1
|
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
|
2
|
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
|
3
|
Chokunonga E, Borok MZ, Chirenje ZM, Nyakabau AM, Parkin DM. Trends in the incidence of cancer in the black population of Harare, Zimbabwe 1991-2010. Int J Cancer 2013; 133:721-9. [PMID: 23364833 DOI: 10.1002/ijc.28063] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 01/09/2013] [Indexed: 12/15/2022]
Abstract
Incidence rates of different cancers have been calculated for the black population of Harare, Zimbabwe for a 20-year period (1991-2010) coinciding with continuing social and lifestyle changes, and the peak, and subsequent wane, of the HIV-AIDS epidemic. The overall risk of cancer increased during the period in both sexes, with rates of cervix and prostate cancers showing particularly dramatic increases (3.3% and 6.4% annually, respectively). By 2004, prostate cancer had become the most common cancer of men. The incidence of cancer of the esophagus, formerly the most common cancer of men, has remained relatively constant, whereas rates of breast and cervix cancers, the most common malignancies of women, have shown significant increases (4.9% and 3.3% annually, respectively). The incidence of Kaposi sarcoma increased to a maximum around 1998-2000 and then declined in all age groups, and in both sexes The incidence of squamous cell cancers of the conjunctiva is relatively high, with temporal trends similar to those of Kaposi sarcoma. Non-Hodgkin lymphoma, the fifth most common cancer of men and fourth of women, showed a steady increase in incidence throughout the period (6.7-6.9% annually), although rates in young adults (15-39) have decreased since 2001. Cancer control in Zimbabwe, as elsewhere in sub-Saharan Africa, involves meeting the challenge of emerging cancers associated with westernization of lifestyles (large bowel, breast and prostate), while the incidence of cancers associated with poverty and infection (liver, cervix and esophagus) shows little decline, and the residual burden of the AIDS-associated cancers remains significant.
Collapse
Affiliation(s)
- E Chokunonga
- Zimbabwe National Cancer Registry, Harare, Zimbabwe
| | | | | | | | | |
Collapse
|
4
|
Chokunonga E, Borok MZ, Chirenje ZM, Nyabakau AM, Parkin DM. Cancer survival in Harare, Zimbabwe, 1993-1997. IARC Sci Publ 2011:249-255. [PMID: 21675430] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The Zimbabwe national cancer registry was established in 1985 as a population-based cancer registry covering Harare city. Cancer is not a notifiable disease, and registration of cases is done by active methods. The registry contributed data on randomly drawn sub-samples of Harare resident cases among 17 common cancer sites or types registered during 1993-1997 from black and white populations. Follow-up was carried out predominantly by active methods with median follow-up ranging from 1-54 months for different cancers. The proportion with histologically verified diagnosis for various cancers ranged from 20-100%; death certificate only (DCO) cases comprised 0-34%; 58-97% of total registered cases were included for survival analysis. Complete follow-up at five years ranged from 94-100%. Five-year age-standardized relative survival rates of selected cancers among both races combined were cervix (42%), breast (68%), Kaposi sarcoma (4%), liver (3%), oesophagus (12%), stomach (20%) and lung (14%). Survival was markedly higher among white than black populations for most cancers with adequate cases. Five-year relative survival by age group was fluctuating, with no definite pattern or trend.
Collapse
Affiliation(s)
- E Chokunonga
- Zimbabwe National Cancer Registry, Parirenyatwa Hospital, Avondale, Harare, Zimbabwe.
| | | | | | | | | |
Collapse
|
5
|
Masanganise R, Rusakaniko S, Makunike R, Hove M, Chokunonga E, Borok MZ, Mauchaza BG, Chirenje M, Masanganise VN, Magure T. A historical perspective of registered cases of malignant ocular tumors in Zimbabwe (1990 to 1999). Is HIV infection a factor? ACTA ACUST UNITED AC 2008; 54:28-32. [PMID: 21650077 DOI: 10.4314/cajm.v54i5-8.62586] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Anecdotal and published reports suggest that ocular tumours are on the increase in Zimbabwe. OBJECTIVES To determine the trends in incidence rates of common malignant ocular tumours registered with the Zimbabwe Cancer Registry during the last decade (1990 to 1999). DESIGN Retrospective study. SETTING Data were collected from the Zimbabwe National Cancer Registry, the Zimbabwe National Census 1992 and 2002 Reports, and patient records from hospitals. SUBJECTS All cases of malignant ocular tumours registered with the Zimbabwe National Cancer Registry between 1 January 1990 and 31 December 1999. MAIN OUTCOME MEASURES Age standardized annual incidence rates for registered cases of common ocular tumours. RESULTS The age-adjusted annual incidence rates of squamous cell carcinoma of the conjunctiva had a more than 10-fold increase from 0.17 to 1.8 per 100,000 people during periods 1990 and 1999 respectively. Retinoblastoma dropped by more than half from 0.8 to 0.34 per 100,000 during the same period. The annual age standardised incidence rates for all ocular tumours showed a significant upward linear trend (chi2: 362.78, df=9 and p < 0.001). There was no significant gender difference in the distribution of these tumours amongst the study population. CONCLUSION The increasing trend in the age-adjusted annual incidence rates of ocular surface squamous neoplasms could be attributed to the worsening HIV and AIDS pandemic in Zimbabwe or improved access/utilization of health services by the public.
Collapse
Affiliation(s)
- R Masanganise
- University of Zimbabwe, College of Health Sciences, P.O. Box A178, Avondale Harare, Zimbabwe.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Gumbo T, Just-Nübling G, Robertson V, Latif AS, Borok MZ, Hohle R. Clinicopathological features of cutaneous histoplasmosis in human immunodeficiency virus-infected patients in Zimbabwe. Trans R Soc Trop Med Hyg 2001; 95:635-6. [PMID: 11816437 DOI: 10.1016/s0035-9203(01)90103-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Reports of disseminated Histoplasma infection in African AIDS patients are scanty. In Zimbabwe, 12 patients presented in 1994-2000 with facial nodular/papular cutaneous lesions, which became umbilicated and finally ulcerated. Histology revealed non-granulomatous inflammation and macrophages stuffed with Histoplasma. Recognition of these clinical features may lead to more rapid diagnosis of disseminated histoplasmosis in Africa.
Collapse
Affiliation(s)
- T Gumbo
- Department of Medicine, University of Zimbabwe Medical School, Harare, Zimbabwe
| | | | | | | | | | | |
Collapse
|
7
|
Abstract
BACKGROUND Zimbabwe is severely affected by the AIDS epidemic, and many cancers in African populations are related to infectious agents. OBJECTIVE To study the current pattern, and short-term changes in incidence, of cancers related to infectious agents (and especially to HIV), with respect to the evolving epidemic of AIDS. METHODS Analysis of data on the African population of Harare, Zimbabwe, from the Zimbabwe Cancer Registry, for the period 1990-1995. Comparison with data on prevalence of HIV seropositivity, and notifications of AIDS. RESULTS Comparing results from 1993-1995 with those for 1990-1992 shows a continuing increase in the incidence of Kaposi's sarcoma with a doubling of the rates in both men and women. A dramatic increase in the incidence of squamous cell tumours of the conjunctiva was also observed, as well as a significant increase in the incidence of non-Hodgkin's lymphoma in women. There was no apparent increase in risk for Hodgkin's disease, myeloma, liver cancer, or cancer of the cervix. CONCLUSIONS The AIDS epidemic has had a dramatic effect on the profile of cancer. The changes in incidence involve several cancers previously linked to AIDS in North America and Europe.
Collapse
Affiliation(s)
- E Chokunonga
- Zimbabwe Cancer Registry, Parirenyatwa Hospital, Harare
| | | | | | | | | | | | | |
Collapse
|
8
|
Borok MZ, Nathoo KJ, Gabriel R, Porter KA. Clinicopathological features of Zimbabwean patients with sustained proteinuria. Cent Afr J Med 1997; 43:152-8. [PMID: 9431741] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To describe clinico-pathological features of patients admitted with significant proteinuria. DESIGN Hospital based prospective survey conducted from 1982 to 1987. SETTING Paediatric and medical wards at both tertiary referral hospitals in Harare. SUBJECTS 119 patients who presented with significant proteinuria were investigated. RESULTS Of the primary nephritides, diffuse mesangial proliferative glomerulonephritis was the most common finding (25/119); IgM was the dominant or sole immunoglobulin identified in 17/25. Minor glomerular abnormalities were common (19/119); there were 11 patients with minimal change disease and this number accounted for 42% of the children aged three to 12 years who were nephrotic. This incidence is higher than previously reported from Africa. Diffuse membranous nephropathy was frequent (18/119); hepatitis B surface antigen was present in only five of these patients. Focal sclerosing glomerulo-sclerosis was as frequent as diffuse membranous nephropathy (18/119) and appeared to be idiopathic. Diffuse mesangiocapillary glomerulonephritis (membranoproliferative) was present in 15/119 patients; no causal association was made. CONCLUSION The pattern of primary glomerulonephritis is described from 1982 to 1987. We describe a slightly higher number of patients with minimal change disease and minor glomerular abnormalities than previously reported and a surprisingly small number of patients with diffuse endocapillary glomerulonephritis. In common with other African series, no patient with IgA nephropathy was found.
Collapse
Affiliation(s)
- M Z Borok
- Department of Medicine, University of Zimbabwe Medical School, Harare, Zimbabwe
| | | | | | | |
Collapse
|
9
|
Borok MZ, Gabriel R. Alpha-galactosidase A deficiency (Fabry's disease) in a black Zimbabwean. S Afr Med J 1993; 83:350-1. [PMID: 8211434] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
We describe a patient with Fabry's disease with renal and myocardial involvement. He has been followed up for 10 years. This metabolic defect has not been noted before in southern Africa; the clinical course is similar to that of western European and American cases.
Collapse
Affiliation(s)
- M Z Borok
- Department of Medicine, University of Zimbabwe, Harare
| | | |
Collapse
|
10
|
Wilcock G, Grace S, De Villiers D, Borok MZ, Emmanual J, Downing R. Kaposi's sarcoma in Zimbabwe. II. Peripheral lymphocytes, immunoglobulin G levels and HIV antibody positivity. J Clin Lab Immunol 1988; 27:25-8. [PMID: 3251044] [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] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Patients with Kaposi's Sarcoma (KS) were grouped according to their clinical symptoms into "indolent", "locally aggressive", "endemic generalised aggressive" and "epidemic generalised aggressive" disease. Only the patients in the epidemic generalised aggressive disease group had serum antibodies to HIV. Complete peripheral blood counts, including lymphocyte subsets, and serum IgG assays were performed on all patients before treatment was initiated. In all the aggressive disease groups there was evidence of immune deficiency in that T helper/inducer (T4) cells were reduced leading to reduced T4,T8 (suppresser/cytotoxic) ratio. All patient groups had increased levels of serum IgG. Although immune deficiency and aggressive KS can be explained in the HIV infected patients no underlying cause has been found in the HIV negative patients with aggressive KS.
Collapse
Affiliation(s)
- G Wilcock
- Department of Physiology, University of Zimbabwe, Harare
| | | | | | | | | | | |
Collapse
|