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Hämmerl L, Mezger NCS, Seraphin TP, Joko-Fru WY, Griesel M, Feuchtner J, Gnahatin F, Gnangnon FHR, Okerosi N, Amulen PM, Hansen R, Borok MZ, Carrilho C, Mallé B, Ahoui Apendi C, Buziba NG, Seife E, Liu B, Mikolajczyk R, Parkin DM, Kantelhardt EJ, Jemal A. Treatment and Survival Among Patients With Colorectal Cancer in Sub-Saharan Africa: A Multicentric Population-Based Follow-Up Study. J Natl Compr Canc Netw 2023; 21:924-933.e7. [PMID: 37673109 DOI: 10.6004/jnccn.2023.7041] [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: 02/27/2023] [Accepted: 05/31/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND The burden of colorectal cancer (CRC) is increasing in Sub-Saharan Africa (SSA). However, little is known about CRC treatment and survival in the region. METHODS A random sample of 653 patients with CRC diagnosed from 2011 to 2015 was obtained from 11 population-based cancer registries in SSA. Information on clinical characteristics, treatment, and/or vital status was obtained from medical records in treating hospitals for 356 (54%) of the patients ("traced cohort"). Concordance of CRC treatment with NCCN Harmonized Guidelines for SSA was assessed. A Cox proportional hazards model was used to examine the association between survival and human development index (HDI). RESULTS Of the 356 traced patients with CRC, 51.7% were male, 52.8% were from countries with a low HDI, 55.1% had colon cancer, and 73.6% were diagnosed with nonmetastatic (M0) disease. Among the patients with M0 disease, however, only 3.1% received guideline-concordant treatment, 20.6% received treatment with minor deviations, 31.7% received treatment with major deviations, and 35.1% received no treatment. The risk of death in patients who received no cancer-directed therapy was 3.49 (95% CI, 1.83-6.66) times higher than in patients who received standard treatment or treatment with minor deviations. Similarly, the risk of death in patients from countries with a low HDI was 1.67 (95% CI, 1.07-2.62) times higher than in those from countries with a medium HDI. Overall survival at 1 and 3 years was 70.9% (95% CI, 65.5%-76.3%) and 45.3% (95% CI, 38.9%-51.7%), respectively. CONCLUSIONS Fewer than 1 in 20 patients diagnosed with potentially curable CRC received standard of care in SSA, reinforcing the need to improve healthcare infrastructure, including the oncology and surgical workforce.
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Affiliation(s)
- Lucia Hämmerl
- Global Working Group, Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle an der Saale, Germany
| | - Nikolaus C S Mezger
- Global Working Group, Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle an der Saale, Germany
| | - Tobias P Seraphin
- Global Working Group, Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle an der Saale, Germany
| | - Walburga Yvonne Joko-Fru
- African Cancer Registry Network, International Network for Cancer Treatment and Research, African Registry Programme, Oxford, United Kingdom
- Clinical Trials Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Mirko Griesel
- Global Working Group, Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle an der Saale, Germany
| | - Jana Feuchtner
- Global Working Group, Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle an der Saale, Germany
| | - Franck Gnahatin
- Registre des Cancers d'Abidjan, Programme National de Lutte contre le Cancer, Abidjan, Côte d'Ivoire
| | | | - Nathan Okerosi
- National Cancer Registry, Kenya Medical Research Institute, Nairobi, Kenya
| | - Phoebe Mary Amulen
- Kampala Cancer Registry, Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rolf Hansen
- Namibia National Cancer Registry, Cancer Association of Namibia, Windhoek, Namibia
| | | | - Carla Carrilho
- Maputo City Cancer Registry, Maputo City, Mozambique
- Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo Central Hospital, Maputo, Mozambique
| | | | | | - Nathan G Buziba
- Eldoret Cancer Registry, Moi Teaching Hospital, Eldoret, Kenya
- Moi University School of Medicine, Eldoret, Kenya
| | - Edom Seife
- Addis Ababa City Cancer Registry, Radiotherapy Center, Addis-Ababa-University, Addis Ababa, Ethiopia
| | - Biying Liu
- African Cancer Registry Network, International Network for Cancer Treatment and Research, African Registry Programme, Oxford, United Kingdom
| | - Rafael Mikolajczyk
- Global Working Group, Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle an der Saale, Germany
| | - Donald M Parkin
- Clinical Trials Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- International Agency for Research on Cancer, Lyon, France
| | - Eva J Kantelhardt
- Global Working Group, Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle an der Saale, Germany
- Department of Gynaecology, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle an der Saale, Germany
| | - Ahmedin Jemal
- Department of Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
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Boni SP, Gnahatin F, Comoé JC, Tchounga B, Ekouevi D, Horo A, Adoubi I, Jaquet A. Barriers and facilitators in cervical cancer screening uptake in Abidjan, Côte d'Ivoire in 2018: a cross-sectional study. BMC Cancer 2021; 21:952. [PMID: 34433459 PMCID: PMC8390229 DOI: 10.1186/s12885-021-08650-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 07/29/2021] [Indexed: 12/24/2022] Open
Abstract
Backgrounds Cervical cancer (CC) incidence remains unacceptably high in Côte d’Ivoire. In an effort to prevent this malignant condition, a national CC screening program has been scaled up in the country. This study aimed at assessing CC screening uptake and its associated factors in Abidjan in 2018. Methods A cross-sectional survey was conducted from July to September 2018 in the main healthcare facilities of three randomly selected out of the eight health districts of Abidjan. During the study period, a standardized questionnaire was administrated by research assistants to all women aged 25 to 55 years old, attending the three participating facilities. Demographics, knowledge on CC, personal history of CC screening and reasons for not attending CC screening were collected. A logistic regression model was computed to document factors associated with reported CC screening uptake. Results A total of 1158 women with a median age of 32 years (IQR [27–36]), including 364 (31.4%) with no formal education were included. Of those participants, 786 (67.9%) had ever heard about CC. CC screening uptake at least once was reported by 7.5% [95% CI: 6.0–9.0] participants. In multivariable analysis, being ≥45 years (aOR: 6.2 [2.3–17.2]), having a university level (aOR: 2.8 [1.2–6.6]) (versus non formal education) and access to mass campaign information (aOR: 18.2 [8.5–39.1]) were associated with a reported CC screening uptake. The main reported barriers to CC screening were unawareness towards CC screening (75.5%), negligence (20.5%), fear of CC detection (3.9%) and fear of additional costs (3.3%). Conclusion CC screening uptake remains low despite current initiatives to support awareness and prevention in Abidjan. Awareness campaigns need to be massively increased with the adjunction of tailored messages based on the level of women’s education to enhance the CC screening coverage and reach the WHO goal of CC elimination by 2030.
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Affiliation(s)
- Simon P Boni
- Programme National de Lutte contre le Cancer (PNLCa), Abidjan, Côte d'Ivoire. .,Programme PAC-CI, Site ANRS Treichville, Abidjan, Côte d'Ivoire.
| | - Franck Gnahatin
- Programme National de Lutte contre le Cancer (PNLCa), Abidjan, Côte d'Ivoire
| | - Jean-Claude Comoé
- Jhpiego, a John Hopkins University affiliate, oncology department, Abidjan, Côte d'Ivoire
| | - Boris Tchounga
- Elizabeth Glaser Paediatric AIDS Foundation, Yaoundé, Cameroon
| | - Didier Ekouevi
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), UMR, 1219, Bordeaux, France.,Département de Santé Publique, Université de Lomé, Lomé, Togo
| | - Apollinaire Horo
- Département mère-enfant, Université Félix Houphouët Boigny, Abidjan, Côte d'Ivoire.,Service de Gynéco-Obstétrique, Centre Hospitalier Universitaire de Yopougon, Abidjan, Côte d'Ivoire
| | - Innocent Adoubi
- Programme National de Lutte contre le Cancer (PNLCa), Abidjan, Côte d'Ivoire.,Service de cancérologie, Centre Hospitalier Universitaire de Treichville, Abidjan, Côte d'Ivoire.,Département Cancérologie-Immunologie-Hématologie, Université Félix Houphouët Boigny, Abidjan, Côte d'Ivoire
| | - Antoine Jaquet
- University of Bordeaux, Inserm, French National Research Institute for Sustainable Development (IRD), UMR, 1219, Bordeaux, France
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Parkin DM, Youlden DR, Chitsike I, Chokunonga E, Couitchéré L, Gnahatin F, Nambooze S, Wabinga H, Aitken JF. Stage at diagnosis and survival by stage for the leading childhood cancers in three populations of sub-Saharan Africa. Int J Cancer 2021; 148:2685-2691. [PMID: 33433927 DOI: 10.1002/ijc.33468] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 09/21/2020] [Revised: 11/14/2020] [Accepted: 12/03/2020] [Indexed: 01/22/2023]
Abstract
The lack of accurate population-based information on childhood cancer stage and survival in low-income countries is a barrier to improving childhood cancer outcomes. In our study, data from three population-based registries in sub-Saharan Africa (Abidjan, Harare and Kampala) were examined for children aged under 15. We assessed the feasibility of assigning stage at diagnosis according to Tier 1 of the Toronto Childhood Cancer Stage Guidelines for patients with non-Hodgkin lymphoma [including Burkitt lymphoma (BL)], retinoblastoma and Wilms' tumour. Patients were actively followed-up, allowing calculation of 3-year relative survival by cancer type and registry. Stage-specific observed survival was estimated. The cohort comprised 381 children, of whom half (n = 192, 50%) died from any cause within 3 years of diagnosis. Three-year relative survival varied by malignancy and location and ranged from 17% [95% confidence interval (CI) = 6%-33%] for BL in Harare to 57% (95% CI = 31%-76%) for retinoblastoma in Kampala. Stage was assigned for 83% of patients (n = 317 of 381), with over half having metastatic or advanced disease at diagnosis (n = 166, 52%). Stage was a strong predictor of survival for each malignancy; for example, 3-year observed survival was 88% (95% CI = 68%-96%) and 13% (4%-29%) for localised and advanced BL, respectively (P < .001). These are the first data on stage distribution and stage-specific survival for childhood cancers in Africa. They demonstrate the feasibility of the Toronto Stage Guidelines in a low-resource setting and highlight the value of population-based cancer registries in aiding our understanding of the poor outcomes experienced by this population.
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Affiliation(s)
- Donald Maxwell Parkin
- Cancer Surveillance Unit, International Agency for Research on Cancer, Lyon, France
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- African Cancer Registry Network, INCTR, Oxford, UK
| | - Danny R Youlden
- Cancer Council Queensland, Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Inam Chitsike
- Paediatric Heme-Oncology Unit, University of Zimbabwe, Harare, Zimbabwe
| | | | - Line Couitchéré
- Pediatric Unit, Teaching Hospital of Treichville, Félix Houphouët Boigny Université, Abidjan, Côte d'Ivoire
| | - Franck Gnahatin
- Registre du Cancer d'Abidjan (RCA), Programme National de Lutte contre le Cancer (PNLCa), Ministère de la Santé et de l'Hygiène Publique (MSHP), Abidjan, Côte d'Ivoire
| | - Sarah Nambooze
- Kampala Cancer Registry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Henry Wabinga
- Department of Pathology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joanne F Aitken
- Cancer Council Queensland, Brisbane, Queensland, Australia
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
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