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Kaimila B, Yano Y, Mulima G, Chen Y, Kajombo C, Salima A, Khan S, Gopal S, Dawsey SM, Abnet CC. Poor oral health and the risk of esophageal squamous cell carcinoma in Malawi. Int J Cancer 2024; 154:1587-1595. [PMID: 38194606 DOI: 10.1002/ijc.34829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/25/2023] [Accepted: 11/15/2023] [Indexed: 01/11/2024]
Abstract
Esophageal squamous cell carcinoma (ESCC) is the second most common cancer in Malawi. Risk factors for this cancer in Malawi are poorly understood. Poor oral health has previously been linked to increased ESCC risk in other high-incidence regions, including parts of Eastern and Southern Africa. We assessed the relationship between oral health and ESCC risk in a sex, age and location frequency-matched case-control study based at two hospitals in Lilongwe, Malawi from 2017 to 2020. Trained interviewers used a structured questionnaire and direct observation to collect data on demographics; behaviors; oral hygiene habits; the sum of decayed, missing or filled teeth (DMFT score); oral mucosa status; lip depigmentation and dental fluorosis via a visual scale. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CI), adjusted for known and suspected ESCC risk factors. During the study period, 300 cases and 300 controls were enrolled. Subjects in the highest tertile of DMFT score (≥7) had an increased risk of ESCC with an adjusted OR of 1.96 (95% CI: 1.16-3.36) compared to those with a DMFT score of 0. Severe dental fluorosis was associated with a statistically nonsignificant increased risk of ESCC (adjusted OR = 2.24, 95% CI: 0.97-5.49) compared to individuals with no fluorosis. Associations with oral mucosa status, lip depigmentation and toothbrushing method and frequency were mostly null or uncertain. Poor oral health, indicated by a higher DMFT score, was associated with increased ESCC risk in Malawi. Dental fluorosis is another possible risk factor in this population, but further evaluation is necessary to clarify any effects of fluorosis on ESCC risk.
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Affiliation(s)
- Bongani Kaimila
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Yukiko Yano
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | | | - Yingxi Chen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | | | - Ande Salima
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Shiraz Khan
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | - Satish Gopal
- Center for Global Health, National Cancer Institute, Rockville, Maryland, USA
| | - Sanford M Dawsey
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
| | - Christian C Abnet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
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Kaimila B, Chen Y, Mulima G, Kajombo C, Salima A, Yano Y, Gopal S, Dawsey SM, Abnet CC. Survival After Diagnosis of Esophageal Squamous Cell Carcinoma in Malawi. JCO Glob Oncol 2023; 9:e2300173. [PMID: 37944090 PMCID: PMC10645405 DOI: 10.1200/go.23.00173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 08/07/2023] [Accepted: 09/11/2023] [Indexed: 11/12/2023] Open
Abstract
PURPOSE Esophageal cancer (EC) is the second most common cancer in Malawi, with esophageal squamous cell carcinoma (ESCC) representing >90% of all ECs. Despite significant morbidity and mortality, little is known about disease outcomes. In this study, we assess survival after ESCC diagnosis in Malawi. METHODS We report on ESCC cases enrolled in a case-control study at Kamuzu Central Hospital in Lilongwe from August 2017 to April 2020. Suspected cases completed a questionnaire interview; provided blood, urine, and saliva specimens; and underwent a tumor biopsy for histologic confirmation. Cases were followed up by phone biweekly from enrollment to the study end date (December 31, 2020), date of death, or loss to follow-up. Survival was assessed using Kaplan-Meier analysis with the log-rank test. We also examined associations between treatment and ESCC mortality using Cox regression models. RESULTS There were 300 patients with ESCC enrolled in this study, of whom 290 (97%) had known vital status at the end of follow-up and 10 (3%) were lost to follow-up. Among the 290 patients, 282 (97%) died during follow-up. The median age at enrollment was 55 years (IQR, 48-66), and the median time to death was 106 days (95% CI, 92 to 127). The 1-year, 2-year, and 3-year survival rates were 11% (95% CI, 8 to 15), 3% (95% CI, 1 to 6), and 0.9% (95% CI, 0.8 to 4), respectively. Palliative chemotherapy significantly improved the overall survival of patients with ESCC (Plog-rank = .038) and was significantly associated with reduced mortality (adjusted hazard ratio, 0.71 [95% CI, 0.51 to 0.99]). No significant association was observed between tobacco use, alcohol consumption, or HIV status and mortality. CONCLUSION Survival after diagnosis of ESCC was poor in Malawi. Although palliative chemotherapy was associated with improved survival, prevention and earlier detection remain key priorities to improve ESCC mortality at a population level.
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Affiliation(s)
| | - Yingxi Chen
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
| | | | | | | | - Yukiko Yano
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Satish Gopal
- Center for Global Health, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Sanford M. Dawsey
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Christian C. Abnet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD
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Tilly AE, Evans A, Chen JS, Manda A, Salima A, Bingo S, Chikasema M, Westmoreland KD. Kusankha Pamodzi: Health Care Decision-Making Preferences Among Patients with Cancer in Malawi. Palliat Med Rep 2023; 4:127-132. [PMID: 37138948 PMCID: PMC10150710 DOI: 10.1089/pmr.2023.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 05/05/2023] Open
Abstract
Background Oncology teams are encouraged to include patient preferences and goals of care in determining appropriate treatment courses. There are no existing data from Malawi exploring decision-making preferences among cancer patients. Methods In the oncology clinic in Lilongwe, Malawi, 50 patients were surveyed for decision making. Results Most participants (70%, n = 35) preferred to engage in shared decision making regarding cancer treatment. About half (52%, n = 24) did not feel that their medical team involved them in decision making and 64% (n = 32) felt that they were never or only sometimes listened to by the medical team. Nearly all (94%, n = 47) preferred to have their medical team inform them how likely treatments are to lead to cure. Conclusions Shared decision making was the preferred mode of treatment decision making by the majority of the surveyed cancer patients in Malawi. Cancer patients in Malawi may have similar preferences to cancer patients in other low-resource settings regarding decision making and communication.
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Affiliation(s)
- Alyssa E. Tilly
- UNC Project-Malawi, Lilongwe, Malawi
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Address correspondence to: Alyssa E. Tilly, MD, UNC Project-Malawi, Lilongwe A-104, Malawi,
| | - April Evans
- UNC Project-Malawi, Lilongwe, Malawi
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jane S. Chen
- UNC Project-Malawi, Lilongwe, Malawi
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | | | | | | | - Katherine D. Westmoreland
- UNC Project-Malawi, Lilongwe, Malawi
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Gondwe Y, Salima A, Manda A, Ozuah N, Mapurisa G, Brandt K, Gopal S, Tomoka T, Fedoriw Y, Westmoreland KD. Spatial distribution of incident pediatric Burkitt lymphoma in central and northern Malawi and association with malaria prevalence. Pediatr Blood Cancer 2022; 69:e29867. [PMID: 35731580 PMCID: PMC10846644 DOI: 10.1002/pbc.29867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/27/2022] [Accepted: 06/09/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Burkitt lymphoma (BL) accounts for 90% of pediatric lymphomas in sub-Saharan Africa. Plasmodium falciparum malaria is considered an etiological factor of BL. We describe the geographic distribution of pediatric BL in Malawi and association with P. falciparum malaria prevalence rate (PfPR). METHODS We enrolled 220 pathologically confirmed incident pediatric BL cases (2013-2018) into an observational clinical cohort at Kamuzu Central Hospital (KCH) in Lilongwe district. KCH is the main tertiary cancer referral center serving the central and northern regions of Malawi. Using an ecological study design, we calculated district-level annual BL incidence rate using census population estimates. District-level PfPR was extracted from the National Malaria Control Program 2010 report. BL incidence and PfPR maps were constructed in QGIS. Moran's I test was used to identify BL spatial clusters. Pearson's correlation and multiple linear regression analyses were used to statistically examine the relationship between PfPR and BL. RESULTS BL incidence was higher in central region districts (8.2 cases per million) than northern districts (2.9 cases per million) and was elevated in lakeshore districts. Districts with elevated PfPR tended to have elevated BL incidence. A low-risk BL cluster was detected in the north. Statistically, BL incidence was positively correlated with PfPR (r = .77, p < .01). A 1% increase in PfPR predicted an increase in BL incidence of 0.2 cases per million (p = .03), when controlling for travel time from referral district hospital to KCH. CONCLUSION Our study supports evidence for an association between P. falciparum and BL and highlights a need to improve geographic accessibility to tertiary cancer services in Malawi's northern region.
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Affiliation(s)
- Yolanda Gondwe
- University of North Carolina Project-Malawi, University of North Carolina, Lilongwe, Malawi
| | - Ande Salima
- University of North Carolina Project-Malawi, University of North Carolina, Lilongwe, Malawi
| | - Agness Manda
- University of North Carolina Project-Malawi, University of North Carolina, Lilongwe, Malawi
| | | | - Gugulethu Mapurisa
- University of North Carolina Project-Malawi, University of North Carolina, Lilongwe, Malawi
| | - Katerina Brandt
- Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Satish Gopal
- National Cancer Institute Center for Global Health, Bethesda, Maryland, USA
| | - Tamiwe Tomoka
- University of North Carolina Project-Malawi, University of North Carolina, Lilongwe, Malawi
| | - Yuri Fedoriw
- University of North Carolina Project-Malawi, University of North Carolina, Lilongwe, Malawi
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Katherine D Westmoreland
- University of North Carolina Project-Malawi, University of North Carolina, Lilongwe, Malawi
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
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Kaimila B, Mulima G, Kajombo C, Salima A, Nietschke P, Pritchett N, Chen Y, Murphy G, Dawsey SM, Gopal S, Phiri KS, Abnet CC. Tobacco and other risk factors for esophageal squamous cell carcinoma in Lilongwe Malawi: Results from the Lilongwe esophageal cancer case: Control study. PLOS Glob Public Health 2022; 2:e0000135. [PMID: 36962303 PMCID: PMC10021825 DOI: 10.1371/journal.pgph.0000135] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 05/11/2022] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Esophageal cancer is the second commonest cancer in Malawi, and 95% of all cases are esophageal squamous cell carcinoma (ESCC). Very little is known about the epidemiology of ESCC in Malawi including risk factors. The main objective of the study was to evaluate and describe risk factors of ESCC in Malawi. METHODS We conducted a case-control study from 2017 to 2020 at two hospitals in Lilongwe, Malawi and consenting adults were eligible for inclusion. Endoscopy was conducted on all cases and biopsies were obtained for histological confirmation. Controls were selected from patients or their guardians in orthopedic, dental and ophthalmology wards and they were frequency matched by sex, age, and region of origin to cases. An electronic structured questionnaire was delivered by a trained interviewer. Multivariate conditional logistic regression models were used to assess the associations between subject characteristics, habits, and medical history and risk of ESCC. RESULTS During the study period, 300 cases and 300 controls were enrolled into the study. Median age of cases and controls was 56 years and 62% of the cases were male. Among cases, 30% were ever cigarette smokers as were 22% of controls. Smoking cigarettes had an adjusted odds ratio of 2.4 (95% CI 1.4-4.2 p = 0.003). HIV+ status was present in 11% of cases and 4% controls, which resulted in an adjusted odds ratio was 4.0 (95% CI 1.8-9.0 p = 0.001). Drinking hot tea was associated with an adjusted odd ratio of 2.9 (95% CI 1.3-6.3 p = 0.007). Mold on stored grain has an adjusted odd ratio of 1.6 (95% CI 1.1-2.5 p = 0.021). CONCLUSION Reducing smoking cigarettes, consumption of scalding hot tea, and consumption of contaminated grain, could potentially help reduce the burden of ESCC in Malawi. Further investigation of the association between HIV status and ESCC are warranted.
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Affiliation(s)
- Bongani Kaimila
- UNC Project, Department of Cancer Research, Lilongwe, Malawi
| | - Gift Mulima
- Kamuzu Central Hospital, Department of Surgery, Lilongwe, Malawi
| | - Chifundo Kajombo
- Kamuzu Central Hospital, Department of Surgery, Lilongwe, Malawi
| | - Ande Salima
- UNC Project, Department of Cancer Research, Lilongwe, Malawi
| | - Peter Nietschke
- St. Gabriel Hospital, Department of Medicine, Lilongwe, Malawi
| | - Natalie Pritchett
- National Cancer Institute, Department of Cancer Epidemiology and Genetics, Metabolic Epidemiology Branch, Rockville, Maryland, United States of America
| | - Yingxi Chen
- National Cancer Institute, Department of Cancer Epidemiology and Genetics, Metabolic Epidemiology Branch, Rockville, Maryland, United States of America
| | - Gwen Murphy
- National Cancer Institute, Department of Cancer Epidemiology and Genetics, Metabolic Epidemiology Branch, Rockville, Maryland, United States of America
| | - Sanford M. Dawsey
- National Cancer Institute, Department of Cancer Epidemiology and Genetics, Metabolic Epidemiology Branch, Rockville, Maryland, United States of America
| | - Satish Gopal
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Kamija S. Phiri
- Kamuzu University of Health Sciences, School of Public Health, Blantyre, Malawi
| | - Christian C. Abnet
- National Cancer Institute, Department of Cancer Epidemiology and Genetics, Metabolic Epidemiology Branch, Rockville, Maryland, United States of America
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Tilly AE, Ellis GK, Chen JS, Manda A, Salima A, Mtangwanika A, Tewete B, Kaimila B, Kasonkanji E, Kayira E, Chikasema M, Nyirenda R, Bingo S, Chiyoyola S, Seguin R, Gopal S, Zuze T, Tomoka T, Westmoreland KD. Implementation and Evaluation of Educational Videos to Improve Cancer Knowledge and Patient Empowerment. JCO Glob Oncol 2022; 8:e2100315. [PMID: 35175832 PMCID: PMC8863121 DOI: 10.1200/go.21.00315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/15/2021] [Accepted: 01/12/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Low health literacy is a leading cause of treatment abandonment among patients receiving cancer care at Kamuzu Central Hospital (KCH) in Malawi. METHODS We developed cancer educational videos featuring Malawian providers and played them in the KCH oncology clinic. The videos addressed cancer-related topics, including disease biology, common myths, diagnostic procedures, treatment, side effects, and survivorship. After 6 months of implementation, we compared results from 50 pre- and postintervention surveys to assess change in cancer knowledge and care experience. RESULTS Both pre- and postintervention cancer knowledge were good: a median of nine questions were answered correctly of 11 in both assessments. Despite the intervention, most continued to incorrectly identify cancer as an infection (pre: n = 26, 52%; post: n = 25, 50%; P = 1.0), although improvements were observed in patients' knowledge of correct actions for fever at home (pre: n = 38, 76%; post: n = 43, 86%; P = .31). Care experiences were overall good. Postintervention results indicate that more patients felt always listened to by their providers (pre: n = 18, 36%; post: n = 29, 58%; P < .01). However, we also noted a higher rate of patient dissatisfaction of care as more patients felt that they could not understand chemotherapy counseling (pre: n = 11, 22%; post: n = 22, 44%; P < .01). Assessments of video satisfaction indicate that patients found the videos very helpful in terms of understanding their disease (n = 47, 96%) and side effects (n = 48, 98%) and felt empowered to speak up with their providers (n = 46, 96%). CONCLUSION Standardized education materials for patients that can be feasibly implemented throughout sub-Saharan Africa are urgently needed. Cancer educational videos are a low-cost way to educate and empower patients with cancer in resource-constrained settings although in-person discussions remain a crucial part of care.
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Affiliation(s)
- Alyssa E. Tilly
- UNC Project-Malawi, Lilongwe, Malawi
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Jane S. Chen
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | | | | | | | | | | | | | | | | | | | | | - Satish Gopal
- UNC Project-Malawi, Lilongwe, Malawi
- University of North Carolina at Chapel Hill, Chapel Hill, NC
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Buckle GC, Mrema A, Mwachiro M, Ringo Y, Selekwa M, Mulima G, Some FF, Mmbaga BT, Mody GN, Zhang L, Paciorek A, Akoko L, Ayuo P, Burgert S, Bukusi E, Charles A, Chepkemoi W, Chesumbai G, Kaimila B, Kenseko A, Kibwana KS, Koech D, Macharia C, Moirana EN, Mushi BP, Mremi A, Mwaiselage J, Mwanga A, Ndumbalo J, Nvakunga G, Ngoma M, Oduor M, Oloo M, Opakas J, Parker R, Seno S, Salima A, Servent F, Wandera A, Westmoreland KD, White RE, Williams B, Mmbaga EJ, Van Loon K. Treatment outcomes of esophageal cancer in Eastern Africa: protocol of a multi-center, prospective, observational, open cohort study. BMC Cancer 2022; 22:82. [PMID: 35045815 PMCID: PMC8772224 DOI: 10.1186/s12885-021-09124-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 12/18/2021] [Indexed: 11/19/2022] Open
Abstract
Background Esophageal squamous cell carcinoma (ESCC) is a major cause of cancer morbidity and mortality in Eastern Africa. The majority of patients with ESCC in Eastern Africa present with advanced disease at the time of diagnosis. Several palliative interventions for ESCC are currently in use within the region, including chemotherapy, radiation therapy with and without chemotherapy, and esophageal stenting with self-expandable metallic stents; however, the comparative effectiveness of these interventions in a low resource setting has yet to be examined. Methods This prospective, observational, multi-center, open cohort study aims to describe the therapeutic landscape of ESCC in Eastern Africa and investigate the outcomes of different treatment strategies within the region. The 4.5-year study will recruit at a total of six sites in Kenya, Malawi and Tanzania (Ocean Road Cancer Institute and Muhimbili National Hospital in Dar es Salaam, Tanzania; Kilimanjaro Christian Medical Center in Moshi, Tanzania; Tenwek Hospital in Bomet, Kenya; Moi Teaching and Referral Hospital in Eldoret, Kenya; and Kamuzu Central Hospital in Lilongwe, Malawi). Treatment outcomes that will be evaluated include overall survival, quality of life (QOL) and safety. All patients (≥18 years old) who present to participating sites with a histopathologically-confirmed or presumptive clinical diagnosis of ESCC based on endoscopy or barium swallow will be recruited to participate. Key clinical and treatment-related data including standardized QOL metrics will be collected at study enrollment, 1 month following treatment, 3 months following treatment, and thereafter at 3-month intervals until death. Vital status and QOL data will be collected through mobile phone outreach. Discussion This study will be the first study to prospectively compare ESCC treatment strategies in Eastern Africa, and the first to investigate QOL benefits associated with different treatments in sub-Saharan Africa. Findings from this study will help define optimal management strategies for ESCC in Eastern Africa and other resource-limited settings and will serve as a benchmark for future research. Trial registration This study was retrospectively registered with the ClinicalTrials.gov database on December 15, 2021, NCT05177393. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-09124-5.
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Affiliation(s)
- Geoffrey C Buckle
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 505 Parnassus Ave, M1296, San Francsico, CA, 94143, USA.
| | - Alita Mrema
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | | | - Yona Ringo
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Msiba Selekwa
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Fatma F Some
- Moi University School of Medicine, Eldoret, Kenya
| | - Blandina T Mmbaga
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania.,Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Gita N Mody
- University of North Carolina, Chapel Hill, USA
| | - Li Zhang
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 505 Parnassus Ave, M1296, San Francsico, CA, 94143, USA
| | - Alan Paciorek
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 505 Parnassus Ave, M1296, San Francsico, CA, 94143, USA
| | - Larry Akoko
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Paul Ayuo
- Moi University School of Medicine, Eldoret, Kenya
| | | | | | | | | | | | | | - Aida Kenseko
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | - David Koech
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | | | | | - Alex Mremi
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | - Ally Mwanga
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | | | - Gissela Nvakunga
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Mamsau Ngoma
- Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | | | - Mark Oloo
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Jesse Opakas
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Robert Parker
- Tenwek Hospital, Bomet, Kenya.,Warren Alpert School of Medicine at Brown University, Providence, RI, USA
| | - Saruni Seno
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | - Furaha Servent
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | - Kate D Westmoreland
- University of North Carolina, Chapel Hill, USA.,UNC-Project Malawi, Lilongwe, Malawi
| | - Russell E White
- Tenwek Hospital, Bomet, Kenya.,Warren Alpert School of Medicine at Brown University, Providence, RI, USA
| | | | - Elia J Mmbaga
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Katherine Van Loon
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 505 Parnassus Ave, M1296, San Francsico, CA, 94143, USA
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Ellis GK, Chapman H, Manda A, Salima A, Itimu S, Banda G, Seguin R, Manda G, Butia M, Huibers M, Ozuah N, Tilly A, Stover AM, Basch E, Gopal S, Reeve BB, Westmoreland KD. Pediatric lymphoma patients in Malawi present with poor health-related quality of life at diagnosis and improve throughout treatment and follow-up across all Pediatric PROMIS-25 domains. Pediatr Blood Cancer 2021; 68:e29257. [PMID: 34339099 PMCID: PMC8497011 DOI: 10.1002/pbc.29257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 06/11/2021] [Accepted: 07/13/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patient-reportedoutcomes (PROs) that assess health-related quality of life (HRQoL) are increasingly important components of cancer care and research that are infrequently used in sub-Saharan Africa (SSA). METHODS We administered the Chichewa Pediatric Patient-Reported Outcome Measurement Information System Pediatric (PROMIS)-25 at diagnosis, active treatment, and follow-up among pediatric lymphoma patients in Lilongwe, Malawi. Mean scores were calculated for the six PROMIS-25 HRQoL domains (Mobility, Anxiety, Depressive Symptoms, Fatigue, Peer Relationships, Pain Interference). Differences in HRQoL throughout treatment were compared using the minimally important difference (MID) and an ANOVA analysis. Kaplan-Meier survival estimates and Cox hazard ratios for mortality are reported. RESULTS Seventy-five children completed PROMIS-25 surveys at diagnosis, 35 (47%) during active treatment, and 24 (32%) at follow-up. The majority of patients died (n = 37, 49%) or were lost to follow-up (n = 6, 8%). Most (n = 51, 68%) were male, median age was 10 (interquartile range [IQR] 8-12), 48/73 (66%) presented with advanced stage III/IV, 61 (81%) were diagnosed with Burkitt lymphoma and 14 (19%) Hodgkin lymphoma. At diagnosis, HRQoL was poor across all domains, except for Peer Relationships. Improvements in HRQoL during active treatment and follow-up exceeded the MID. On exploratory analysis, fair-poor PROMIS Mobility <40 and severe Pain Intensity = 10 at diagnosis were associated with increased mortality risk and worse survival, but were not statistically significant. CONCLUSIONS Pediatric lymphoma patients in Malawi present with poor HRQoL that improves throughout treatment and survivorship. Baseline PROMIS scores may provide important prognostic information. PROs offer an opportunity to include patient voices and prioritize holistic patient-centered care in low-resource settings.
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Affiliation(s)
| | | | | | | | - Salama Itimu
- UNC Project-Malawi,Texas Children’s Cancer and Hematology Centers, Global Hematology-Oncology Pediatric Excellence (HOPE) Program
| | | | | | - Geoffrey Manda
- Texas Children’s Cancer and Hematology Centers, Global Hematology-Oncology Pediatric Excellence (HOPE) Program
| | - Mercy Butia
- Texas Children’s Cancer and Hematology Centers, Global Hematology-Oncology Pediatric Excellence (HOPE) Program
| | - Minke Huibers
- Texas Children’s Cancer and Hematology Centers, Global Hematology-Oncology Pediatric Excellence (HOPE) Program,Baylor College of Medicine
| | - Nmazuo Ozuah
- Texas Children’s Cancer and Hematology Centers, Global Hematology-Oncology Pediatric Excellence (HOPE) Program,Baylor College of Medicine
| | | | | | | | - Satish Gopal
- UNC Project-Malawi,University of North Carolina at Chapel Hill
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Ellis GK, Manda A, Topazian H, Stanley CC, Seguin R, Minnick CE, Tewete B, Mtangwanika A, Chawinga M, Chiyoyola S, Chikasema M, Salima A, Kimani S, Kasonkanji E, Mithi V, Kaimila B, Painschab MS, Gopal S, Westmoreland KD. Feasibility of upfront mobile money transfers for transportation reimbursement to promote retention among patients receiving lymphoma treatment in Malawi. Int Health 2021; 13:297-304. [PMID: 33037426 PMCID: PMC8079308 DOI: 10.1093/inthealth/ihaa075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/22/2020] [Accepted: 09/28/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Cancer outcomes in sub-Saharan Africa (SSA) remain suboptimal, in part due to poor patient retention. Many patients travel long distances to receive care, and transportation costs are often prohibitively expensive. These are well-known and established causes of delayed treatment and care abandonment in Malawi and across SSA. METHODS We sent visit reminder texts and offered upfront money to cover transportation costs through a mobile money transfer (MMT) platform to lymphoma patients enrolled in a prospective cohort in Malawi. The primary aim was to test the feasibility of upfront MMTs. RESULTS We sent 1034 visit reminder texts to 189 participating patients. Of these texts, 614 (59%) were successfully delivered, with 536 (52%) responses. 320/536 (60%) MMTs were sent to interested patients and 312/320 (98%) came to their appointment on time. Of 189 total patients, 120 (63%) were reached via text and 84 (44%) received MMTs a median of three times (IQR 2-5). Median age of reachable patients was 41 (IQR 30-50), 75 (63%) were male, 62 (52%) were HIV+ and 79 (66%) resided outside of Lilongwe. CONCLUSION MMTs were a feasible way to cover upfront transportation costs for patients reachable via text, however many of our patients were unreachable. Future studies exploring barriers to care, particularly among unreachable patients, may help improve the efficacy of MMT initiatives and guide retention strategies throughout SSA.
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Affiliation(s)
| | | | - Hillary Topazian
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | | | | | | | | | | | | | - Stephen Kimani
- UNC Project-Malawi, Lilongwe, Malawi
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | - Matthew S Painschab
- UNC Project-Malawi, Lilongwe, Malawi
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Satish Gopal
- National Cancer Institute, Center for Global Health, Rockville, MD, USA
| | - Katherine D Westmoreland
- UNC Project-Malawi, Lilongwe, Malawi
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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10
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Horner MJ, Salima A, Chilima C, Mukatipa M, Kumwenda W, Kampani C, Chimzimu F, Mukunda B, Tomoka T, Mulenga M, Nyasosela R, Chasimpha S, Dzamalala C, Gopal S. Frequent HIV and Young Age Among Individuals With Diverse Cancers at a National Teaching Hospital in Malawi. J Glob Oncol 2019; 4:1-11. [PMID: 30085887 PMCID: PMC6223526 DOI: 10.1200/jgo.17.00174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose Cancer surveillance provides a critical evidence base to guide cancer control efforts, yet population-based coverage in Africa is sparse. Hospital-based registries may help fill this need by providing local epidemiologic data to guide policy and forecast local health care needs. We report the epidemiology of patients with cancer recorded by a de novo hospital-based cancer registry at Kamuzu Central Hospital, Malawi, the sole provider of comprehensive oncology services for half the country and location of a high-volume pathology laboratory. Methods We conducted active case finding across all hospital departments and the pathology laboratory from June 2014 to March 2016. Patient demographics, tumor characteristics, treatment, and HIV status were collected. We describe epidemiology of the cancer caseload, registry design, and costs associated with registry operations. Results Among 1,446 registered patients, Kaposi sarcoma and cervical cancer were the most common cancers among men and women, respectively. Burkitt lymphoma was most common cancer among children. The current rate of pathology confirmation is 65%, a vast improvement in the diagnostic capacity for cancer through the hospital’s pathology laboratory. Among leading cancer types, an alarming proportion occurred at young ages; 50% of Kaposi sarcoma and 25% of esophageal, breast, and cervical cancers were diagnosed among those younger than 40 years of age. A systematic, cross-sectional assessment of HIV status reveals a prevalence of 58% among adults and 18% among children. Conclusion We report a high caseload among typically young patients and a significant burden of HIV infection among patients with cancer. In low- and middle-income countries with intermittent, sparse, or nonexistent cancer surveillance, hospital-based cancer registries can provide important local epidemiologic data while efforts to expand population-based registration continue.
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Affiliation(s)
- Marie-Josèphe Horner
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Ande Salima
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Chrissie Chilima
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Matthews Mukatipa
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Wiza Kumwenda
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Coxcilly Kampani
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Fred Chimzimu
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Bal Mukunda
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Tamiwe Tomoka
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Maurice Mulenga
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Richard Nyasosela
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Steady Chasimpha
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Charles Dzamalala
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
| | - Satish Gopal
- Marie-Josèphe Horner and Satish Gopal, University of North Carolina at Chapel Hill, Chapel Hill, NC; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, Coxcilly Kampani, Fred Chimzimu, Bal Mukunda, Tamiwe Tomoka, Maurice Mulenga, Richard Nyasosela, and Satish Gopal, University of North Carolina Project-Malawi; Marie-Josèphe Horner, Ande Salima, Chrissie Chilima, Matthews Mukatipa, Wiza Kumwenda, and Satish Gopal, Kamuzu Central Hospital Cancer Registry; Satish Gopal, Malawi Cancer Consortium & Regional Center of Research Excellence for Non-Communicable Diseases, Lilongwe; Steady Chasimpha and Charles Dzamalala, Malawi Cancer Registry; and Charles Dzamalala and Satish Gopal, University of Malawi College of Medicine, Blantyre, Malawi
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11
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Ellis GK, Reeve BB, Itimu S, Salima A, Banda G, Manda A, Manthalu O, Seguin R, Gopal S, Westmoreland KD. Experiences of pediatric lymphoma patients undergoing treatment in Malawi across all PROMIS-25 domains. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.27_suppl.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
203 Background: Health-related quality of life (HRQoL) is an important outcome in cancer care and research, but such data from sub-Saharan Africa are scant. We translated and validated the Pediatric Patient-Reported Outcome Measurement Information System (PROMIS)-25 questionnaire for use in Malawi. Methods: We administered the Pediatric PROMIS-25 at baseline, mid-treatment, treatment completion, and follow-up to pediatric lymphoma patients receiving care in Lilongwe. Domain scores were transformed into PROMIS T-scores. Differences in follow-up and baseline values were calculated and compared to published minimally important difference (MID) estimates of 3 points. Results: Eighty-one questionnaires were completed at diagnosis, 41 at mid-treatment, 24 at treatment completion, and 25 at follow-up [Table]. At baseline, 57 (70%) were male, median age was 11 (IQR 9-13), and 50 (62%) reported Pain Intensity ≥8. Mobility, Anxiety, Depressive Symptoms, and Pain Interference improved during treatment, but seemed to worsen at treatment completion. At follow-up, substantial improvements in HRQoL were reported [Table]. Conclusions: Despite poor HRQoL at baseline, improvements in all measured domains exceeded accepted MID thresholds. This suggests treatment led to meaningful improvements in HRQoL, but high mortality in data may reflect a survivor effect. Incorporating serial HRQoL assessments in emerging cancer programs in sub-Saharan Africa should be a regional priority. HRQoL T-scores during care, median (IQR). Lower Mobility and Peer Relationship scores reflect worse functioning; higher symptom scores reflect worse symptom burden. [Table: see text]
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12
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Westmoreland K, Reeve BB, Amuquandoh A, van der Gronde T, Manthalu O, Correia H, Stanley C, Itimu S, Salima A, Chikasema M, Ward P, Mpasa A, Wachepa S, Mtete I, Butia M, Chasela M, Mtunda M, Wasswa P, Martin S, Kim NEM, Kazembe P, Gopal S. Translation, psychometric validation, and baseline results of the Patient-Reported Outcomes Measurement Information System (PROMIS) pediatric measures to assess health-related quality of life of patients with pediatric lymphoma in Malawi. Pediatr Blood Cancer 2018; 65:e27353. [PMID: 30015407 DOI: 10.1002/pbc.27353] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/21/2018] [Accepted: 06/12/2018] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Internationally validated tools to measure patient-reported health-related quality of life (HRQoL) are available, but efforts to translate and culturally validate such tools in sub-Saharan Africa (SSA) are scarce, particularly among children. METHODS The Patient-Reported Outcomes Measurement Information System 25-item pediatric short form (PROMIS-25) assesses six HRQoL domains-mobility, anxiety, depression, fatigue, peer relationships, and pain interference-by asking four questions per domain. There is a single-item pain intensity item. The PROMIS-25 was translated into Chichewa and validated for use in Malawi using mixed qualitative and quantitative methods. The validity and reliability of the PROMIS-25 was assessed. RESULTS Fifty-four pediatric patients with lymphoma completed the PROMIS-25. Structural validity was supported by interitem correlations and principal component analysis. Reliability of each scale was satisfactory (range alpha = 0.71-0.93). Known group validity testing showed that anemic children had worse fatigue (P = 0.016) and children with poor performance status had worse mobility (P < 0.001) and pain interference (P = 0.005). Compared to children with cancer in the United States, children from Malawi reported lower levels of mobility, higher anxiety, higher depressive symptoms, higher fatigue, better satisfaction with peer relationships, and higher pain interference. CONCLUSION Translation and cultural validation of the PROMIS-25 into Chichewa for Malawi was successful. Baseline HRQoL for patients with pediatric lymphoma in Malawi is poor for all domains except peer relationships. This emphasizes an urgent need to address HRQoL among children undergoing cancer treatment in SSA using self-reported instruments validated within the local context.
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Affiliation(s)
- Katherine Westmoreland
- Cancer Program, UNC Project-Malawi, Lilongwe, Malawi.,Department of Pediatrics, Pediatric Hematology-Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Bryce B Reeve
- Department of Population Health Science, Duke University School of Medicine, Durham, North Carolina
| | | | | | | | - Helena Correia
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Salama Itimu
- Cancer Program, UNC Project-Malawi, Lilongwe, Malawi
| | - Ande Salima
- Cancer Program, UNC Project-Malawi, Lilongwe, Malawi
| | | | - Paula Ward
- Cancer Program, UNC Project-Malawi, Lilongwe, Malawi
| | - Atupele Mpasa
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Stella Wachepa
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Idah Mtete
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Mercy Butia
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Mary Chasela
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Mary Mtunda
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Peter Wasswa
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.,Department of Pediatrics, Pediatric Hematology-Oncology, Texas Children's Hospital, Houston, Texas
| | - Steven Martin
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi.,Department of Pediatrics, Pediatric Hematology-Oncology, Texas Children's Hospital, Houston, Texas
| | - Nader El-Mallawany Kim
- Department of Pediatrics, Pediatric Hematology-Oncology, Texas Children's Hospital, Houston, Texas
| | - Peter Kazembe
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Satish Gopal
- Cancer Program, UNC Project-Malawi, Lilongwe, Malawi.,Department of Medicine, Divisions of Hematology-Oncology & Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina.,Department of Medicine, University of Malawi, Blantyre, Malawi
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13
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Stanley CC, Westmoreland KD, Itimu S, Salima A, van der Gronde T, Wasswa P, Mtete I, Butia M, El-Mallawany NK, Gopal S. Quantifying bias in survival estimates resulting from loss to follow-up among children with lymphoma in Malawi. Pediatr Blood Cancer 2017; 64:10.1002/pbc.26370. [PMID: 27896944 PMCID: PMC5520975 DOI: 10.1002/pbc.26370] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 10/08/2016] [Accepted: 10/31/2016] [Indexed: 12/20/2022]
Abstract
Pediatric lymphoma is common in sub-Saharan Africa, where survival estimates are often based on limited follow-up with incomplete retention, introducing potential for bias. We compared follow-up and overall survival (OS) between passive and active tracing within a prospective cohort of children with lymphoma in Malawi. Median follow-up times were 4.4 months (interquartile range [IQR] 2.0-9.4) and 10.8 months (IQR 6.2-20.6) in passive and active follow-up, respectively. Twelve-month overall survival (OS) was 69% (95% confidence interval [CI] 54-80) in passive and 44% (95% CI 34-54) in active follow-up. Passive follow-up significantly overestimated the OS and underestimated the mortality. Efforts to improve retention in regional studies are needed.
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Affiliation(s)
| | - Kate D. Westmoreland
- UNC Project—Malawi, Lilongwe, Malawi,University of North Carolina, Chapel Hill, North Carolina
| | | | | | | | - Peter Wasswa
- Texas Children’s Hospital, Houston, Texas,Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
| | - Idah Mtete
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
| | - Mercy Butia
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
| | | | - Satish Gopal
- UNC Project—Malawi, Lilongwe, Malawi,University of North Carolina, Chapel Hill, North Carolina,University of Malawi College of Medicine, Blantyre, Malawi
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14
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Xu B, Basuli F, Wu H, Salima A, Opina A, Lane K, Griffiths GL, Jagoda E, Green M, Seidel J, Choyke P. Abstract LB-420: Long circulating 18F-labeled liposomes for PET imaging. Cancer Res 2012. [DOI: 10.1158/1538-7445.am2012-lb-420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Liposomes are lipid nanoparticles comprised of phospholipid bilayers with an aqueous interior. They have emerged as promising multi-modality imaging agents and engender significant interest as drug delivery vehicles, e.g. doxorubicin liposomes. Although a number of methods for radiolabeling liposomes with various radionuclides have been developed, 18F is the most useful for PET imaging. In this study, preformed maleimide-PEG functionalized liposomes with a mean diameter of 70 nm were obtained by sonication of a lipid mixture consisting of DPPC, cholesterol, and DSPE-PEG2000-Mal (61:30:9) in acetate buffer (pH 6.5) followed by extrusion. 18F labeled 2-(2-(2-(2-fluoroethoxy)ethoxy)ethoxy)ethanethiol was prepared, followed by conjugation with the maleimide-PEG functionalized liposome in 0.1M acetate buffer (0.1% EDTA), pH 6.5-8.0. Liposome sizes did not differ significantly before and after the 18F labeling. The overall radiochemical yield of the reaction was 10-25% (n= 12, uncorrected) in a 180 minute radiolabeling time. Micro PET imaging of rats was done at various times, up to 4 hrs, following IV injection of the 18F liposomes and their bio-distribution was also investigated. Our imaging studies with 18F liposomes appear comparable to images from previously described labeling methods with 18F liposomes remaining in the blood pool at 4 hrs. Our results indicate that this will allow the ready availability of 18F liposomes for vascular imaging and also potentially for cancer imaging. Research Support: This study was funded by the intramural program of the National Institutes of Health.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr LB-420. doi:1538-7445.AM2012-LB-420
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Affiliation(s)
- Biying Xu
- 1National Institutes of Health, Rockville, MD
| | - F Basuli
- 1National Institutes of Health, Rockville, MD
| | - H Wu
- 1National Institutes of Health, Rockville, MD
| | - A. Salima
- 1National Institutes of Health, Rockville, MD
| | - A Opina
- 1National Institutes of Health, Rockville, MD
| | - K Lane
- 1National Institutes of Health, Rockville, MD
| | | | - E. Jagoda
- 2National Institutes of Health, Bethesda, MD
| | - M Green
- 2National Institutes of Health, Bethesda, MD
| | - J. Seidel
- 2National Institutes of Health, Bethesda, MD
| | - P. Choyke
- 2National Institutes of Health, Bethesda, MD
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