia. The Oncology Department of Tikur Anbessa (Black Lion) Specialized Hospital in Addis Ababa is the sole specialist unit for cancer care in the country. With only a handful of oncologists, a lack of resources, and a huge patient load, the work is challenging, especially in terms of achieving effective and ethical patient consultations. Patients, usually accompanied by family members, often wait for a long time to receive medical attention and frequently depart without treatment. Handling consultations effectively is essential to help patients as much as possible within such limitations.

Objective

The project has the following three main aims: (1) to enhance and expand the understanding of communicative and associated ethical challenges in Ethiopian cancer care; (2) to enhance and expand the understanding of the implications and use of person- and family-centered solutions to address such communicative challenges in practice; and (3) to plan and evaluate interventions in this area.

Methods

This project develops and consolidates a research collaboration to better understand and mitigate the communicative challenges in Ethiopian cancer care, with a focus on the handling and sharing of decision making and ethical tension among patients, staff, and family. Using theoretical models from linguistics, health communication, and health care ethics, multiple sources of data will be analyzed. Data sources currently include semistructured interviews with Ethiopian staff (n= 16), patients (n= 54), and family caregivers (n= 22); survey data on cancer awareness (n=150) and attitudes toward breaking bad news (n=450); and video recordings of medical consultations (n=45). In addition, we will develop clinical and methodological solutions to formulate educational interventions.

Results

The project was awarded funding by the Swedish Research Council in December 2017 for the period 2018 to 2021. The research ethics boards in Sweden and Ethiopia approved the project in May 2018. The results of the studies will be published in 2020 and 2021.

Conclusions

The project is the first step toward providing unique and seminal knowledge for the specific context of Ethiopia in the areas of physician-patient communication research and ethics. It contributes to the understanding of the complexity of the role of family and ethical challenges in relation to patient involvement and decision making in Ethiopia. Improved knowledge in this area can provide a fundamental model for ways to improve cancer care in many other low-resource settings in Africa and the Middle East, which share central cultural prerequisites, such as a strong patriarchal family structure, along with strong and devout religiosity. The project will also serve to develop greater understanding about the current challenges in Western health systems associated with greater family and patient participation in decision making. In addition, the project will contribute to improving the education of Ethiopian health professionals working in cancer care by developing a training program to help them better understand and respond to identified challenges associated with communication.

International Registered Report Identifier (IRRID)

DERR1-10.2196/16493

Communicative challenges among physicians, patients, and family caregivers in cancer care: An exploratory qualitative study in Ethiopia

Background

Cancer is a growing concern in Ethiopia. Though communication is essential for the treatment process, few studies have looked at communication in Ethiopian cancer care. Due to the large number of patients and scarcity of resources, it is vital to understand how to manage consultations in order to effectively help as many patients as possible in this challenging work environment. Thus, research is needed to analyze and understand the communicative challenges experienced by physicians, patients, and family caregivers, in order to successfully handle patient care in practice.

Objective

We explore communication in Ethiopian cancer care and present the main challenges faced by physicians, patients, and family caregivers.

Methods

This explorative qualitative study was conducted at the Oncology Department of the Tikur Anbessa (Black Lion) Specialized Teaching Hospital (TASH) in Addis Ababa, Ethiopia. A triangulation of data collection methods was used: 91 audio-recorded, semi-structured interviews and 21 video-recordings of authentic interactions during hospital rounds. The aim was to obtain as complete a picture as possible of communication from the perspectives of physicians, patients, and family caregivers. The interviews were analyzed using thematic content analysis and the identified themes were supported by excerpts from the transcribed recordings.

Results

Eight themes emerged from the data. Workload and time pressure, in combination with restricted space for privacy, limited the possibilities for physicians to deliver detailed information and provide emotional support. Furthermore, patient literacy levels, in combination with no or little cancer awareness, financial problems, reliance on traditional and religious treatments, the stigma of cancer, and a fatalistic attitude, resulted in delays in patients seeking care and participating in positive health behaviors, and, subsequently, often resulted in an unwillingness to openly discuss problems with physicians and adhere to treatment. The study also illustrates the paramount role of family in physician-patient communication in Ethiopia. Though family caregivers provide a valuable interpreting support when patients have limited language skills, they can also prevent patients from sharing information with physicians. Another important finding is that family caregivers were often responsible for making decisions about treatment and avoided telling patients about a poor prognosis, believing that conveying bad news may upset them. All of these themes have important implications for the role of ethically acceptable communication in patient-centered care.

Conclusions

This study has identified a number of serious challenges for successful and ethically acceptable health communication in Ethiopian cancer care. The study contributes to our understanding of the complexity around the role of family, combined with patients’ dependency on family members for communication, support, and access to care, which creates particular ethical dilemmas for the medical staff. The questions raised by this study concern how to organize consultations to achieve patient-centered health communication, while maintaining a constructive alliance with the family and not jeopardizing the patient’s continued access to care. The integration of communication training for medical students in Ethiopia, with a focus on ethical guidelines for family-centered patient consultation suitable for these circumstances, would be an essential step.