1
|
Anakwenze CP, Allanson E, Ewongwo A, Lumley C, Bazzett-Matabele L, Msadabwe SC, Kamfwa P, Shouman T, Lombe D, Rubagumya F, Polo A, Ntekim A, Vanderpuye V, Ghebre R, Kochbati L, Awol M, Gnangnon FHR, Snyman L, Fokom Domgue J, Incrocci L, Ndlovu N, Razakanaivo M, Abdel-Wahab M, Trimble E, Schmeler K, Simonds H, Grover S. Mapping of Radiation Oncology and Gynecologic Oncology Services Available to Treat the Growing Burden of Cervical Cancer in Africa. Int J Radiat Oncol Biol Phys 2024; 118:595-604. [PMID: 37979709 DOI: 10.1016/j.ijrobp.2023.10.036] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 09/09/2023] [Accepted: 10/22/2023] [Indexed: 11/20/2023]
Abstract
PURPOSE To meet the demand for cervical cancer care in Africa, access to surgical and radiation therapy services needs to be understood. We thus mapped the availability of gynecologic and radiation therapy equipment and staffing for treating cervical cancer. METHODS AND MATERIALS We collected data on gynecologic and radiation oncology staffing, equipment, and infrastructure capacities across Africa. Data was obtained from February to July 2021 through collaboration with international partners using Research Electronic Data Capture. Cancer incidence was taken from the International Agency for Research on Cancer's GLOBOCAN 2020 database. Treatment capacity, including the numbers of radiation oncologists, radiation therapists, physicists, gynecologic oncologists, and hospitals performing gynecologic surgeries, was calculated per 1000 cervical cancer cases. Adequate capacity was defined as 2 radiation oncologists and 2 gynecologic oncologists per 1000 cervical cancer cases. RESULTS Forty-three of 54 African countries (79.6%) responded, and data were not reported for 11 countries (20.4%). Respondents from 31 countries (57.4%) reported access to specialist gynecologic oncology services, but staffing was adequate in only 11 countries (20.4%). Six countries (11%) reported that generalist obstetrician-gynecologists perform radical hysterectomies. Radiation oncologist access was available in 39 countries (72.2%), but staffing was adequate in only 16 countries (29.6%). Six countries (11%) had adequate staffing for both gynecologic and radiation oncology; 7 countries (13%) had no radiation or gynecologic oncologists. Access to external beam radiation therapy was available in 31 countries (57.4%), and access to brachytherapy was available in 25 countries (46.3%). The number of countries with training programs in gynecologic oncology, radiation oncology, medical physics, and radiation therapy were 14 (26%), 16 (30%), 11 (20%), and 17 (31%), respectively. CONCLUSIONS We identified areas needing comprehensive cervical cancer care infrastructure, human resources, and training programs. There are major gaps in access to radiation oncologists and trained gynecologic oncologists in Africa.
Collapse
Affiliation(s)
- Chidinma P Anakwenze
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Emma Allanson
- Division of Obstetrics & Gynecology, King Edward Memorial Hospital for Women, Subiaco, Australia, and Institute for Health Research, University of Notre Dame, Fremantle, Australia
| | | | - Christian Lumley
- Office of Global Health, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lisa Bazzett-Matabele
- Department of Obstetrics & Gynecology, University of Botswana, Gaborone, Botswana, and Department of Obstetrics & Gynecology, Yale University School of Medicine, New Haven, Connecticut
| | | | - Paul Kamfwa
- Gynecologic Oncology Unit, Cancer Diseases Hospital, Lusaka, Zambia
| | | | - Dorothy Lombe
- Cancer Screening, Treatment and Support Cluster, Health New Zealand, Palmerston North, New Zealand
| | - Fidel Rubagumya
- Rwanda Military Hospital, Kigali, Rwanda, and Division of Cancer Care and Epidemiology and Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - Alfredo Polo
- Applied Radiation Biology and Radiotherapy Section, Division of Human Health, Department of Nuclear Sciences & Applications, International Atomic Energy Agency, Vienna, Austria
| | - Atara Ntekim
- Department of Radiation Oncology, University of Ibadan, Ibadan, Nigeria
| | - Verna Vanderpuye
- National Center for Radiotherapy, Oncology, and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | - Rahel Ghebre
- Department of Obstetrics, Gynecology, and Women's Health and Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Lofti Kochbati
- Department of Radiotherapy, Abderrahmen Mami Hospital, Tunis, Tunisia
| | - Munir Awol
- Department of Oncology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Freddy Houéhanou Rodrigue Gnangnon
- Department of Visceral Surgery, National Teaching Hospital of Cotonou, Cotonou, Benin, Department of Epidemiology of Chronic Diseases in the Tropical Zone, Institute of Epidemiology and Tropical Neurology, Limoges, France, and Laboratory of Epidemiology of Chronic and Neurological Diseases, University of Abomey-Calavi, Cotonou, Benin
| | - Leon Snyman
- Department Obstetrics & Gynaecology, University of Pretoria, Pretoria, South Africa
| | - Joël Fokom Domgue
- Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, Texas, and Faculty of Medicine and Biomedical Sciences, Department of Obstetrics and Gynecology, University of Yaoundé, Yaoundé, Cameroon
| | - Luca Incrocci
- Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Ntokozo Ndlovu
- Department of Oncology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe, and Department of Radiotherapy and Oncology, Parirenyatwa Hospital, Harare, Zimbabwe
| | - Malala Razakanaivo
- Department of Radiotherapy, Joseph Ravoahangy Andrianavalona University Hospital, Antananarivo, Madagascar
| | - May Abdel-Wahab
- Division of Human Health, Department of Nuclear Sciences & Applications, International Atomic Energy Agency, Vienna, Austria
| | | | - Kathleen Schmeler
- Department of Gynecologic Oncology & Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hannah Simonds
- Department of Radiation Oncology, Stellenbosch University, Cape Town, South Africa, and Department of Oncology, University Hospitals Plymouth Trust, Plymouth, United Kingdom
| | - Surbhi Grover
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, and Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Dare AJ, Bayle A, Hatoqai A, Mungo C, Velilla DG, Soto-Perez-de-Celis E, Gnangnon FHR, Lim MSH, Ralefala T, Mushininga VD. Ensuring Global Access to Cancer Medicines: A Generational Call to Action. Cancer Discov 2023; 13:269-274. [PMID: 36734325 DOI: 10.1158/2159-8290.cd-22-1372] [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: 12/07/2022] [Accepted: 12/09/2022] [Indexed: 02/04/2023]
Abstract
SUMMARY Essential cancer treatments are not accessible, affordable, or available to patients who need them in many parts of the world. A new Access to Oncology Medicines (ATOM) Coalition, using public-private partnerships, aims to bring essential cancer medicines and diagnostics to patients in low- and lower middle-income countries.
Collapse
Affiliation(s)
- Anna J Dare
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Arnauld Bayle
- Oncostat U1018, Inserm, Paris-Saclay University, Gustave Roussy, Villejuif, France
| | - Asma Hatoqai
- Cancer Control Office, King Hussein Cancer Center, Amman, Jordan
| | - Chemtai Mungo
- Department of Obstetrics and Gynecology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Diego Gimenez Velilla
- Departamento de Oncología Radiante, Instituto Nacional del Cáncer (INCAN), Capiatá, Paraguay
| | | | | | - Melissa Siaw Han Lim
- Department of Paraclinical Sciences, Faculty of Medicine and Health Sciences, University Malaysia Sarawak (UNIMAS), Sarawak, Malaysia
| | - Tlotlo Ralefala
- Princess Marina Hospital, Ministry of Health and Wellness, Gaborone, Botswana
| | | |
Collapse
|
4
|
Gbessi DG, Gnangnon FHR, Kpossou AR, Gbetchedji PP, Seidou F, Imorou Souaïbou Y, Attolou SGR, Lawani I, Laleye MC, Gangbo F, Dossou FM, Sehonou J, Mehinto DK. Challenge of gastro-intestinal stromal tumor management in low-income countries: example of Benin. World J Surg Oncol 2022; 20:247. [PMID: 36451201 PMCID: PMC9714201 DOI: 10.1186/s12957-022-02709-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 05/30/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND GISTs are rare tumors but the most frequent mesenchymal tumors of the digestive tract. Diagnosis and treatment are challenging in low-income countries due to relatively poor access to immunohistochemistry and targeted therapy. In Africa, there are few studies about it. Imatinib, an oral targeted therapy, has been available in Benin since 2010 and free since 2016. This study describes the diagnosis and therapeutic management of GIST in Cotonou, Benin. METHODS This is a descriptive cross-sectional study, with retrospective data collection over a 10-year period from 2010 to 2020, focused on patients with histological confirmed gastro-intestinal stromal tumor (GIST). Cases were identified using the registry database and the archival files of the Hubert Koutoukou Maga National University Hospital of Cotonou (CNHU-HKM). RESULTS Fifteen GISTs were identified during the study period. The median age was 52 and the sex ratio was 2:1 (10 males and 5 females). The most frequent symptom was abdominal pain (n = 12). Delay in care seeking after onset of symptoms ranged from 24 h to 15 years. The most common site for GISTs was the stomach (n = 8). The median tumor size was 11 cm and the majority (n=10) was metastatic or locally advanced at the time of diagnosis. The tumors were often spindle-shaped at histology (n = 13) and the majority expressed KIT (n = 14). Most of the tumors (n = 12) were at high risk of recurrence according to the Joensuu scoring system. The availability of imatinib has improved the outcome of GIST with response in all cases it was used in neoadjuvant setting (n = 7). CONCLUSION GISTs are rare tumors and preferentially affect the stomach in Cotonou). Most of the tumors were large, unresectable at the time of diagnosis and at high risk of recurrence. Access to imatinib has revolutionized the management of those tumors in our country.
Collapse
Affiliation(s)
- Dansou Gaspard Gbessi
- grid.420217.2Department of Visceral Surgery, National University Hospital Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Republic of Benin
| | | | - Aboudou Raïmi Kpossou
- grid.420217.2Department of Hepato-Gastroenterology, National University Hospital Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Republic of Benin
| | - Pacifique Prudent Gbetchedji
- grid.420217.2Department of Visceral Surgery, National University Hospital Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Republic of Benin
| | - Falilatou Seidou
- Department of Pathology, Faculty of Health Sciences/ Abomey-Calavi University (FSS/UAC), Cotonou, Republic of Benin
| | - Yacoubou Imorou Souaïbou
- grid.420217.2Department of Visceral Surgery, National University Hospital Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Republic of Benin
| | - Setondji Gilles Roger Attolou
- grid.420217.2Department of Visceral Surgery, National University Hospital Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Republic of Benin
| | - Ismaïl Lawani
- Department of General Surgery, Departmental University Hospital Oueme-Plateau (CHDU-OP), Porto-Novo, Republic of Benin
| | - Marie-Christel Laleye
- grid.420217.2Department of Visceral Surgery, National University Hospital Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Republic of Benin
| | - Flore Gangbo
- Department of Pathology, Faculty of Health Sciences/ Abomey-Calavi University (FSS/UAC), Cotonou, Republic of Benin
| | - Francis Moïse Dossou
- Department of General Surgery, Departmental University Hospital Oueme-Plateau (CHDU-OP), Porto-Novo, Republic of Benin
| | - Jean Sehonou
- grid.420217.2Department of Hepato-Gastroenterology, National University Hospital Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Republic of Benin
| | - Delphin Kuassi Mehinto
- grid.420217.2Department of Visceral Surgery, National University Hospital Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Republic of Benin
| |
Collapse
|
5
|
Gnangnon FHR, Lawani I, Natta N'tcha HN, Haag EK, Dossou FM, Mehinto DK. A giant metastatic low-grade endometrial sarcoma requiring surgical management. Int J Surg Case Rep 2022; 94:107163. [PMID: 35658315 PMCID: PMC9092967 DOI: 10.1016/j.ijscr.2022.107163] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/01/2022] [Accepted: 05/01/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction and importance Low-grade endometrial stromal sarcomas are relatively rare tumors. We here report a case of a woman presenting with a giant metastatic low-grade endometrial stromal sarcoma with thromboembolic complications requiring urgent surgical management. Case presentation A 58-year-old obese female was admitted, with a voluminous abdominopelvic mass, due to complications related to its size and extent. The tumor derived from the uterus and invaded the ureters, bladder and rectum. It compressed the right iliac vessels causing both deep vein thrombosis and pulmonary embolism. She developed a painful irreducible umbilical. We proceeded with a debulking surgery (hysterectomy with bilateral salpingo-oophorectomy). Histological findings were consistent with a low-grade endometrial stromal sarcoma. Clinical discussion Low-grade endometrial stromal sarcomas are generally low-grade malignant neoplasms with an indolent clinical course. Surgery is the cornerstone of treatment. In low-income countries, malignancies are more often diagnosed at a late stage, which limits therapeutic options. Cytoreduction is recommended in advanced tumors with extrauterine manifestation, depending on symptoms and with palliative intent. Conclusion Low-grade endometrial stromal sarcomas are indolent uterine malignancies with metastatic potential. Even in advanced cases, cytoreduction must be considered. Endometrial stromal sarcomas (ESS) are relatively rare tumors. They are classified into three categories: low-grade, high-grade, and undifferentiated. Staging is the most important prognostic factor. Cytoreduction surgery is recommended even in advanced tumors. Late presentation of cancers is commonplace in most low-income countries.
Collapse
Affiliation(s)
| | - Ismaïl Lawani
- Department of General Surgery, Departmental University Hospital Oueme-Plateau, Porto-Novo, Benin
| | - Habib Ndome Natta N'tcha
- Department of Visceral Surgery, National University Hospital Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Benin
| | - Edwin Kelly Haag
- Department of Visceral Surgery, National University Hospital Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Benin
| | - Francis Moïse Dossou
- Department of General Surgery, Departmental University Hospital Oueme-Plateau, Porto-Novo, Benin
| | - Delphin Kuassi Mehinto
- Department of Visceral Surgery, National University Hospital Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Benin
| |
Collapse
|
6
|
Joko-Fru WY, Griesel M, Mezger NCS, Hämmerl L, Seraphin TP, Feuchtner J, Wabinga H, N'da G, Mathewos A, Kamaté B, Nsonde Malanda J, Gnangnon FHR, Chesumbai GC, Korir A, Lorenzoni C, Zietsman A, Borok MZ, Liu B, Thomssen C, McGale P, Jemal A, Parkin DM, Kantelhardt EJ. Breast Cancer Diagnostics, Therapy, and Outcomes in Sub-Saharan Africa: A Population-Based Registry Study. J Natl Compr Canc Netw 2021; 20:jnccn20412. [PMID: 34965508 DOI: 10.6004/jnccn.2021.7011] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 01/20/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Breast cancer (BC) is the most common cancer in sub-Saharan Africa (SSA). However, little is known about the actual therapy received by women with BC and their survival outcome at the population level in SSA. This study aims to describe the cancer-directed therapy received by patients with BC at the population level in SSA, compare these results with the NCCN Harmonized Guidelines for SSA (NCCN Harmonized Guidelines), and evaluate the impact on survival. METHODS Random samples of patients with BC (≥40 patients per registry), diagnosed from 2009 through 2015, were drawn from 11 urban population-based cancer registries from 10 countries (Benin, Congo, Cote d'Ivoire, Ethiopia, Kenya, Mali, Mozambique, Namibia, Uganda, and Zimbabwe). Active methods were used to update the therapy and outcome data of diagnosed patients ("traced patients"). Excess hazards of death by therapy use were modeled in a relative survival context. RESULTS A total of 809 patients were included. Additional information was traced for 517 patients (63.8%), and this proportion varied by registry. One in 5 traced patients met the minimum diagnostic criteria (cancer stage and hormone receptor status known) for use of the NCCN Harmonized Guidelines. The hormone receptor status was unknown for 72.5% of patients. Of the traced patients with stage I-III BC (n=320), 50.9% received inadequate or no cancer-directed therapy. Access to therapy differed by registry area. Initiation of adequate therapy and early-stage diagnosis were the most important determinants of survival. CONCLUSIONS Downstaging BC and improving access to diagnostics and care are necessary steps to increase guideline adherence and improve survival for women in SSA. It will also be important to strengthen health systems and facilities for data management in SSA to facilitate patient follow-up and disease surveillance.
Collapse
Affiliation(s)
- Walburga Yvonne Joko-Fru
- 1Nuffield Department of Population Health, University of Oxford
- 2The African Cancer Registry Network, INCTR African Registry Programme, Oxford, United Kingdom
| | - Mirko Griesel
- 3Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Nikolaus Christian Simon Mezger
- 3Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Lucia Hämmerl
- 3Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Tobias Paul Seraphin
- 3Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Jana Feuchtner
- 3Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Henry Wabinga
- 4Kampala Cancer Registry, Makerere University School of Medicine, Kampala, Uganda
| | - Guy N'da
- 5Registre des cancers d'Abidjan, Abidjan, Côte d'Ivoire
| | - Assefa Mathewos
- 6Radiotherapy Center, Addis-Ababa-University, Addis Ababa, Ethiopia
| | | | | | | | | | - Anne Korir
- 11Nairobi Cancer Registry, Nairobi, Kenya
| | - Cesaltina Lorenzoni
- 12Maputo City Cancer Registry, Maputo City, Mozambique
- 13Department of Pathology, Faculty of Medicine, Eduardo Mondlane University, Maputo Central Hospital, Maputo, Mozambique
| | | | | | - Biying Liu
- 2The African Cancer Registry Network, INCTR African Registry Programme, Oxford, United Kingdom
| | - Christoph Thomssen
- 16Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Paul McGale
- 1Nuffield Department of Population Health, University of Oxford
| | - Ahmedin Jemal
- 17Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Donald Maxwell Parkin
- 1Nuffield Department of Population Health, University of Oxford
- 2The African Cancer Registry Network, INCTR African Registry Programme, Oxford, United Kingdom
- 18International Agency for Research in Cancer, Lyon, France
| | - Eva Johanna Kantelhardt
- 3Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
- 16Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| |
Collapse
|
7
|
Gbessi DG, Gnangnon FHR, Souaïbou YI, Haag KE, Lawani I, Mehinto DK. Sister Mary Joseph's nodule revealing a jejunal adenocarcinoma: A case report. Int J Surg Case Rep 2021; 89:106620. [PMID: 34861547 PMCID: PMC8640445 DOI: 10.1016/j.ijscr.2021.106620] [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: 10/15/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Adenocarcinoma of the jejunum is a diagnostic challenge for the physician because of its extreme rareness and the fact that it classically presents with vague clinical symptoms. On the other hand, the Sister Mary Joseph's nodule is a rare clinical sign that refers to umbilical metastasis of an internal malignancy. We here report a rare case of jejunal adenocarcinoma revealed by a Sister Mary Joseph's nodule. CASE PRESENTATION A 55-year-old man presented with an ulcerated umbilical tumor, which was found to be a secondary lesion of an advanced jejunal adenocarcinoma invading the transverse colon. He underwent surgical resection of the umbilical tumor and the intestinal primitive. CLINICAL DISCUSSION The presence of umbilical metastasis usually represents advanced disease but can be its first manifestation. Gastro-intestinal tract tumors such as jejunal adenocarcinomas and gynecologic malignancies are the most common primary sites. CONCLUSION Practicians must be aware of clinical implication of Sister Mary Joseph nodule. Aggressive surgery when feasible can be beneficial for survival.
Collapse
Affiliation(s)
- Dansou Gaspard Gbessi
- Department of Visceral Surgery, National University Hospital Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Benin
| | | | - Yacoubou Imorou Souaïbou
- Department of Visceral Surgery, National University Hospital Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Benin
| | - Kelly Edwin Haag
- Department of Visceral Surgery, National University Hospital Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Benin
| | - Ismaïl Lawani
- Department of General Surgery, Departmental University Hospital Oueme-Plateau, Porto-Novo, Benin
| | - Delphin Kuassi Mehinto
- Department of Visceral Surgery, National University Hospital Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Benin
| |
Collapse
|
8
|
Gullickson C, Goodman M, Joko-Fru YW, Gnangnon FHR, N'Da G, Woldegeorgis MA, Buziba NG, Karugu C, Manraj SS, Lorenzoni CF, Hansen R, Finesse A, Somdyala NIM, Bukirwa P, Chingonzoh T, Chokunonga E, Liu B, Kantelhardt E, Parkin DM, Jemal A. Colorectal cancer survival in sub-Saharan Africa by age, stage at diagnosis and Human Development Index: A population-based registry study. Int J Cancer 2021; 149:1553-1563. [PMID: 34164808 DOI: 10.1002/ijc.33715] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 04/28/2021] [Revised: 06/06/2021] [Accepted: 06/08/2021] [Indexed: 02/05/2023]
Abstract
There are limited population-based survival data for colorectal cancer (CRC) in sub-Saharan Africa. Here, 1707 persons diagnosed with CRC from 2005 to 2015 were randomly selected from 13 population-based cancer registries operating in 11 countries in sub-Saharan Africa. Vital status was ascertained from medical charts or through next of kin. 1-, 3- and 5-year overall and relative survival rates for all registries and for each registry were calculated using the Kaplan-Meier estimator. Multivariable analysis was used to examine the associations of 5-year relative survival with age at diagnosis, stage and country-level Human Development Index (HDI). Observed survival for 1448 patients with CRC across all registries combined was 72.0% (95% CI 69.5-74.4%) at 1 year, 50.4% (95% CI 47.6-53.2%) at 3 years and 43.5% (95% CI 40.6-46.3%) at 5 years. We estimate that relative survival at 5 years in these registry populations is 48.2%. Factors associated with poorer survival included living in a country with lower HDI, late stage at diagnosis and younger or older age at diagnosis (<50 or ≥70 years). For example, the risk of death was 1.6 (95% CI 1.2-2.1) times higher for patients residing in medium-HDI and 2.7 (95% CI 2.2-3.4) times higher for patients residing in low-HDI compared to those residing in high-HDI countries. Survival for CRC remains low in sub-Saharan African countries, though estimates vary considerably by HDI. Strengthening health systems to ensure access to prevention, early diagnosis and appropriate treatment is critical in improving outcomes of CRC in the region.
Collapse
Affiliation(s)
- Cricket Gullickson
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael Goodman
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Yvonne W Joko-Fru
- The African Cancer Registry Network, INCTR African Registry Programme, Oxford, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Guy N'Da
- Abidjan Cancer Registry, Abidjan, Côte d'Ivoire
| | | | | | | | - Shyam S Manraj
- Mauritius National Cancer Registry, Port Louis, Mauritius
| | | | | | - Anne Finesse
- Seychelles National Cancer Registry, Victoria, Seychelles
| | | | | | | | | | - Biying Liu
- The African Cancer Registry Network, INCTR African Registry Programme, Oxford, UK
| | - Eva Kantelhardt
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle, Germany
- Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Donald M Parkin
- The African Cancer Registry Network, INCTR African Registry Programme, Oxford, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Cancer Surveillance Unit, International Agency for Research on Cancer, Lyon, France
| | | |
Collapse
|
9
|
Gnangnon FHR, Souaibou YI, Gbessi DG, Agbo TMG, Dossou FM, Méhinto DK. Surgical management of erosive adenomatosis of the nipple: A case report. Int J Surg Case Rep 2021; 86:106234. [PMID: 34500249 PMCID: PMC8430389 DOI: 10.1016/j.ijscr.2021.106234] [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: 06/13/2021] [Revised: 07/17/2021] [Accepted: 07/20/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction and importance Known as a very uncommon disease, erosive adenomatosis of the nipple is a benign neoplasm of the breast. However, its destructive process can have a considerably negative impact on patient's quality of life. Case presentation We report the case of a 45-year-old woman who presented at the visceral surgery department of the National Teaching Hospital of Cotonou-Benin (CNHU-HKM) for a burgeoning mass of the left nipple. She was diagnosed an erosive adenomatosis of the nipple and underwent a nipple resection with reconstruction. Clinical discussion Erosive adenomatosis is one differential diagnosis for lesion of the nipple. Clinically, it should be discussed with malignant nipple tumours including Paget's disease. Conclusion Surgery is the cornerstone of the treatment, and the prognosis is excellent. Erosive adenomatosis of the nipple (EAN) is a rare benign neoplasm of the breast. Clinically, it should always be discussed with malignant nipple tumours including Paget's disease Surgery (nipple resection) is the cornerstone of the management Tissue sparing techniques are advocated for women of childbearing age The prognosis is excellent.
Collapse
Affiliation(s)
| | - Yacoubou Imorou Souaibou
- Department of Visceral Surgery, National Teaching Hospital-Hubert Koutoukou Maga, Cotonou, Benin
| | - Dansou Gaspard Gbessi
- Department of Visceral Surgery, National Teaching Hospital-Hubert Koutoukou Maga, Cotonou, Benin
| | - Tiani Marie Gaston Agbo
- Department of Visceral Surgery, National Teaching Hospital-Hubert Koutoukou Maga, Cotonou, Benin
| | - Francis Moïse Dossou
- Department of General Surgery, University Regional Hospital of Ouémé-Plateau, Porto-Novo, Benin
| | - Delphin Kuassi Méhinto
- Department of Visceral Surgery, National Teaching Hospital-Hubert Koutoukou Maga, Cotonou, Benin
| |
Collapse
|
10
|
Kpossou AR, Gbessi DG, Gnangnon FHR, Ba Boukari MM, Vignon RK, Sokpon CNM, Sehonou J. [Cancers of the pancreas at the National Hospital and University Center of Cotonou: epidemiological, diagnostic, therapeutic and prognostic features]. Pan Afr Med J 2021; 39:18. [PMID: 34394809 PMCID: PMC8348281 DOI: 10.11604/pamj.2021.39.18.26261] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 04/29/2021] [Indexed: 12/09/2022] Open
Abstract
INTRODUCTION cancer is a major cause of death in the world. The purpose of this study is to evaluate the epidemiological, clinical, therapeutic and prognostic features of cancers of the pancreas (CP) at the National Hospital and University Center of Cotonou. METHODS we conducted a cross-sectional descriptive and analytical study with a prospective and retrospective data collection over a period of ten years, from 1 October 2009 to 31 October 2019. RESULTS out of 15.102 hospitalizations, we identified 72 cases of CP, reflecting a hospitalization rate of 0.5%. The average age of patients was 59 years. The sex-ratio (H/F) was 1.5. The main reason for consultation was abdominal pain. More than half (51.4%) of patients had metastatic tumor at the time of diagnosis. Histological evidence of adenocarcinoma was only reported in 15.1% of cases. The rate of operable patients was 37.5% while the rate of resectable patients was 2.7%. Palliative chemotherapy was given to 13.9% of patients. The average cost of treatment was 955.882,4 FCFA (23.9 times the Guaranteed Interprofessional Minimum Wage in Benin). Median overall survival was 6 months. Mortality rate was 86.9% (53/61), survival rate at one year was 31.4%, and zero at five years. Palliative surgery (p = 0.021) and chemotherapy (p = 0.023) improved patient survival. CONCLUSION cancer of the pancreas, due to its non-specific signs and insidious outcome, is often diagnosed at a late stage. A metastatic tumor and the limited individual and institutional therapeutic possibilities lead to more pejorative prognosis.
Collapse
Affiliation(s)
- Aboudou Raïmi Kpossou
- Clinique Universitaire d´Hépato-gastroentérologie, Centre National Hospitalier Universitaire-Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Bénin
| | - Dansou Gaspard Gbessi
- Clinique Universitaire de Chirurgie Viscérale, Centre National Hospitalier Universitaire-Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Bénin
| | - Freddy Houéhanou Rodrigue Gnangnon
- Clinique Universitaire de Chirurgie Viscérale, Centre National Hospitalier Universitaire-Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Bénin
| | - Meissarath Modoukpè Ba Boukari
- Clinique Universitaire d´Hépato-gastroentérologie, Centre National Hospitalier Universitaire-Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Bénin
| | - Rodolph Koffi Vignon
- Clinique Universitaire d´Hépato-gastroentérologie, Centre National Hospitalier Universitaire-Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Bénin
| | - Comlan N´déhougbéa Martin Sokpon
- Clinique Universitaire d´Hépato-gastroentérologie, Centre National Hospitalier Universitaire-Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Bénin
| | - Jean Sehonou
- Clinique Universitaire d´Hépato-gastroentérologie, Centre National Hospitalier Universitaire-Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Bénin
| |
Collapse
|
11
|
Kpossou AR, Gbessi DG, Gnangnon FHR, Kanhonou KDCE, Sokpon CNM, Vignon RK, Séidou F, Séhonou J. [Epidemiology of primitive digestive cancers in adult in three specialized health centers in Cotonou (Benin Republic)]. ACTA ACUST UNITED AC 2020; 113:254-257. [PMID: 33881252 DOI: 10.3166/bspe-2020-0152] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Health research studies are increasingly focusing on digestive cancers because of their increasing frequency and severity. The objective of this work was to study the epidemiological aspects of primary digestive cancers in adults in three hospital centers in the commune of Cotonou. A total of 676 cases of digestive cancers were identified out of 25,093 patients received during the study period (2.7%). The mean age was 54 ± 14.1 years: [16-96] and the sex ratio was 2:1. The most frequent cancers were those of the liver (259; 38.3%) and colon-rectum (154; 22.8%). The next most common cancers in descending order were gastric cancer (12%), esophageal cancer (11.4%), pancreatic cancer (11.4%), anal cancer (1.9%), hail cancer (1.5%) and biliary cancer (0.7%). The average time to visit was 9 months. The main risk factors found were viral hepatitis B and C, alcoholism, diabetes, obesity, colonic polyps, smoking, excessive consumption of salt and dietary nitrates. Lethality was 58.4%, with cancers of the liver, colon-rectum, pancreas, and esophagus in descending order of mortality. The average overall survival was 10 months. Digestive cancers most often affect people in their fifties, who are usually men in Cotonou. They are dominated by liver cancer and colorectal cancer. Modifiable risk factors are often found. The control of these factors and early diagnosis could help improve the survival of patients affected.
Collapse
Affiliation(s)
- A R Kpossou
- Clinique universitaire d'hépatogastroentérologie, Centre national hospitalier universitaire Hubert-Koutoukou-Maga (CNHU-HKM) de Cotonou, Bénin.,2 Service de chirurgie viscérale, CNHU-HKM, Cotonou, Bénin
| | - D G Gbessi
- Service de chirurgie viscérale, CNHU-HKM, Cotonou, Bénin
| | - F H R Gnangnon
- Service de chirurgie viscérale, CNHU-HKM, Cotonou, Bénin
| | - K D C E Kanhonou
- Clinique universitaire d'hépatogastroentérologie, Centre national hospitalier universitaire Hubert-Koutoukou-Maga (CNHU-HKM) de Cotonou, Bénin.,2 Service de chirurgie viscérale, CNHU-HKM, Cotonou, Bénin
| | - C N M Sokpon
- Clinique universitaire d'hépatogastroentérologie, Centre national hospitalier universitaire Hubert-Koutoukou-Maga (CNHU-HKM) de Cotonou, Bénin.,2 Service de chirurgie viscérale, CNHU-HKM, Cotonou, Bénin
| | - R K Vignon
- Clinique universitaire d'hépatogastroentérologie, Centre national hospitalier universitaire Hubert-Koutoukou-Maga (CNHU-HKM) de Cotonou, Bénin.,2 Service de chirurgie viscérale, CNHU-HKM, Cotonou, Bénin
| | - F Séidou
- Laboratoire d'anatomopathologie et de cytopathologie, faculté des sciences de la santé, Cotonou, Bénin
| | - J Séhonou
- Clinique universitaire d'hépatogastroentérologie, Centre national hospitalier universitaire Hubert-Koutoukou-Maga (CNHU-HKM) de Cotonou, Bénin.,2 Service de chirurgie viscérale, CNHU-HKM, Cotonou, Bénin
| |
Collapse
|