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Balta B, Taylor L, Bogale N, Hailu D, Zerhouni YA. Survival and predictors of mortality among colorectal cancer patients on follow-up in Hawassa University Comprehensive Specialized Hospital, Sidama region, Southern Ethiopia, 2022. A 5-year retrospective cohort study. PLoS One 2024; 19:e0304820. [PMID: 39186504 PMCID: PMC11346650 DOI: 10.1371/journal.pone.0304820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 05/18/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND The incidence and mortality of colorectal cancer were still rising rapidly in many low-income and middle-income countries, which was linked to ongoing societal and economic status. Colorectal cancer is the leading cancer in Ethiopia with relatively lower survival. However, colorectal cancer patients' survival time and predictors have not been well studied in Southern Ethiopia. OBJECTIVE This study aimed to assess five-year survival and predictors of mortality among colorectal cancer patients at Hawassa Comprehensive Specialized Hospital, Ethiopia. METHOD Facility-based retrospective cohort study was conducted among 323 patients who visited Hawassa Comprehensive Specialized Hospital from May 1st, 2017 to April 30th, 2022. The Kaplan-Meier survival curve with the Log-rank test was used to estimate the survival time. Bivariable and multivariable Cox proportional hazards regression models were used to determine the net effect of each independent variable on time to death after diagnosis. RESULT Over the 5-year observation period, the overall mortality rate was 38.5%, with an incidence density of 31 fatalities per 100 person-years observation. Survival at 1, 2, 3, 4, and 5 years was 78%, 53, 32.4%, 23.3%, and 18.7% respectively. The multivariable analysis showed that metastatic disease (AHR = 4.2, CI: 1.5-11.5), baseline carcinoembryonic antigen level ≥5ng/ml (AHR: 2.4, CI: 1.2-5.8), living in rural areas (AHR = 2.2, CI:1.03-4.8) and mucinous carcinoma (AHR = 0.33, CI: 0.13-0.87) were independent predictors of colorectal cancer mortality. CONCLUSION Overall survival of colorectal cancer patients in the study was low compared to similar studies in developing and developed worlds. A significantly low survival rate was observed for patients with advanced stage, elevated carcinoembryonic antigen levels, and rural residents indicating the key role of early detection and timely initiation of treatment to improve survival and quality of life of patients with colorectal cancer.
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Affiliation(s)
- Bargude Balta
- Hawassa University Comprehensive Specialized Hospital Cancer Center, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Lesley Taylor
- Division of Breast Surgery, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, California, United States of America
| | - Netsanet Bogale
- Hawassa University Comprehensive Specialized Hospital Cancer Center, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Dejene Hailu
- Department of Public Health, Hawassa, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Yasmin A. Zerhouni
- Division of Colorectal Surgery, City of Hope, Department of Surgery, Comprehensive Cancer Center, Duarte, California, United States of America
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Becerra-Tomás N, Markozannes G, Cariolou M, Balducci K, Vieira R, Kiss S, Aune D, Greenwood DC, Dossus L, Copson E, Renehan AG, Bours M, Demark-Wahnefried W, Hudson MM, May AM, Odedina FT, Skinner R, Steindorf K, Tjønneland A, Velikova G, Baskin ML, Chowdhury R, Hill L, Lewis SJ, Seidell J, Weijenberg MP, Krebs J, Cross AJ, Tsilidis KK, Chan DSM. Post-diagnosis adiposity and colorectal cancer prognosis: A Global Cancer Update Programme (CUP Global) systematic literature review and meta-analysis. Int J Cancer 2024; 155:400-425. [PMID: 38692659 DOI: 10.1002/ijc.34905] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/15/2023] [Accepted: 01/17/2024] [Indexed: 05/03/2024]
Abstract
The adiposity influence on colorectal cancer prognosis remains poorly characterised. We performed a systematic review and meta-analysis on post-diagnosis adiposity measures (body mass index [BMI], waist circumference, waist-to-hip ratio, weight) or their changes and colorectal cancer outcomes. PubMed and Embase were searched through 28 February 2022. Random-effects meta-analyses were conducted when at least three studies had sufficient information. The quality of evidence was interpreted and graded by the Global Cancer Update Programme (CUP Global) independent Expert Committee on Cancer Survivorship and Expert Panel. We reviewed 124 observational studies (85 publications). Meta-analyses were possible for BMI and all-cause mortality, colorectal cancer-specific mortality, and cancer recurrence/disease-free survival. Non-linear meta-analysis indicated a reverse J-shaped association between BMI and colorectal cancer outcomes (nadir at BMI 28 kg/m2). The highest risk, relative to the nadir, was observed at both ends of the BMI distribution (18 and 38 kg/m2), namely 60% and 23% higher risk for all-cause mortality; 95% and 26% for colorectal cancer-specific mortality; and 37% and 24% for cancer recurrence/disease-free survival, respectively. The higher risk with low BMI was attenuated in secondary analyses of RCTs (compared to cohort studies), among studies with longer follow-up, and in women suggesting potential methodological limitations and/or altered physiological state. Descriptively synthesised studies on other adiposity-outcome associations of interest were limited in number and methodological quality. All the associations were graded as limited (likelihood of causality: no conclusion) due to potential methodological limitations (reverse causation, confounding, selection bias). Additional well-designed observational studies and interventional trials are needed to provide further clarification.
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Affiliation(s)
- Nerea Becerra-Tomás
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Georgios Markozannes
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Margarita Cariolou
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Katia Balducci
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Rita Vieira
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Sonia Kiss
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Nutrition, Oslo New University College, Oslo, Norway
- Department of Research, The Cancer Registry of Norway, Oslo, Norway
| | - Darren C Greenwood
- Leeds Institute for Data Analytics, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Laure Dossus
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Ellen Copson
- Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Andrew G Renehan
- The Christie NHS Foundation Trust, Manchester Cancer Research Centre, NIHR Manchester Biomedical Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Martijn Bours
- Department of Epidemiology, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Wendy Demark-Wahnefried
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Melissa M Hudson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Roderick Skinner
- Department of Paediatric and Adolescent Haematology/Oncology, Great North Children's Hospital and Translational and Clinical Research Institute, and Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Diet, Cancer and Health, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Galina Velikova
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | | | - Rajiv Chowdhury
- Department of Global Health, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Lynette Hill
- World Cancer Research Fund International, London, UK
| | - Sarah J Lewis
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jaap Seidell
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Matty P Weijenberg
- Department of Epidemiology, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - John Krebs
- Department of Biology, University of Oxford, Oxford, UK
| | - Amanda J Cross
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Konstantinos K Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Doris S M Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
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Chan DSM, Cariolou M, Markozannes G, Balducci K, Vieira R, Kiss S, Becerra-Tomás N, Aune D, Greenwood DC, González-Gil EM, Copson E, Renehan AG, Bours M, Demark-Wahnefried W, Hudson MM, May AM, Odedina FT, Skinner R, Steindorf K, Tjønneland A, Velikova G, Baskin ML, Chowdhury R, Hill L, Lewis SJ, Seidell J, Weijenberg MP, Krebs J, Cross AJ, Tsilidis KK. Post-diagnosis dietary factors, supplement use and colorectal cancer prognosis: A Global Cancer Update Programme (CUP Global) systematic literature review and meta-analysis. Int J Cancer 2024; 155:445-470. [PMID: 38692645 DOI: 10.1002/ijc.34906] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/15/2023] [Accepted: 01/17/2024] [Indexed: 05/03/2024]
Abstract
The role of diet in colorectal cancer prognosis is not well understood and specific lifestyle recommendations are lacking. We searched for randomised controlled trials (RCTs) and longitudinal observational studies on post-diagnosis dietary factors, supplement use and colorectal cancer survival outcomes in PubMed and Embase from inception until 28th February 2022. Random-effects dose-response meta-analyses were conducted when at least three studies had sufficient information. The evidence was interpreted and graded by the CUP Global independent Expert Committee on Cancer Survivorship and Expert Panel. Five RCTs and 35 observational studies were included (30,242 cases, over 8700 all-cause and 2100 colorectal cancer deaths, 3700 progression, recurrence, or disease-free events). Meta-analyses, including 3-10 observational studies each, were conducted for: whole grains, nuts/peanuts, red and processed meat, dairy products, sugary drinks, artificially sweetened beverages, coffee, alcohol, dietary glycaemic load/index, insulin load/index, marine omega-3 polyunsaturated fatty acids, supplemental calcium, circulating 25-hydroxyvitamin D (25[OH]D) and all-cause mortality; for alcohol, supplemental calcium, circulating 25(OH)D and colorectal cancer-specific mortality; and for circulating 25(OH)D and recurrence/disease-free survival. The overall evidence was graded as 'limited'. The inverse associations between healthy dietary and/or lifestyle patterns (including diets that comprised plant-based foods), whole grains, total, caffeinated, or decaffeinated coffee and all-cause mortality and the positive associations between unhealthy dietary patterns, sugary drinks and all-cause mortality provided 'limited-suggestive' evidence. All other exposure-outcome associations provided 'limited-no conclusion' evidence. Additional, well-conducted cohort studies and carefully designed RCTs are needed to develop specific lifestyle recommendations for colorectal cancer survivors.
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Affiliation(s)
- Doris S M Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Margarita Cariolou
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Georgios Markozannes
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
| | - Katia Balducci
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Rita Vieira
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Sonia Kiss
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Nerea Becerra-Tomás
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Nutrition, Oslo New University College, Oslo, Norway
- Department of Research, The Cancer Registry of Norway, Oslo, Norway
| | - Darren C Greenwood
- Leeds Institute for Data Analytics, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Esther M González-Gil
- Nutrition and Metabolism Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Ellen Copson
- Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Andrew G Renehan
- The Christie NHS Foundation Trust, Manchester Cancer Research Centre, NIHR Manchester Biomedical Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Martijn Bours
- Department of Epidemiology, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Wendy Demark-Wahnefried
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Melissa M Hudson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Anne M May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Roderick Skinner
- Department of Paediatric and Adolescent Haematology/Oncology, Great North Children's Hospital and Translational and Clinical Research Institute, and Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | - Karen Steindorf
- Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Diet, Cancer and Health, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Galina Velikova
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | | | - Rajiv Chowdhury
- Department of Global Health, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, Florida, USA
| | - Lynette Hill
- World Cancer Research Fund International, London, UK
| | - Sarah J Lewis
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jaap Seidell
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Matty P Weijenberg
- Department of Epidemiology, GROW School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - John Krebs
- Department of Biology, University of Oxford, Oxford, UK
| | - Amanda J Cross
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Konstantinos K Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
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Aynalem ZB, Adal AB, Ayele TF, Bayeh GM, Yeshiwas AG, Dessie TM, Tsega TD. Mortality rate and predictors of colorectal cancer patients in Ethiopia: a systematic review and meta-analysis. BMC Cancer 2024; 24:821. [PMID: 38987683 PMCID: PMC11234545 DOI: 10.1186/s12885-024-12597-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 07/03/2024] [Indexed: 07/12/2024] Open
Abstract
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.
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Affiliation(s)
- Zewdu Bishaw Aynalem
- Department of Nursing, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia.
| | - Abebaw Bires Adal
- Department of Nursing, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Temesgien Fentahun Ayele
- Department of Nursing, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Gashaw Melkie Bayeh
- Department of Environmental Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Almaw Genet Yeshiwas
- Department of Environmental Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Tadesse Miretie Dessie
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Tilahun Degu Tsega
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
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El Badisy I, BenBrahim Z, Khalis M, Elansari S, ElHitmi Y, Abbass F, Mellas N, El Rhazi K. Risk factors affecting patients survival with colorectal cancer in Morocco: survival analysis using an interpretable machine learning approach. Sci Rep 2024; 14:3556. [PMID: 38346963 PMCID: PMC10861582 DOI: 10.1038/s41598-024-51304-3] [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: 01/02/2023] [Accepted: 01/03/2024] [Indexed: 02/15/2024] Open
Abstract
The aim of our study was to assess the overall survival rates for colorectal cancer at 3 years and to identify associated strong prognostic factors among patients in Morocco through an interpretable machine learning approach. This approach is based on a fully non-parametric survival random forest (RSF), incorporating variable importance and partial dependence effects. The data was povided from a retrospective study of 343 patients diagnosed and followed at Hassan II University Hospital. Covariate selection was performed using the variable importance based on permutation and partial dependence plots were displayed to explore in depth the relationship between the estimated partial effect of a given predictor and survival rates. The predictive performance was measured by two metrics, the Concordance Index (C-index) and the Brier Score (BS). Overall survival rates at 1, 2 and 3 years were, respectively, 87% (SE = 0.02; CI-95% 0.84-0.91), 77% (SE = 0.02; CI-95% 0.73-0.82) and 60% (SE = 0.03; CI-95% 0.54-0.66). In the Cox model after adjustment for all covariates, sex, tumor differentiation had no significant effect on prognosis, but rather tumor site had a significant effect. The variable importance obtained from RSF strengthens that surgery, stage, insurance, residency, and age were the most important prognostic factors. The discriminative capacity of the Cox PH and RSF was, respectively, 0.771 and 0.798 for the C-index while the accuracy of the Cox PH and RSF was, respectively, 0.257 and 0.207 for the BS. This shows that RSF had both better discriminative capacity and predictive accuracy. Our results show that patients who are older than 70, living in rural areas, without health insurance, at a distant stage and who have not had surgery constitute a subgroup of patients with poor prognosis.
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Affiliation(s)
- Imad El Badisy
- Mohammed VI Center for Research and Innovation, Rabat, Morocco.
- International School of Public Health, Mohammed VI University of Sciences and Health, Casablanca, Morocco.
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Aix Marseille Univ, Marseille, France.
| | - Zineb BenBrahim
- Faculty of Medicine, Pharmacy & Dental Medicine, Sidi Mohamed Ben Abdillah University, Fez, Morocco
| | - Mohamed Khalis
- Mohammed VI Center for Research and Innovation, Rabat, Morocco
- International School of Public Health, Mohammed VI University of Sciences and Health, Casablanca, Morocco
- Higher Institute of Nursing Professions and Technical Health, Rabat, Morocco
- Laboratory of Biostatistics, Clinical, and Epidemiological Research, Faculty of Medicine and Pharmacy, Department of Public Health, Mohamed V University, Rabat, Morocco
| | - Soukaina Elansari
- Department of Oncology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Youssef ElHitmi
- Department of Oncology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Fouad Abbass
- Laboratory of Epidemiology and Research in Health Sciences, Department of Epidemiology and Public Health, Faculty of Medicine of Fez, Sidi Mohamed Ben Abdillah University, Fez, Morocco
| | - Nawfal Mellas
- Department of Oncology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Karima El Rhazi
- Laboratory of Epidemiology and Research in Health Sciences, Department of Epidemiology and Public Health, Faculty of Medicine of Fez, Sidi Mohamed Ben Abdillah University, Fez, Morocco
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Kefale B, Engidaw MT, Tesfa D, Molla M, Kefale Y, Tafere C. Management pattern and medication-related harms and its predictors in colorectal cancer patients: an institutional-based retrospective study. Front Oncol 2023; 13:1253845. [PMID: 38023189 PMCID: PMC10644778 DOI: 10.3389/fonc.2023.1253845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Data on colorectal cancer (CRC) patients' thorough management practices and medication-related harms (MRH) are scarce. This study's aim was to investigate the MRHs in patients receiving CRC chemotherapy at the comprehensive specialized hospital of the University of Gondar (UoGCSH). Methods A registry-based retrospective cohort study was conducted on CRC patients at the UoGCSH during 2017-2021. From February to May 2022, medical records were reviewed using a pretested data collection tool to collect socio-demographic and disease-related characteristics, MRHs, and medication regimens. MRHs occurrence and adverse drug reactions (ADRs) severity were assessed using standard guidelines and protocols. Version 16/MP of STATA for Windows was used for the analysis. Independent predictors of MRHs were investigated using logistic regression analysis. A p-value ≤0.05 was used to determine an independent variable's statistical significance. Results One hundred forty three CRC patients were included, with a mean age of 49.9 ± 14.5 years. About 32.9% and 33.6% had stage II and III cancer, respectively. Significant patients had co-morbidities (15.4%) and complications (13.3%). Fluorouracil (5-FU)-based regimens were given to more than half (56%) of the patients. MRHs were found in 53.1% of the patients, with a mean of 2.45 ± 1.37 MRHs. The most common MRHs were the need for additional drug therapy, sub-therapeutic dose, DDIs, and ADRs. Being on stage IV (AOR = 27.7, 95% CI = 3.85-199.38, p = 0.001), having co-morbidity (AOR = 7.42, 95% CI = 1.80-30.59, p = 0.018) and having complication (AOR = 11.04, 95% CI = 1.72-70.95, p = 0.011) and treated with five or more drugs (AOR = 2.54, 95% CI = 1.07-6.07, p = 0.035) were independent predictors of MRHs. Conclusion A fluorouracil-based treatment regimen was most frequently used. MRHs were found in nearly half of CRC patients. Furthermore, MRHs were significantly associated with cancer stage, comorbidity and complication status, and the number of medications used. Because MRHs are common, improving clinical pharmacy services is critical for optimizing drug therapy in CRC patients.
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Affiliation(s)
- Belayneh Kefale
- Clinical Pharmacy Unit and Research team, Department of Pharmacy, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Melaku Tadege Engidaw
- Department of Social and Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Desalegn Tesfa
- Department of Social and Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mulugeta Molla
- Pharmacology and Toxicology Unit, Department of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yitayih Kefale
- Department of Pharmacy, Bahir Dar Health Science College, Bahir Dar, Ethiopia
| | - Chernet Tafere
- Pharmaceutics Unit and Research team, Department of Pharmacy, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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7
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El Badisy I, BenBrahim Z, Khalis M, Elansari S, ElHitmi Y, Abbas F, Mellas N, EL Rhazi K. Risk factors affecting patients survival with colorectal cancer in Morocco : Survival Analysis using an Interpretable Machine Learning Approach. RESEARCH SQUARE 2023:rs.3.rs-2435106. [PMID: 36711858 PMCID: PMC9882696 DOI: 10.21203/rs.3.rs-2435106/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The aim of our study was to assess the overall survival rates for colorectal patients in Morocco and to identify strong prognostic factors using a novel approach combining survival random forest and the Cox model. Covariate selection was performed using the variable importance based on permutation and partial dependence plots were displayed to explore in depth the relationship between the estimated partial effect of a given predictor and survival rates. The predictive performance was measured by two metrics, the Concordance Index (C-index) and the Brier Score (BS). Overall survival rates at 1, 2 and 3 years were, respectively, 87% (SE = 0.02; CI-95% = 0.84-0.91), 77% (SE = 0.02; CI-95% = 0.73-0.82) and 60% (SE = 0.03; CI-95% = 0.54-0.66). In the Cox model after adjustment for all covariates, sex, tumor differentiation had no significant effect on prognosis, but rather tumor site had a significant effect. The variable importance obtained from RSF strengthens that surgery, stage, insurance, residency, and age were the most important prognostic factors. The discriminative capacity of the Cox PH and RSF was, respectively, 0.771 and 0.798 for the C-index, while the accuracy of the Cox PH and RSF was, respectively, 0.257 and 0.207 for the Brier Score. This shows that RSF had both better discriminative capacity and predictive accuracy. Our results show that patients who are older than 70, living in rural areas, without health insurance, at a distant stage and who have not had surgery constitute a subgroup of patients with poor prognosis.
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Affiliation(s)
- Imad El Badisy
- Mohammed VI Center for Research & Innovation, Rabat, Morocco. Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix Marseille Univ, Marseille, France
| | - Zineb BenBrahim
- Department of Oncology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Mohamed Khalis
- Mohammed VI Center for Research & Innovation, Rabat, Morocco. Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
| | - Soukaina Elansari
- Department of Oncology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Youssef ElHitmi
- Department of Oncology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Fouad Abbas
- Department of Epidemiology and Public Health, Faculty of Medicine of Fez, Research Laboratory “Epidemiology and Research in Health Sciences”, Sidi Mohamed Ben Abdillah University, Fez, Morocco
| | - Nawfal Mellas
- Department of Oncology, University Hospital Hassan II, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Karima EL Rhazi
- Department of Epidemiology and Public Health, Faculty of Medicine of Fez, Research Laboratory “Epidemiology and Research in Health Sciences”, Sidi Mohamed Ben Abdillah University, Fez, Morocco
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Hassen HY, Hussien FM, Hassen AM, Dewau R, Amsalu ET, Limenih MA, Berhe NM, Kassaw NA, Sisay BG, Manzar MD. Survival pattern of colorectal cancer in Sub-Saharan Africa: A systematic review and meta-analysis. Cancer Epidemiol 2022; 81:102276. [PMID: 36257176 DOI: 10.1016/j.canep.2022.102276] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/01/2022] [Accepted: 10/04/2022] [Indexed: 12/03/2022]
Abstract
Cancer incidence is relatively low in sub-Saharan Africa (SSA), however, prognosis is expected to be poor in comparison with high-income countries. Comprehensive evidence is limited on the survival pattern of colorectal cancer patients in the region. We conducted a systematic review and meta-analysis to investigate the pattern of colorectal cancer survival in the region and to identify variation across countries and over time. We searched international databases MEDLINE, Scopus, Embase, Web of Science, ProQuest, CINAHL, and Google Scholar to retrieve studies that estimated survival from colorectal cancer in SSA countries from inception to December 31, 2021 without language restriction. Due to between-study heterogeneity, we performed a random-effects meta-analysis to pool survival rates. To identify study-level sources of variation, we performed subgroup analysis and meta-regression. Results are reported in line with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) 2020 guideline and the protocol was registered in PROSPERO database (CRD42021246935). 23 studies involving 10,031 patients were included in the review, of which, 20 were included in the meta-analysis. The meta-analysis results showed that the pooled 1-, 2-, 3-, 4-, and 5-year survival rates in SSA were 0.74 (95% CI, 0.66-0.81), 0.50 (95% CI, 0.41-0.58), 0.36 (95% CI, 0.27-0.47), 0.31 (95% CI, 0.22-0.42), and 0.28 (95% CI, 0.19-0.38) respectively. Subgroup analyses indicated that the survival rate varied according to year of study, in which those conducted in recent decades showed relatively better survival. The 5-year survival was higher in middle-income SSA countries (0.31; 95%CI: 0.17-0.49) than low-income countries (0.20; 95%CI: 0.11-0.35), however, the difference was not statistically significant. In conclusion, survival from colorectal cancer is low in sub-Saharan Africa compared to other regions. Thus, intervention strategies to improve screening, early diagnosis and treatment of colorectal cancer should be developed and implemented to improve survival in the region.
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Affiliation(s)
- Hamid Y Hassen
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp 2610, Belgium.
| | - Foziya M Hussien
- School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Anissa M Hassen
- School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Reta Dewau
- School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Erkihun T Amsalu
- School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Miteku A Limenih
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp 2610, Belgium
| | - Neamin M Berhe
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp 2610, Belgium
| | - Nigussie A Kassaw
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Binyam G Sisay
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Md Dilshad Manzar
- Department of Nursing, College of Applied Medical Sciences, Majmaah University, Al Majmaah, Saudi Arabia
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Kefale B, Engidaw MT, Tesfa D, Yazie TS, Molla M, Yismaw MB. Clinical pattern and drug-related problems among colorectal cancer patients at oncology center in Ethiopia: A hospital-based study. SAGE Open Med 2022; 10:20503121221131691. [PMID: 36277439 PMCID: PMC9580089 DOI: 10.1177/20503121221131691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 09/22/2022] [Indexed: 11/05/2022] Open
Abstract
Objective: Despite the fact that cancer patients are highly susceptible to drug-related problems due to the effects of cytotoxic agents, data are limited due to a lack of studies on those patients. Hence, we aimed to investigate drug-related problems among patients diagnosed with colorectal cancer. Method: A registry-based cross-sectional study was conducted on colorectal cancer patients at the Felege Hiwot Comprehensive Specialized Hospital. Socio-demographic and disease-related characteristics, treatment regimens, and drug-related problems were recorded by reviewing medical records. Standard guidelines, protocols, and databases were used to evaluate the occurrence of drug-related problems and the severity of adverse drug reactions. For the analysis, Stata version 16/MP for Windows was used. Logistic regression analysis was employed to investigate the potential-associated factors of drug-related problems. A p-value ⩽ 0.05 was used to declare the statistical significance of each independent variable. Results: A total of 150 colorectal cancer patients were included, with a mean age of 51.4 ± 13.8 years. About 30% and 41.3% had stage II and stage III cancers, respectively. About three-quarters (73.8%) of the patients were given 5-fluorouracil-based combination regimens. The prevalence of drug-related problems was found to be 48.7%, with a mean of 2.12 ± 0.93 drug-related problems. In the Felege Hiwot Comprehensive Specialized Hospital, drug–drug interactions and adverse drug reactions were the most prevalent drug-related problems, which accounted for 50 (32.7%) and 49 (32%) cases, respectively. Being elderly (>50 years old) (p = 0.013), having co-morbidity (p = 0.001), and being on five or more medications (p = 0.002) were independent predictors of drug-related problems. Conclusion: Fluorouracil-based chemotherapy was the most frequently used treatment regimen. Almost, half of the colorectal cancer patients had one or more drug-related problems. About one-third of patients had adverse drug reactions and drug–drug interactions. Furthermore, age, co-morbidity status, and the number of medications used were significantly associated with drug-related problems. Clinical pharmacy services should be implemented to optimize drug therapy because the majority of colorectal cancer patients have one or more drug-related problems.
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Affiliation(s)
- Belayneh Kefale
- Clinical Pharmacy Unit and Research team, Department of Pharmacy, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia,Belayneh Kefale, Clinical Pharmacy and Research Unit, Department of Pharmacy, College of Medicine and Health Sciences, Bahir Dar University, P.O.Box 79, Bahir Dar, Ethiopia.
| | - Melaku Tadege Engidaw
- Department of Social and Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Desalegn Tesfa
- Department of Social and Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Taklo Simeneh Yazie
- Pharmacology and Toxicology Unit, Department of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Mulugeta Molla
- Pharmacology and Toxicology Unit, Department of Pharmacy, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Malede Berihun Yismaw
- Clinical Pharmacy Unit and Research team, Department of Pharmacy, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Wassie M, Beshah DT, Tiruneh YM. Advanced stage presentation and its determinant factors among colorectal cancer patients in Amhara regional state Referral Hospitals, Northwest Ethiopia. PLoS One 2022; 17:e0273692. [PMID: 36206231 PMCID: PMC9543633 DOI: 10.1371/journal.pone.0273692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/14/2022] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Nowadays, the burden of colorectal cancer (CRC) has been increasing in the world, particularly in developing nations. This could be related to the poor prognosis of the disease due to late presentation at diagnosis and poor treatment outcomes. In Ethiopia, studies related to the stage of colorectal cancer at diagnosis and its determinants are limited. Therefore, the study was intended to assess advanced stage presentation and its associated factors among colorectal cancer patients in northwest Ethiopia. METHODS An institution-based retrospective study was conducted among 367 CRC patients at two oncologic centers (the University of Gondar and Felege Hiwot comprehensive specialized hospitals) from January 1, 2017, to December 31, 2020. Data were entered into EPi-data 4.2.0.0 and transferred to STATA version 14 statistical software for analysis. Binary logistic regression was used to identify factors associated with the outcome variable. All variables with P-value < 0.2 during bi-variable analysis were considered for multivariable logistic regression. The level of statistical significance was declared at P-value <0.05. RESULTS The magnitude of advanced stage presentation of colorectal cancer was 83.1%. Being rural dwellers (Adjusted odds ratio (AOR) = 3.6; 95% CI: 1.8,7.2), not medically insured (AOR = 3.9; 95% CI: 1.9,7.8), patients delay (AOR = 6.5; 95% CI:3.2, 13.3), recurrence of the disease (AOR = 2.3; 95% CI: 1.1,4.7), and no comorbidity illness (AOR = 4.4; 95% CI: 2.1, 9.1) were predictors of advanced stage presentation of CRC. CONCLUSION The current study revealed that the advanced-stage presentation of colorectal cancer patients was high. It is recommended that the community shall be aware of the signs and symptoms of the disease using different media, giving more emphasis to the rural community, expanding health insurance, and educating patients about the recurrence chance of the disease. Moreover, expansion of colorectal treatment centers and screening of colorectal cancer should be given emphasis.
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Affiliation(s)
- Mulugeta Wassie
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Debrework Tesgera Beshah
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yenework Mulu Tiruneh
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Tiruneh YM, Beshah DT, Wassie M. Incidence of Mortality and Associated Factors Among Colorectal Cancer Patients at Oncology Units of Northwest Ethiopia: A Retrospective Cohort Study. Cancer Manag Res 2022; 14:1445-1455. [PMID: 35444464 PMCID: PMC9013708 DOI: 10.2147/cmar.s349495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/04/2022] [Indexed: 12/09/2022] Open
Abstract
Background Colorectal cancer is one of the commonest types of malignant neoplasm with an estimated 935,000 deaths in 2020 worldwide. In Ethiopia, colorectal cancer is the third most common cancer with an incidence of 8/100,000 person-years. Despite studies related to the burden of colorectal cancer, data of mortality related to colorectal cancer are limited and unknown in the study areas. Therefore, the aim of this study was to assess the incidence of mortality and associated factors among colorectal cancer patients who were followed-up at oncology units of Northwest Amhara hospitals, Ethiopia. Methods and Materials A retrospective cohort study was conducted among 367 study participants from January 1, 2017, to December 31, 2020 at oncology units of Northwest Amhara hospitals. Data were entered into EPi-data 4.2.0.0 and transferred to STATA version 14 statistical software for statistical analysis. The Cox regression model was used to identify factors associated with mortality. All variables with P-value < 0.2 during bi-variable analysis were considered for multivariable Cox regression model and level of statistical significance was declared at P value ≤ 0.05. Results The overall incidence of colorectal cancer mortality was 22.5 per 100 person-years (95% CI: 18.5, 27.38). Being male [AHR =1.60; 95% CI (1.03, 2.48)], having rural residence [AHR=1.68; 95% CI (1.11, 2.55)], carcinoembryonic antigen level ≥5ng/mL [AHR=1.84; 95% CI: (1.02, 3.30)], delay to first health care visit [AHR=1.97; 95% CI (1.19, 3.25)], delay to confirmed diagnosis [AHR=2.45; 95% CI (1.22, 4.90)], and patients who had recurrence after treatment [AHR=1.61;95% CI (1.05, 2.47)] were independently associated with mortality. Conclusion Incidence of colorectal cancer mortality was high. Sex, residency, carcinoembryonic antigen level, time to health care visit, time to confirmed diagnosis, and recurrence significantly increased incidence of mortality. Therefore, creating awareness of colorectal cancer and expanding cancer treatment centers could have paramount importance in reducing the burden of mortality.
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Affiliation(s)
- Yenework Mulu Tiruneh
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondor, Ethiopia
- Correspondence: Yenework Mulu Tiruneh, Tel +251967149363, Email
| | - Debrework Tesgera Beshah
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondor, Ethiopia
| | - Mulugeta Wassie
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondor, Ethiopia
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Wismayer R, Kiwanuka J, Wabinga H, Odida M. Prognostic Factors for Survival of Colorectal Adenocarcinoma Patients in Uganda. Cancer Manag Res 2022; 14:875-893. [PMID: 35250313 PMCID: PMC8896376 DOI: 10.2147/cmar.s354360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/18/2022] [Indexed: 11/24/2022] Open
Abstract
Background In Uganda, similar to other countries in East Africa, the incidence of colorectal cancer (CRC) has been steadily increasing. This increase in incidence is accompanied by a poor prognosis. There is limited knowledge on factors responsible for the poor outcome of patients with CRC in Uganda. Cancer survival analysis is one way of determining some of these prognostic factors. The aim of this study was to determine prognostic factors associated with CRC survival in Ugandan patients. Methods This was a retroprospective cohort study involving patients with linked data in the Kampala cancer registry and medical records from hospitals in Uganda. Participants with a diagnosis of colorectal adenocarcinoma between 1st January 2008 and 31st December 2018 were included. Variables included patients’ demographic data, grade, stage and location of CRC, data on whether a patient was operated on, type of operation, treatment modalities and date of diagnosis. Our outcome variable was time to death after diagnosis. We computed and compared survival using the Log rank test and used Cox proportional hazards regression to determine factors associated with survival. Results A total of 247 patients were included in the study with a mean (SD) age of 53.3 (15.7) years and a female: male ratio of 1.14:1. The proportions of patients surviving at 1, 2 and 3 years were 65.2% (95% CI: 58.8–70.9), 42.0% (95% CI:35.6–48.3) and 33.3% (95% CI:27.3–39.4) respectively. In multivariate analysis, factors associated with increased mortality included clinical stage II (aHR = 2.44, 95% CI: 1.10–5.41, p=0.028), stage III (aHR=2.65, 95% CI: 1.31–5.39, p=0.007) and stage IV (aHR=5.47, 95% CI: 2.40–12.48, p<0.001). Curative surgery alone (aHR=0.63, 95% CI: 0.39–1.01, p=0.057) and curative surgery with chemotherapy (aHR=0.53, 95% CI: 0.32–0.88, p=0.015) were associated with a better survival. Conclusion The survival rate among CRC patients in Uganda is low. Advanced stage CRC accelerates mortality, while surgery alone or in combination with chemotherapy improves survival. Implementation of national screening programmes for early diagnosis of CRC and increasing surgery and oncology infrastructure is recommended to improve the CRC survival rate in the Ugandan population.
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Affiliation(s)
- Richard Wismayer
- Department of Surgery, Masaka Regional Referral Hospital, Masaka, Uganda
- Department of Surgery, Faculty of Health Sciences, Habib Medical School, IUIU University, Kampala, Uganda
- Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
- Correspondence: Richard Wismayer, Email ;
| | - Julius Kiwanuka
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Henry Wabinga
- Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Michael Odida
- Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Pathology, Faculty of Medicine, Gulu University, Gulu, Uganda
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Cheng YW, Li YC. Factors affecting the follow-up time after a positive result in the fecal occult blood test. PLoS One 2021; 16:e0258130. [PMID: 34610043 PMCID: PMC8491872 DOI: 10.1371/journal.pone.0258130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 09/20/2021] [Indexed: 11/18/2022] Open
Abstract
In 2010, Taiwan included the fecal occult blood test (FOBT) under preventive health insurance services. For patients whose test positive, receiving follow-ups is paramount. This study investigated factors affecting the follow-up time of these patients. This retrospective study used data from the colorectal cancer screening archives. The study period was from 2010 to 2013, and the subjects were 50-75-year-old persons who tested positive for FOBT. The t test, one-way ANOVA, and multiple regression were performed to address the differences in the mean tracking period between variables such as the population's demographic characteristics. The mean follow-up time for the 98,482 participants whose screening results were positive exhibited significant differences (p < 0.001) according to medical unit region and classification, age, screening location, family history, examination method, and diagnosis. The model predicting the mean follow-up time predicted a period of 10.079 days longer for those whose hospital was on an offshore island than that of those whose hospital was in the eastern regions. The follow-up time was 1.257 days shorter for people who were inpatients than those who were outpatients and was 8.902 days longer for people who underwent double contrast barium enema plus flexible sigmoidoscopy than those who underwent other examination methods. Patients with a family history of colorectal cancer and those whose examination results indicated cancer had a follow-up time of 2.562 and 2.476 days shorter than those who did not know their family history and those with other results, respectively. Factors affecting the follow-up time of people whose FOBT results were positive consisted of the location and classification of the follow-up institution, age, screening location, family history, examination method, and diagnosis. This provides valuable references for improving the cancer screening program.
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Affiliation(s)
- Yin-Wen Cheng
- Department of Business Management, College of Management, National Sun Yat-Sen University, Kaohsiung, Taiwan, R.O.C
| | - Ying-Chun Li
- Institute of Health Care Management, National Sun Yat-Sen University, Kaohsiung, Taiwan, R.O.C
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Teka MA, Yesuf A, Hussien FM, Hassen HY. Histological characteristics, survival pattern and prognostic determinants among colorectal cancer patients in Ethiopia: A retrospective cohort study. Heliyon 2021; 7:e06366. [PMID: 33718651 PMCID: PMC7920880 DOI: 10.1016/j.heliyon.2021.e06366] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 12/21/2020] [Accepted: 02/22/2021] [Indexed: 02/07/2023] Open
Abstract
Background The incidence of colorectal cancer (CRC) and associated mortality are rising in low- and middle-income countries. In Ethiopia, colorectal cancer is among the leading causes of cancer morbidity and mortality in both sexes. Although some studies provided estimations on the national burden and regional distribution, the histological characteristics, survival pattern and determinants among colorectal cancer patients are not well-documented. Aim This study aimed to describe the histological characteristics, to determine the patterns of survival, and identify factors that determine mortality rate among CRC patients in Ethiopia. Methods A retrospective cohort study was conducted among CRC patients registered at cancer treatment center of Tikur Anbessa Specialized Hospital, from January 2012 to December 2016. Data were extracted from a total of 161 patient medical records using a pretested abstraction form and supplemented by phone calls with the patients/caregivers. To determine colorectal cancer specific survival overtime, we performed a Kaplan-Meier survival analysis and significance of variation in survival across covariates and treatment categories was tested using log-rank test. A multivariable Cox proportional-hazards model was performed to identify determinants of survival after diagnosis with colorectal cancer. Results Overall, the median survival time was 21 months [95%CI: 16-35], with two-, three- and five-year CRC-specific survival rates of 46.8%, 39.5% and 28.7% respectively. In the multivariable Cox regression model, the rate of death due to CRC is significantly higher for patients with elevated baseline carcinoembryonic antigen (CEA) level (Adjusted Hazard Ratio (AHR) = 2.31, 95%CI: 1.27-4.19), stage IV at diagnosis (AHR = 2.66, 95%CI: 1.44-4.91), and mucinous or signet-ring cell carcinoma histology type (AHR = 4.92, 95%CI: 1.75-13.80). Moreover, patients who underwent surgery showed a better survival than those who did not (AHR = 0.35, 95%CI: 0.14-0.88). Conclusion In Ethiopia, patients diagnosed with CRC showed a low rate of cancer-specific survival. Histology type, stage of cancer and CEA level at diagnosis, and the type of treatment a patient received significantly determine mortality rate. Hence, cancer screening programs could help to detect the disease at an earlier stage and to initiate available treatments timely so as to extend the lifespan of CRC patients.
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Affiliation(s)
- Mohammed Ahmed Teka
- Ethiopian Field Epidemiology Training Program, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Aman Yesuf
- Department of Public Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Foziya Mohammed Hussien
- Department of Public Health Nutrition, School of Public Health, College of Medicine and Health Science, Wollo University, Ethiopia
| | - Hamid Yimam Hassen
- Department of Public Health, Faculty of Medicine and Health Sciences, Mizan Tepi University, Mizan Teferi, Ethiopia
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