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Meghani K, Puri P, Bazzett-Matabele L, Vuylsteke P, Luckett R, Monare B, Chiyapo S, Ketlametswe R, Ralefala TB, Bvochora-Nsingo M, Zetola N, Ramogola-Masire D, Grover S. Significance of HIV status in cervical cancer patients receiving curative chemoradiation therapy, definitive radiation alone, or palliative radiation in Botswana. Cancer 2024. [PMID: 38529676 DOI: 10.1002/cncr.35289] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/10/2024] [Accepted: 02/13/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Cervical cancer associated with human papillomavirus has the highest cancer incidence and mortality for women in Botswana because of a high HIV prevalence and limited screening. This study investigates the significance of HIV on the overall survival (OS) of patients with locally advanced cervical cancer by various treatment categories (curative chemoradiation, definitive radiation [RT] alone, or palliative RT alone). METHODS This study included patients diagnosed with cervical cancer between 2013 and 2020, prospectively enrolled in the Botswana Prospective Cancer Cohort. OS based on HIV status and completion of planned treatment regimen was estimated by the Kaplan-Meier method. Comparisons of 2-year OS by HIV status was performed by the log-rank test, univariate and multivariable Cox analyses adjusting for cancer stage, RT dose, number of chemotherapy cycles, and baseline hemoglobin levels. RESULTS Of 1131 patients diagnosed with stage IB-IVB cervical cancer, 69.8% were women living with HIV (n = 789). For patients receiving curative chemoradiation, HIV status was not significantly associated with OS in unadjusted (p = .987) and adjusted (p = .578) analyses. For RT only treatment and definitive (high-dose) RT alone, HIV status was significantly associated with OS in unadjusted analysis (HR = 1.77, p = .002; HR = 1.95, p = .014), but not in adjusted analysis (p = .227, p = .73). For patients receiving palliative (low-dose) RT, HIV status was not associated with OS in unadjusted (p = .835) or adjusted analysis (p = .359). CONCLUSIONS In Botswana, a resource-limited setting, HIV status had no significant effect on 2-year OS in patients with cervical cancer with well-managed HIV receiving chemoradiation, RT alone, or palliative RT. This demonstrates that patients living with HIV receiving antiretroviral treatment can receive clinically appropriate treatment with no evidence that HIV may lead to poorer outcomes.
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Affiliation(s)
- Kinza Meghani
- School of Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | - Priya Puri
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Peter Vuylsteke
- Department of Oncology, Gaborone Private Hospital, Gaborone, Botswana
| | - Rebecca Luckett
- Department of Obstetrics and Gynecology, University of Botswana, Gaborone, Botswana
| | - Barati Monare
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | - Sebathu Chiyapo
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | | | - Tlotlo B Ralefala
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
- Department of Oncology, Princess Marina Hospital, Gaborone, Botswana
| | - Memory Bvochora-Nsingo
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
- Department of Oncology, Princess Marina Hospital, Gaborone, Botswana
| | - Nicola Zetola
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Oncology, Princess Marina Hospital, Gaborone, Botswana
| | - Doreen Ramogola-Masire
- Department of Obstetrics and Gynecology, University of Botswana, Gaborone, Botswana
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | - Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
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George J, Tuli S, Patel PP, Monare B, Ramogola-Masire D, Bazzett-Matabele L, Bvochora-Nsingo M, Chiyapo S, Ralefala T, Vuylsteke P, Rendle KA, Grover S. Delays in Cervical Cancer Treatment Initiation for Patients Living With or Without HIV in Botswana: An Observational Cohort Analysis (2015-2019). Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00354-7. [PMID: 38462016 DOI: 10.1016/j.ijrobp.2024.02.038] [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] [Received: 09/27/2023] [Revised: 02/04/2024] [Accepted: 02/18/2024] [Indexed: 03/12/2024]
Abstract
PURPOSE To assess delays in treatment initiation of chemoradiation or radiation alone for patients with advanced stage cervical cancer in Botswana. METHODS AND MATERIALS Females with locally advanced cervical cancer (stages IB2-IVB) were prospectively enrolled in an observational cohort study from 2015 to 2019. We evaluated delays at 30, 60, 90, 120, 150, and 180 or greater days between the date of diagnosis and treatment initiation. Factors associated with overall survival were modeled with multivariable Cox proportional hazards regression (aHR). Associations between delays in cervical cancer treatment initiation were evaluated via univariable logistic regression. RESULTS Among the 556 patients included (median age = 47.9 years), 386 (69.4%) were females living with HIV with a median CD4 count of 448.0 cells/μL (IQR, 283.0-647.5 cells/μL) at diagnosis. Most patients had stages 2 (38.1%) or 3 (34.5%) cervical cancer. Early-stage patients experienced longer delays in treatment initiation compared to late-stage patients (P = .033). Early-stage patients with delays ≥90 days and pathology diagnosis between 2016 and 2019 (aHR, 0.34; P < .001) versus <90 days had a decreased risk of mortality, and those with delays ≥90 days and pathology diagnosis before 2016 (aHR, 5.67; P = .022) versus <90 days had an increased risk of mortality. Late-stage patients with delays ≥120 days and pathology diagnosis between 2018 and 2019 (aHR, 1.98; P = .025) versus <120 days had an increased risk of mortality. Early-stage patients with pathology diagnosis between 2016 and 2019 (odds ratio, 2.32; P = .043) versus before 2016 were more likely to experience delays ≥90 days, and late-stage patients who traveled >100 km to the treatment facility (odds ratio, 2.83; P < .001) versus <100 km were more likely to experience delays ≥120 days. CONCLUSIONS Delays in care are common in Botswana, particularly for those living farther from the treatment clinic and at advanced stages. This paper is among the first to show an association between treatment delays and worsened overall survival at advanced stages of cervical cancer, highlighting the need for interventions to help patients receive timely care in global settings.
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Affiliation(s)
- Jessica George
- Donald Bren School of Information and Computer Sciences, University of California, Irvine, Irvine, California
| | - Shawna Tuli
- Donald Bren School of Information and Computer Sciences, University of California, Irvine, Irvine, California
| | - Palak P Patel
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Barati Monare
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | | | - Lisa Bazzett-Matabele
- Department of Obstetrics & Gynecology, University of Botswana, Gaborone, Botswana; Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut
| | | | | | | | - Peter Vuylsteke
- CHU Namur, Site Sainte-Elisabeth, UCLouvain, Namur, Belgium; Department of Internal Medicine, University of Botswana, Gaborone, Botswana
| | - Katharine A Rendle
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana; Department of Family Medicine & Community Health, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Surbhi Grover
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana; Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
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3
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Lumley C, Batman S, Bazzett-Matabele L, Monare B, Bvochora-Nsingo M, Chiyapo S, Ketlametswe R, Mbulawa G, Seiphetlheng A, Ramontshonyane G, Ralefala T, Luckett R, Vuylsteke P, Grover S. Patterns of care and outcomes for endometrial and ovarian cancers in botswana 2015-2021. Gynecol Oncol Rep 2023; 49:101262. [PMID: 37691756 PMCID: PMC10485036 DOI: 10.1016/j.gore.2023.101262] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/14/2023] [Accepted: 08/18/2023] [Indexed: 09/12/2023] Open
Abstract
Purpose Endometrial and ovarian cancers are leading causes of cancer death among women. However, there is little data on these patients from low- and middle-income countries including Botswana, a country in sub-Saharan Africa. This study reports data on demographics, treatment, and outcomes for patients with endometrial and ovarian cancer in Botswana. Methods This prospective cohort study included all prospectively enrolled patients with endometrial or ovarian cancer who presented to Princess Marina or Gaborone Private Hospital between May 2015 and May 2021. Demographic, treatment, and survival data were analyzed. Results 99 patients with endometrial and 38 patients with ovarian cancer were included. Median age at diagnosis was 64 for patients with endometrial cancer and 57 for patients with ovarian cancer. Just over half of patients with endometrial cancer (52.6%) presented with FIGO stages I and II, whereas most patients with ovarian cancer (65.8%) presented with stages III and IV. 24.2% of patients with endometrial cancer received chemotherapy, 32.3% received radiotherapy, 74.7% received surgical treatment, and 16.2% received no treatment; of patients with ovarian cancer, 42.1% received chemotherapy, 2.6% received radiotherapy, 52.6% received surgical treatment, and 31.6% of patients received no treatment. 1-and 2-year overall survival probabilities were 76.9% and 59.7% for patients with endometrial cancer and 62.8% and 43.7% for patients with ovarian cancer, respectively. Conclusion This study demonstrates that a large proportion of patients with ovarian and endometrial cancer in Botswana are diagnosed at an advanced stage, and many do not receive standard-of-care treatment. Further inquiry is required to characterize challenges to diagnosis and treatment of ovarian and endometrial cancers in Botswana.
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Affiliation(s)
- Christian Lumley
- The University of Texas Southwestern Medical Center, Office of Global Health, Dallas, United States
| | - Samantha Batman
- The University of Texas MD Anderson Cancer Center, Department of Gynecologic Oncology and Reproductive Medicine, Houston, United States
| | - Lisa Bazzett-Matabele
- University of Botswana, Department of Obstetrics and Gynecology, Faculty of Medicine, Gaborone, Botswana
- Yale University, Department of Obstetrics and Gynecology, New Haven, United States
| | - Barati Monare
- Botswana-University of Pennsylvania Partnership, Princess Marina Hospital, Gaborone, Botswana
| | | | - Sebathu Chiyapo
- Princess Marina Hospital, Department of Adult Oncology, Gaborone, Botswana
| | - Rebecca Ketlametswe
- Princess Marina Hospital, Department of Adult Oncology, Gaborone, Botswana
- Botswana-University of Pennsylvania Partnership, Princess Marina Hospital, Gaborone, Botswana
| | - Gaborone Mbulawa
- Princess Marina Hospital, Department of Adult Oncology, Gaborone, Botswana
| | | | | | - Tlotlo Ralefala
- Government of Botswana, Ministry of Health and Wellness, Gaborone, Botswana
- Princess Marina Hospital, Department of Adult Oncology, Gaborone, Botswana
| | - Rebecca Luckett
- University of Botswana, Department of Obstetrics and Gynecology, Faculty of Medicine, Gaborone, Botswana
- The Government of Botswana & Harvard University, Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Beth Israel Deaconess Medical Center, Department of Obstetrics and Gynecology, Boston, United States
| | - Peter Vuylsteke
- University of Botswana, Department of Internal Medicine, Gaborone, Botswana
| | - Surbhi Grover
- Botswana-University of Pennsylvania Partnership, Princess Marina Hospital, Gaborone, Botswana
- Hospital of The University of Pennsylvania, Department of Radiation Oncology, Philadelphia, United States
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4
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Ige T, Lewis P, Shelley C, Pistenmaa D, Coleman CN, Aggarwal A, Dosanjh M, Zergoug I, Eduardo HM, Bvochora-Nsingo M, Fulu K, Ralefala T, Grover S, Maison-Mayeh AM, Ndi SR, Attalla E, Deiab N, Belay EY, Acquah GF, Amankwaa-Frempong E, Foy H, Ngigi E, Badi F, Elburi I, Harivony T, Kone A, Maiga S, Tolba A, Mootoosamy S, El-Boutayeb S, Momade A, Midzi W, Grobler M, Aruah SC, Kra J, Diagne M, Trauernicht C, Elbashir F, Ali NAE, Makwani H, Yusufu S, Farhat L, Mounir B, Awusi K, Azangwe G. Understanding the challenges of delivering radiotherapy in low- and middle-income countries in Africa. J Cancer Policy 2023; 35:100372. [PMID: 36512899 DOI: 10.1016/j.jcpo.2022.100372] [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: 11/20/2022] [Accepted: 11/25/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Access to high quality radiotherapy (RT) continues to be a major issue across Africa with Africa having just 34% of its optimal capacity. METHODS We co-developed a survey with clinical, academic and policy stakeholders designed to provide a structured assessment of the barriers and enablers to RT capacity building in Africa. The survey covered nine key themes including funding, procurement, education and training. The survey was sent to RT professionals in 28 countries and the responses underwent qualitative and quantitative assessment. RESULTS We received completed questionnaires from 26 African countries. Funding was considered a major issue, specifically the lack of a ring fenced funds from the Ministry of Health for radiotherapy and the consistency of revenue streams which relates to a lack of prioritisation for RT. In addition to a significant shortfall in RT workforce disciplines, there is a general lack of formal education and training programmes. 13/26 countries reported having some IAEA support for RT for education and training. Solutions identified to improve access to RT include a) increasing public awareness of its essential role in cancer treatment; b) encouraging governments to simplify procurement and provide adequate funding for equipment; c) increasing training opportunities for all radiotherapy disciplines and d) incentivizing staff retention. CONCLUSION This survey provides unique information on challenges to delivering and expanding radiotherapy services in Africa. The reasons are heterogonous across countries but one key recommendation would be for national Cancer Control plans to directly consider radiotherapy and specifically issues of funding, equipment procurement, servicing and training. POLICY SUMMARY The study demonstrates the importance of mixed methods research to inform policy and overcome barriers to radiotherapy capacity and capability in LMICs.
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Affiliation(s)
- Taofeeq Ige
- National Hospital Abuja, Abuja, Nigeria; University of Abuja, Abuja, Nigeria
| | | | - Charlotte Shelley
- The Royal Surrey County Hospital NHS Foundation trust, Guildford, UK
| | - David Pistenmaa
- ICEC, International Cancer Expert Corps, Washington, DC, USA
| | | | | | - Manjit Dosanjh
- ICEC, International Cancer Expert Corps, Washington, DC, USA; CERN, ATS-DO, Geneva, Switzerland; Department of Physics, University of Oxford, UK.
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5
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Burt LM, McCormak M, Lecuru F, Kanyike DM, Bvochora-Nsingo M, Ndlovu N, Scott AA, Anorlu RI, Sharma V, Plante M, Nyongesa C, Tigeneh W, Fakie N, Suneja G, Gaffney DK. Cervix Cancer in Sub-Saharan Africa: An Assessment of Cervical Cancer Management. JCO Glob Oncol 2021; 7:173-182. [PMID: 33529076 PMCID: PMC8081497 DOI: 10.1200/go.20.00079] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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: 12/13/2022] Open
Abstract
PURPOSE Underdeveloped nations carry the burden of most cervical cancer, yet access to adequate treatment can be challenging. This report assesses the current management of cervical cancer in sub-Saharan Africa to better understand the needs of underdeveloped nations in managing cervical cancer. METHODS A pre- and postsurvey was sent to all centers participating in the Cervical Cancer Research Network's 4th annual symposium. The pre- and postsurvey evaluated human papillomavirus and HIV screening, resources available for workup and/or treatment, treatment logistics, outcomes, and enrollment on clinical trials. Descriptive analyses were performed on survey responses. RESULTS Twenty-nine centers from 12 sub-Saharan countries saw approximately 300 new cases of cervical cancer yearly. Of the countries surveyed, 55% of countries had a human papillomavirus vaccination program and 30% (range, 0%-65%) of women in each region were estimated to have participated in a cervical cancer screening program. In the workup of patients, 43% of centers had the ability to obtain a positron emission tomography and computed tomography scan and 79% had magnetic resonance imaging capabilities. When performing surgery, 88% of those centers had a surgeon with an expertise in performing oncological surgeries. Radiation therapy was available at 96% of the centers surveyed, and chemotherapy was available in 86% of centers. Clinical trials were open at 4% of centers. CONCLUSION There have been significant advancements being made in screening, workup, and management of patients with cervical cancer in sub-Saharan Africa; yet, improvement is still needed. Enrollment in clinical trials remains a struggle. Participants would like to enroll patients on clinical trials with Cervical Cancer Research Network's continuous support.
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Affiliation(s)
- Lindsay M Burt
- Radiation Oncology Department, University of Utah, Huntsman Cancer Institute, Salt Lake City, UH
| | - Mary McCormak
- University College Hospital London, London, United Kingdom
| | | | | | | | - Ntokozo Ndlovu
- University of Zimbabwe College of Health Sciences, Parirenyatwa Hospital Harare, Harare, Zimbabwe
| | | | - Rose I Anorlu
- University of Lagos, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Vinay Sharma
- Charlotte Maxeke Johannesburg Academic Hospital, University of Witwatersrand, Park Town, South Africa
| | | | | | | | - Nazia Fakie
- University of Cape Town, Cape Town, South Africa
| | - Gita Suneja
- Radiation Oncology Department, University of Utah, Huntsman Cancer Institute, Salt Lake City, UH
| | - David K Gaffney
- Radiation Oncology Department, University of Utah, Huntsman Cancer Institute, Salt Lake City, UH
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6
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Tuli S, George J, Monare B, Bvochora-Nsingo M, Lichter K, Chiyapo S, Balang D, Bazzett-Matabele L, Shin S, Zetola N, Grover S. PO-1315 Treatment toxicities of cervical cancer with or without HIV infection in Botswana 2013-2020. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07766-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Grover S, Ning MS, Bale M, Lichter KE, Shah S, Bvochora-Nsingo M, Chiyapo S, Balang D, McGinnis GJ, Ralefala T, Moloi T, Luckett R, Ramogola-Masire D, Robertson ES, Zetola NM. Chemoradiation versus radiation alone in stage IIIB cervical cancer patients with or without human immunodeficiency virus. Int J Gynecol Cancer 2021; 31:1220-1227. [PMID: 34312220 DOI: 10.1136/ijgc-2021-002601] [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: 03/09/2021] [Accepted: 07/08/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Cervical cancer remains the most common cancer among women in sub-Saharan Africa and is also a leading cause of cancer related deaths among these women. The benefit of chemoradiation in comparison with radiation alone for patients with stage IIIB disease has not been evaluated prospectively in women living with human immunodeficiency virus (HIV). We assessed the survival of chemoradiation versus radiation alone among stage IIIB cervical cancer patients based on HIV status. METHODS Between February 2013 and June 2018, patients with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage IIIB cervical cancer with or without HIV and treated with chemoradiation or radiation alone, were prospectively enrolled in an observational cohort study. Overall survival was evaluated using the Kaplan-Meier method. Cox proportional hazards modeling was used to analyze associations with survival. RESULTS Among 187 patients, 63% (n=118) of women had co-infection with HIV, and 48% (n=69) received chemoradiation. Regardless of HIV status, patients who received chemoradiation had improved 2 year overall survival compared with those receiving radiation alone (59% vs 41%, p<0.01), even among women living with HIV (60% vs 38%, p=0.02). On multivariable Cox regression analysis, including all patients regardless of HIV status, 2 year overall survival was associated with receipt of chemoradiation (hazard ratio (HR) 0.63, p=0.04) and total radiation dose ≥80 Gy (HR 0.57, p=0.02). Among patients who received an adequate radiation dose of ≥80 Gy, adjusted overall survival rates were similar between chemoradiation versus radiation alone groups (HR 1.07; p=0.90). However, patients who received an inadequate radiation dose of <80 Gy, adjusted survival was significantly higher in chemoradiation versus radiation alone group (HR 0.45, p=0.01). CONCLUSIONS Addition of chemotherapy to standard radiation improved overall survival, regardless of HIV status, and is even more essential in women who cannot receive full doses of radiation.
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Affiliation(s)
- Surbhi Grover
- Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA .,Oncology, University of Botswana, Gaborone, Botswana
| | - Matthew S Ning
- Radiation Oncology, University of Texas MD Anderson Cancer Center Division of Radiation Oncology, Houston, Texas, USA
| | - Michelle Bale
- Radiation Oncology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Katie E Lichter
- Radiation Oncology, University of California San Francisco, San Francisco, California, USA
| | - Sidrah Shah
- The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | | | - Sebathu Chiyapo
- Life Gaborone Private Hospital, Gaborone, Gaborone, Botswana
| | - Dawn Balang
- Life Gaborone Private Hospital, Gaborone, Gaborone, Botswana
| | - Gwendolyn J McGinnis
- Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | | | - Thabo Moloi
- Princess Marina Hospital, Gaborone, Gaborone, Botswana
| | - Rebecca Luckett
- Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Doreen Ramogola-Masire
- Obstetrics & Gynaecology - Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Erle S Robertson
- Microbiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nicola M Zetola
- Botswana-University of Pennsylvania Partnership, Philadelphia, Pennsylvania, USA
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McGinnis GJ, Ning MS, Bvochora-Nsingo M, Chiyapo S, Balang D, Ralefala T, Lin A, Zetola NM, Grover S. Management of Head and Neck Cancers With or Without Comorbid HIV Infection in Botswana. Laryngoscope 2021; 131:E1558-E1566. [PMID: 33098322 PMCID: PMC8046722 DOI: 10.1002/lary.29206] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 07/06/2020] [Revised: 09/24/2020] [Accepted: 10/13/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVES/HYPOTHESIS Head and neck cancer (HNC) is the fifth most common malignancy in sub-Saharan Africa, a region with hyperendemic human immunodeficiency virus (HIV)-infection. HIV patients have higher rates of HNC, yet the effect of HIV-infection on oncologic outcomes and treatment toxicity is poorly characterized. STUDY DESIGN Prospective observational cohort study. METHODS HNC patients attending a government-funded oncology clinic in Botswana were prospectively enrolled in an observational cohort registry from 2015 to 2019. Clinical characteristics were analyzed via Cox proportional hazards and logistic regression followed by secondary analysis by HIV-status. Overall survival (OS) was evaluated via Kaplan-Meier. RESULTS The study enrolled 149 patients with a median follow-up of 23 months. Patients presented with advanced disease (60% with T4-primaries), received limited treatment (19% chemotherapy, 8% surgery, 29% definitive radiation [RT]), and had delayed care (median time from diagnosis to RT of 2.5 months). Median OS was 36.2 months. Anemia was associated with worse survival (HR 2.74, P = .001). Grade ≥ 3 toxicity rate with RT was 30% and associated with mucosal subsite (OR 4.04, P = .03) and BMI < 20 kg/m2 (OR 6.04, P = .012). Forty percent of patients (n = 59) were HIV-infected; most (85%) were on antiretroviral therapy, had suppressed viral loads (90% with ≤400 copies/mL), and had immunocompetent CD4 counts (median 400 cells/mm3 ). HIV-status was not associated with decreased receipt or delays of definitive RT, worse survival, or increased toxicity. CONCLUSIONS Despite access to government-funded care, HNC patients in Botswana present late and have delays in care, which likely contributes to suboptimal survival outcomes. While a disproportionate number has comorbid HIV infection, HIV-status does not adversely affect outcomes. LEVEL OF EVIDENCE 2c Laryngoscope, 131:E1558-E1566, 2021.
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Affiliation(s)
- Gwendolyn J McGinnis
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, U.S.A
| | - Matthew S Ning
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas, U.S.A
| | | | - Sebathu Chiyapo
- Department of Oncology, Gaborone Private Hospital, Gaborone, Botswana
| | - Dawn Balang
- Department of Oncology, Gaborone Private Hospital, Gaborone, Botswana
| | - Tlotlo Ralefala
- School of Medicine, University of Botswana, Gaborone, Botswana
- Princess Marina Hospital, Gaborone, Botswana
| | - Alexander Lin
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Nicola M Zetola
- School of Medicine, University of Botswana, Gaborone, Botswana
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Surbhi Grover
- School of Medicine, University of Botswana, Gaborone, Botswana
- Princess Marina Hospital, Gaborone, Botswana
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Botswana University of Pennsylvania Partnership, Gaborone, Botswana
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9
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Mante A, Hawrot K, Bvochora-Nsingo M, Chiyapo S, Balang D, Barg F, Baffic C, Monare B, Vapiwala N, Ralefala T, Metz J, Swisher-McClure S, Grover S. Radiation Oncology Rotation in Botswana: Resident Experience and Career Interests. Int J Radiat Oncol Biol Phys 2020; 107:850-852. [PMID: 32386829 DOI: 10.1016/j.ijrobp.2020.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/26/2020] [Accepted: 03/02/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Adjoa Mante
- Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | | | - Sebathu Chiyapo
- Department of Oncology, Gaborone Private Hospital, Gaborone, Botswana
| | - Dawn Balang
- Department of Oncology, Gaborone Private Hospital, Gaborone, Botswana
| | - Frances Barg
- Family Medicine and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cordelia Baffic
- Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | | | - Neha Vapiwala
- Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | | | - James Metz
- Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Samuel Swisher-McClure
- Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Surbhi Grover
- Radiation Oncology, University of Pennsylvania, Gaborone, Botswana.
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Grover S, Zetola N, Ramogola-Masire D, Bvochora-Nsingo M, Schnader AF, Mick R, Gabaitiri L, Matlhagela K, Shen H, Chiyapo S, Balang D, Phaladze N, Nkomazana O, Friedman H, Jemmott J, Chilisa B, Robertson ES. Building research capacity through programme development and research implementation in resource-limited settings - the Ipabalele study protocol: observational cohort studies determining the effect of HIV on the natural history of cervical cancer in Botswana. BMJ Open 2019; 9:e031103. [PMID: 31892649 PMCID: PMC6955487 DOI: 10.1136/bmjopen-2019-031103] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The global burden of cancer continues to increase in low- and middle-income countries, particularly in sub-Saharan Africa (SSA). Botswana, a middle-income country in SSA, has the second highest prevalence of HIV worldwide and has seen an increase in human papillomavirus (HPV)-associated cervical cancer over the last decade in the setting of improved survival of HIV-infected women. There is an urgent need to understand more clearly the causes and consequences of HPV-associated cervical cancer in the setting of HIV infection. We initiated the Ipabalele ('take care of yourself' in Setswana) programme to address this need for new knowledge and to initiate long-term research programme capacity building in the region. In this manuscript, we describe the components of the programme, including three main research projects as well as a number of essential cores to support the activities of the programme. METHODS AND PROCEDURES Our multidisciplinary approach aims to further current understanding of the problem by implementing three complementary studies aimed at identifying its molecular, behavioural and clinical determinants. Three participant cohorts were designed to represent the early, intermediate and late stages of the natural history of cervical cancer.The functional structure of the programme is coordinated through programmatic cores. These allow for integration of each of the studies within the cohorts while providing support for pilot studies led by local junior investigators. Each project of the Ipabalele programme includes a built-in capacity building component, promoting the establishment of long-lasting infrastructure for future research activities. ETHICS AND DISSEMINATION Institutional review board approvals were granted by the University of Pennsylvania, University of Botswana and Ministry of Health and wellness of Botswana. Results will be disseminated via the participating institutions and with the help of the Community Advisory Committee, the project's Botswana advisory group.
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Affiliation(s)
- Surbhi Grover
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Botswana-UPenn Partnership, Gaborone, Botswana
| | - Nicola Zetola
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | | | | | - Allison F Schnader
- Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Marian University College of Osteopathic Medicine, Indianapolis, Indiana, USA
| | - Rosemarie Mick
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lesego Gabaitiri
- Department of Statistics, University of Botswana, Gaborone, Gaborone, Botswana
| | - Keikantse Matlhagela
- Department of Biomedical Sciences, Faculty of Medicine, University of Botswana, Gaborone, Gaborone, Botswana
| | - Hao Shen
- Department of Microbiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sebathu Chiyapo
- Life Gaborone Private Hospital, Gaborone, Gaborone, Botswana
| | - Dawn Balang
- Life Gaborone Private Hospital, Gaborone, Gaborone, Botswana
| | | | - Oathokwa Nkomazana
- Department of Surgery, Faculty of Medicine, University of Botswana, Gaborone, Gaborone, Botswana
| | - Harvey Friedman
- Botswana-UPenn Partnership, Gaborone, Botswana
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - John Jemmott
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Erle S Robertson
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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11
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Iyer HS, Kohler RE, Ramogola-Masire D, Brown C, Molebatsi K, Grover S, Kablay I, Bvochora-Nsingo M, Efstathiou JA, Lockman S, Tapela N, Dryden-Peterson SL. Explaining disparities in oncology health systems delays and stage at diagnosis between men and women in Botswana: A cohort study. PLoS One 2019; 14:e0218094. [PMID: 31170274 PMCID: PMC6553768 DOI: 10.1371/journal.pone.0218094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 02/02/2019] [Accepted: 05/24/2019] [Indexed: 01/04/2023] Open
Abstract
Purpose Men in Botswana present with more advanced cancer than women, leading to poorer outcomes. We sought to explain sex-specific differences in time to and stage at treatment initiation. Methods Cancer patients who initiated oncology treatment between October 2010 and June 2017 were recruited at four oncology centers in Botswana. Primary outcomes were time from first visit with cancer symptom to treatment initiation, and advanced cancer (stage III/IV). Sociodemographic and clinical covariates were obtained retrospectively through interviews and medical record review. We used accelerated failure time and logistic models to estimate standardized sex differences in treatment initiation time and risk differences for presentation with advanced stage. Results were stratified by cancer type (breast, cervix, non-Hodgkin’s lymphoma, anogenital, head and neck, esophageal, other). Results 1886 participants (70% female) were included. After covariate adjustment, men experienced longer excess time from first presentation to treatment initiation (8.4 months) than women (7.0 months) for all cancers combined (1.4 months, 95% CI: 0.30, 2.5). In analysis stratified by cancer type, we only found evidence of a sex disparity (Men: 8.2; Women: 6.8 months) among patients with other, non-common cancers (1.4 months, 95% CI: 0.01, 2.8). Men experienced an increased risk of advanced stage (Men: 67%; Women: 60%; aRD: 6.7%, 95% CI: -1.7%, 15.1%) for all cancers combined, but this disparity was only statistically significant among patients with anogenital cancers (Men: 72%; Women: 50%; aRD: 22.0%, 95% CI: 0.5%, 43.5%). Conclusions Accounting for the types of cancers experienced by men and women strongly attenuated disparities in time to treatment initiation and stage. Higher incidence of rarer cancers among men could explain these disparities.
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Affiliation(s)
- Hari S. Iyer
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Racquel E. Kohler
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Dana-Farber Cancer Institute, Boston, Massachusetts, United States of America
| | - Doreen Ramogola-Masire
- Botswana University of Pennsylvania Partnership, Gaborone, Botswana
- School of Medicine, University of Botswana, Gaborone, Botswana
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Carolyn Brown
- Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA, United States of America
| | | | - Surbhi Grover
- Botswana University of Pennsylvania Partnership, Gaborone, Botswana
- School of Medicine, University of Botswana, Gaborone, Botswana
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Princess Marina Hospital, Gaborone, Botswana
| | | | | | - Jason A. Efstathiou
- Dana-Farber Cancer Institute, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Shahin Lockman
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Botswana Ministry of Health and Wellness, Gaborone, Botswana
| | - Neo Tapela
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Botswana Ministry of Health and Wellness, Gaborone, Botswana
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Scott L. Dryden-Peterson
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
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12
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Grover S, MacDuffie EC, Wang Q, Bvochora-Nsingo M, Bhatia RK, Balang D, Chiyapo SP, Luckett R, Ramogola-Masire D, Dryden-Peterson SL, Lin LL, Shin SS, Zetola NM. HIV infection is not associated with the initiation of curative treatment in women with cervical cancer in Botswana. Cancer 2019; 125:1645-1653. [PMID: 30801696 DOI: 10.1002/cncr.31972] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 08/16/2018] [Revised: 10/29/2018] [Accepted: 11/09/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cervical cancer is the leading cause of cancer death in Sub-Saharan Africa. The risk of developing cancer is increased for women living with human immunodeficiency virus (HIV) infection. It is unknown which factors predict the initiation of curative chemoradiotherapy (CRT) in resource-limited settings and whether HIV is associated with initiating curative CRT in settings with a high HIV burden. METHODS All women living with and without HIV infection who were initiating curative and noncurative CRT for locally advanced cervical cancer in Botswana were prospectively enrolled in an observational study. The factors associated with receiving CRT were evaluated in all patients and the subgroup of women living with HIV. RESULTS Of 519 enrolled women, 284 (55%) initiated CRT with curative intent. The curative cohort included 200 women (70.4%) who were living with HIV and had a median CD4 count of 484.0 cells/μL (interquartile range, 342.0-611.0 cells/μL). In the noncurative cohort, 157 of 235 women (66.8%) were living with HIV and had a median CD4 count of 476.5 cells/μL (interquartile range, 308.0-649.5 cells/μL). HIV status was not associated with initiating curative CRT (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.58-1.56). The factors associated with receiving curative CRT treatment on multivariable analysis in all patients included baseline hemoglobin levels ≥10 g/dL (OR, 1.80; 95% CI, 1.18-2.74) and stage I or II versus stage III or IV disease (OR, 3.16; 95% CI, 2.10-4.75). Women aged >61 years were less likely to receive curative treatment (OR, 0.43; 95% CI, 0.24-0.75). Among women who were living with HIV, higher CD4 cell counts were associated with higher rates of CRT initiation. CONCLUSIONS The initiation of CRT with curative intent does not depend on HIV status. Significant predictors of CRT initiation include baseline hemoglobin level, disease stage, and age.
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Affiliation(s)
- Surbhi Grover
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Botswana-University of Pennsylvania Partnership, Gaborone, Botswana.,Princess Marina Hospital, Gaborone, Botswana.,School of Medicine, University of Botswana, Gaborone, Botswana
| | - Emily C MacDuffie
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Qiao Wang
- Sue and Bill Gross School of Nursing, University of California, Irvine, Irvine, California
| | | | - Rohini K Bhatia
- University of Rochester, School of Medicine and Dentistry, Rochester, New York
| | - Dawn Balang
- Department of Oncology, Gaborone Private Hospital, Gaborone, Botswana
| | | | - Rebecca Luckett
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Doreen Ramogola-Masire
- School of Medicine, University of Botswana, Gaborone, Botswana.,Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Scott L Dryden-Peterson
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana.,Department of Medicine, Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Lilie L Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sanghyuk S Shin
- Sue and Bill Gross School of Nursing, University of California, Irvine, Irvine, California
| | - Nicola M Zetola
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
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13
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Dryden-Peterson S, Bvochora-Nsingo M, Tapela N, Iyer H, Koheler R, Suneja G, Grover S, Lockman S. A Limited Time to Act: Cervical Cancer Stage Progression Prior to Treatment. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.74100] [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
Background: Cervical cancer is the leading cause of cancer death for women in sub-Saharan Africa where access to timely diagnosis and treatment remains a major challenge. Several investigators have documented the adverse impact of delays during curative chemoradiation on survival: 2%-5% decreased survival per week delay. However, the clinical impact of delays in initiating treatment has not previously been estimated and is key to direct allocation of resources and patient care. Aim: To estimate the duration treatment initiation delay leading to a one-stage progression in cervical cancer. Methods: Radiation is available in Botswana from a single linear accelerator and services are provided free of cost to Botswana citizens. Two prolonged service interruptions (late 2014 due to mechanical failure/upgrades, and late 2015 for machine replacement) contributed to substantial additional delays in accessing treatment of several months after service resumed. Using these natural experiments and the prospectively enrolling Thabatse Cancer Cohort (included cases enrolled from September 2014 to January 2018), we used instrumental variable methods to estimate the mean number of weeks to progress one stage (e.g., IIIA to IVA). Our instrument was a binary variable indicating treatment initiation occurred during service interruption. We used inverse probability weighting to adjust for possible bias in exposure to the instrument by HIV status, age, and income. Cancer stage was considered ordinal and we used Poisson regression to calculate weeks for stage progression. We calculated confidence limits using bootstrapping from 500 samples. Analyses were performed in SAS 9.4. Results: A total of 301 cervical cancer cases were included with 138 (46%) exposed to service disruption and 163 (54%) not exposed. The majority, 217 (72%), were HIV-infected with 86% on ART prior to cancer diagnosis. At time of treatment, 27 (9%) stage I, 108 (36%) stage II, 113 (38%) stage III, and 53 (18%) stage IV. Median time from diagnosis to initiation of treatment of all patients was 9.7 weeks (IQR 6.3-13.7), and was longer in those exposed to service disruption (11.0 weeks [IQR 7.7-15.1]) than those not exposed (8.0 weeks [IQR 5.3-11.7]. Time for progression of one cancer stage was 8.9 weeks (95% CI 4.6-15.8). Among HIV-infected women, estimated time for one-stage progression was 6.5 weeks (95% CI 2.3-12.3), significantly faster than HIV-uninfected women ( P < 0.001). The small number of HIV-uninfected women prevented separate estimation. Conclusion: Stage progression is rapid in locally advanced cervical cancer with typical treatment delays of two months associated with a full stage increase. These estimates may not generalize to contexts with lower HIV prevalence; however add urgency to effort to improve efficient access to treatment and avoidance of waiting lists.
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Affiliation(s)
| | | | - N. Tapela
- Harvard Medical School, Medicine, Boston, MA
| | - H. Iyer
- Harvard Medical School, Medicine, Boston, MA
| | | | - G. Suneja
- Harvard Medical School, Medicine, Boston, MA
| | - S. Grover
- Harvard Medical School, Medicine, Boston, MA
| | - S. Lockman
- Harvard Medical School, Medicine, Boston, MA
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14
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Grover S, Bvochora-Nsingo M, Yeager A, Chiyapo S, Bhatia R, MacDuffie E, Puri P, Balang D, Ratcliffe S, Narasimhamurthy M, Gwangwava E, Tsietso S, Kayembe MKA, Ramogola-Masire D, Dryden-Peterson S, Mahantshetty U, Viswanathan AN, Zetola NM, Lin LL. Impact of Human Immunodeficiency Virus Infection on Survival and Acute Toxicities From Chemoradiation Therapy for Cervical Cancer Patients in a Limited-Resource Setting. Int J Radiat Oncol Biol Phys 2018; 101:201-210. [PMID: 29619965 PMCID: PMC5999036 DOI: 10.1016/j.ijrobp.2018.01.067] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [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: 11/28/2017] [Revised: 01/18/2018] [Accepted: 01/22/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE To prospectively compare survival between human immunodeficiency virus (HIV)-infected versus HIV-uninfected cervical cancer patients who initiated curative chemoradiation therapy (CRT) in a limited-resource setting. METHODS AND MATERIALS Women with locally advanced cervical cancer with or without HIV infection initiating radical CRT in Botswana were enrolled in a prospective, observational, cohort study from July 2013 through January 2015. RESULTS Of 182 women treated for cervical cancer during the study period, 143 women initiating curative CRT were included in the study. Eighty-five percent of the participants (122 of 143) had stage II/III cervical cancer, and 67% (96 of 143) were HIV-infected. All HIV-infected patients were receiving antiretroviral therapy (ART) at the time of curative cervical cancer treatment initiation. We found no difference in toxicities between HIV-infected and HIV-uninfected women. The 2-year overall survival (OS) rates were 65% for HIV-infected women (95% confidence interval [CI] 54%-74%) and 66% for HIV-uninfected women (95% CI 49%-79%) (P = .70). Factors associated with better 2-year OS on multivariate analyses included baseline hemoglobin >10 g/dL (hazard ratio [HR] 0.37, 95% CI 0.19-0.72, P = .003), total radiation dose ≥75 Gy (HR 0.52, 95% CI 0.27-0.97, P = .04), and age <40 years versus 40-59 years (HR 2.17, 95% CI 1.05-4.47, P = .03). CONCLUSIONS Human immunodeficiency virus status had no effect on 2-year OS or on acute toxicities in women with well-managed HIV infection who initiated curative CRT in Botswana. In our cohort, we found that baseline hemoglobin levels, total radiation dose, and age were associated with survival, regardless of HIV status.
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Affiliation(s)
- Surbhi Grover
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Botswana University of Pennsylvania Partnership, Gaborone, Botswana; Princess Marina Hospital, Gaborone, Botswana; School of Medicine, University of Botswana, Gaborone, Botswana.
| | | | - Alyssa Yeager
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Rohini Bhatia
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Emily MacDuffie
- Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Priya Puri
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dawn Balang
- Department of Oncology, Gaborone Private Hospital, Gaborone, Botswana
| | - Sarah Ratcliffe
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Sylvia Tsietso
- Department of Oncology, Gaborone Private Hospital, Gaborone, Botswana
| | | | - Doreen Ramogola-Masire
- Botswana University of Pennsylvania Partnership, Gaborone, Botswana; School of Medicine, University of Botswana, Gaborone, Botswana; Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Scott Dryden-Peterson
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; Botswana Harvard AIDS Institute, Gaborone, Botswana; Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | | | - Akila N Viswanathan
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, Maryland
| | - Nicola M Zetola
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Botswana University of Pennsylvania Partnership, Gaborone, Botswana
| | - Lilie L Lin
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
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15
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Dryden-Peterson S, Bvochora-Nsingo M, Suneja G, Efstathiou JA, Grover S, Chiyapo S, Ramogola-Masire D, Kebabonye-Pusoentsi M, Clayman R, Mapes AC, Tapela N, Asmelash A, Medhin H, Viswanathan AN, Russell AH, Lin LL, Kayembe MKA, Mmalane M, Randall TC, Chabner B, Lockman S. HIV Infection and Survival Among Women With Cervical Cancer. J Clin Oncol 2017; 34:3749-3757. [PMID: 27573661 DOI: 10.1200/jco.2016.67.9613] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Purpose Cervical cancer is the leading cause of cancer death among the 20 million women with HIV worldwide. We sought to determine whether HIV infection affected survival in women with invasive cervical cancer. Patients and Methods We enrolled sequential patients with cervical cancer in Botswana from 2010 to 2015. Standard treatment included external beam radiation and brachytherapy with concurrent cisplatin chemotherapy. The effect of HIV on survival was estimated by using an inverse probability weighted marginal Cox model. Results A total of 348 women with cervical cancer were enrolled, including 231 (66.4%) with HIV and 96 (27.6%) without HIV. The majority (189 [81.8%]) of women with HIV received antiretroviral therapy before cancer diagnosis. The median CD4 cell count for women with HIV was 397 (interquartile range, 264 to 555). After a median follow-up of 19.7 months, 117 (50.7%) women with HIV and 40 (41.7%) without HIV died. One death was attributed to HIV and the remaining to cancer. Three-year survival for the women with HIV was 35% (95% CI, 27% to 44%) and 48% (95% CI, 35% to 60%) for those without HIV. In an adjusted analysis, HIV infection significantly increased the risk for death among all women (hazard ratio, 1.95; 95% CI, 1.20 to 3.17) and in the subset that received guideline-concordant curative treatment (hazard ratio, 2.63; 95% CI, 1.05 to 6.55). The adverse effect of HIV on survival was greater for women with a more-limited stage cancer ( P = .035), those treated with curative intent ( P = .003), and those with a lower CD4 cell count ( P = .036). Advanced stage and poor treatment completion contributed to high mortality overall. Conclusion In the context of good access to and use of antiretroviral treatment in Botswana, HIV infection significantly decreases cervical cancer survival.
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Affiliation(s)
- Scott Dryden-Peterson
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Memory Bvochora-Nsingo
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Gita Suneja
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Jason A Efstathiou
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Surbhi Grover
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Sebathu Chiyapo
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Doreen Ramogola-Masire
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Malebogo Kebabonye-Pusoentsi
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Rebecca Clayman
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Abigail C Mapes
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Neo Tapela
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Aida Asmelash
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Heluf Medhin
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Akila N Viswanathan
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Anthony H Russell
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Lilie L Lin
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Mukendi K A Kayembe
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Mompati Mmalane
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Thomas C Randall
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Bruce Chabner
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
| | - Shahin Lockman
- Scott Dryden-Peterson, Akila N. Viswanathan, and Shahin Lockman, Brigham and Women's Hospital; Scott Dryden-Peterson and Shahin Lockman, Harvard T.H. Chan School of Public Health; Scott Dryden-Peterson, Jason A. Efstathiou, Akila N. Viswanathan, Anthony H. Russell, Thomas C. Randall, Bruce Chabner, and Shahin Lockman, Harvard Medical School; Jason A. Efstathiou, Rebecca Clayman, Anthony H. Russell, Thomas C. Randall, and Bruce Chabner, Massachusetts General Hospital; Akila N. Viswanathan, Dana-Farber Cancer Institute, Boston, MA; Scott Dryden-Peterson, Abigail C. Mapes, Neo Tapela, Aida Asmelash, Mompati Mmalane, and Shahin Lockman, Botswana Harvard AIDS Institute Partnership; Memory Bvochora-Nsingo, Gaborone Private Hospital; Sebathu Chiyapo, Princess Marina Hospital; Doreen Ramogola-Masire, Botswana-University of Pennsylvania Partnership; Malebogo Kebabonye-Pusoentsi, Neo Tapela, Heluf Medhin, and Mukendi K.A. Kayembe, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Salt Lake City, UT; and Surbhi Grover and Lilie L. Lin, University of Pennsylvania, Philadelphia, PA
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Buscariollo D, Bagley A, Suneja G, Bvochora-Nsingo M, Niemierko A, Grover S, Chiyapo S, Mmalane M, Taghian A, Efstathiou J, Dryden-Peterson S. Postoperative Radiation Therapy Utilization for Localized Breast Cancer in Botswana. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Suneja G, Brown D, Chang A, Erickson B, Fidarova E, Grover S, Mahantshetty U, Nag S, Narayan K, Bvochora-Nsingo M, Viegas C, Viswanathan AN, Lin MY, Gaffney D. American Brachytherapy Society: Brachytherapy treatment recommendations for locally advanced cervix cancer for low-income and middle-income countries. Brachytherapy 2016; 16:85-94. [PMID: 27919654 DOI: 10.1016/j.brachy.2016.10.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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: 07/28/2016] [Revised: 09/06/2016] [Accepted: 10/21/2016] [Indexed: 01/17/2023]
Abstract
PURPOSE Most cervix cancer cases occur in low-income and middle-income countries (LMIC), and outcomes are suboptimal, even for early stage disease. Brachytherapy plays a central role in the treatment paradigm, improving both local control and overall survival. The American Brachytherapy Society (ABS) aims to provide guidelines for brachytherapy delivery in resource-limited settings. METHODS AND MATERIALS A panel of clinicians and physicists with expertise in brachytherapy administration in LMIC was convened. A survey was developed to identify practice patterns at the authors' institutions and was also extended to participants of the Cervix Cancer Research Network. The scientific literature was reviewed to identify consensus papers or review articles with a focus on treatment of locally advanced, unresected cervical cancer in LMIC. RESULTS Of the 40 participants invited to respond to the survey, 32 responded (response rate 80%). Participants were practicing in 14 different countries including both high-income (China, Singapore, Taiwan, United Kingdom, and United States) and low-income or middle-income countries (Bangladesh, Botswana, Brazil, India, Malaysia, Pakistan, Philippines, Thailand, and Vietnam). Recommendations for modifications to existing ABS guidelines were reviewed by the panel members and are highlighted in this article. CONCLUSIONS Recommendations for treatment of locally advanced, unresectable cervical cancer in LMIC are presented. The guidelines comment on staging, external beam radiotherapy, use of concurrent chemotherapy, overall treatment duration, use of anesthesia, applicator choice and placement verification, brachytherapy treatment planning including dose and prescription point, recommended reporting and documentation, physics support, and follow-up.
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Affiliation(s)
| | - Derek Brown
- University of California San Diego, San Diego, CA
| | - Amy Chang
- Pamela Youde Nethersole Eastern Hospital, Hong Kong
| | | | | | - Surbhi Grover
- University of Pennsylvania, Philadelphia, PA; Princess Marina Hospital, Gaborone, Botswana
| | | | | | | | | | - Celia Viegas
- Instituto Nacional de Cancer- INCA, Rio de Janeiro, Brazil
| | | | - Ming Yin Lin
- Peter MacCallum Cancer Centre, Melbourne, Australia
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Makufa R, Bvochora-Nsingo M, Karumekayi T, Schneider RJ, Efstathiou JA, Dryden-Peterson S, Odom A, Shulman A, Pipman Y, Gierga DP. SU-F-P-09: A Global Medical Physics Collaboration for Implementation of Modern Radiotherapy in Botswana. Med Phys 2016. [DOI: 10.1118/1.4955716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Efstathiou JA, Heunis M, Karumekayi T, Makufa R, Bvochora-Nsingo M, Gierga DP, Suneja G, Grover S, Kasese J, Mmalane M, Moffat H, von Paleske A, Makhema J, Dryden-Peterson S. Establishing and Delivering Quality Radiation Therapy in Resource-Constrained Settings: The Story of Botswana. J Clin Oncol 2015; 34:27-35. [PMID: 26578607 DOI: 10.1200/jco.2015.62.8412] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
There is a global cancer crisis, and it is disproportionately affecting resource-constrained settings, especially in low- and middle-income countries (LMICs). Radiotherapy is a critical and cost-effective component of a comprehensive cancer control plan that offers the potential for cure, control, and palliation of disease in greater than 50% of patients with cancer. Globally, LMICs do not have adequate access to quality radiation therapy and this gap is particularly pronounced in sub-Saharan Africa. Although there are numerous challenges in implementing a radiation therapy program in a low-resource setting, providing more equitable global access to radiotherapy is a responsibility and investment worth prioritizing. We outline a systems approach and a series of key questions to direct strategy toward establishing quality radiation services in LMICs, and highlight the story of private-public investment in Botswana from the late 1990s to the present. After assessing the need and defining the value of radiation, we explore core investments required, barriers that need to be overcome, and assets that can be leveraged to establish a radiation program. Considerations addressed include infrastructure; machine choice; quality assurance and patient safety; acquisition, development, and retention of human capital; governmental engagement; public-private partnerships; international collaborations; and the need to critically evaluate the program to foster further growth and sustainability.
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Affiliation(s)
- Jason A Efstathiou
- Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo, Zimbabwe.
| | - Magda Heunis
- Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo, Zimbabwe
| | - Talkmore Karumekayi
- Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo, Zimbabwe
| | - Remigio Makufa
- Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo, Zimbabwe
| | - Memory Bvochora-Nsingo
- Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo, Zimbabwe
| | - David P Gierga
- Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo, Zimbabwe
| | - Gita Suneja
- Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo, Zimbabwe
| | - Surbhi Grover
- Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo, Zimbabwe
| | - Joseph Kasese
- Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo, Zimbabwe
| | - Mompati Mmalane
- Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo, Zimbabwe
| | - Howard Moffat
- Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo, Zimbabwe
| | - Alexander von Paleske
- Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo, Zimbabwe
| | - Joseph Makhema
- Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo, Zimbabwe
| | - Scott Dryden-Peterson
- Jason A. Efstathiou, David P. Gierga, Massachusetts General Hospital, Harvard Medical School; Scott Dryden-Peterson, Brigham and Women's Hospital, Boston, MA; Magda Heunis, University of Stellenbosch and Tygerberg Hospital, Cape Town, South Africa; Talkmore Karumekayi, Remigio Makufa, and Memory Bvochora-Nsingo, Gaborone Private Hospital; Joseph Kasese, Bokamoso Private Hospital; Mompati Mmalane, Joseph Makhema, and Scott Dryden-Peterson, Botswana Harvard AIDS Institute; Howard Moffat, Botswana Ministry of Health, Gaborone, Botswana; Gita Suneja, University of Utah School of Medicine, Huntsman Cancer Hospital, Salt Lake City, UT; Surbhi Grover, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; and Alexander von Paleske, Mpilo-Hospital, University of Zimbabwe, Bulawayo, Zimbabwe
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Grover S, Raesima M, Bvochora-Nsingo M, Chiyapo SP, Balang D, Tapela N, Balogun O, Kayembe MKA, Russell AH, Monare B, Tanyala S, Bhat J, Thipe K, Nchunga M, Mayisela S, Kizito B, Ho-Foster A, Gaolebale BE, Gaolebale PA, Efstathiou JA, Dryden-Peterson S, Zetola N, Hahn SM, Robertson ES, Lin LL, Morroni C, Ramogola-Masire D. Cervical Cancer in Botswana: Current State and Future Steps for Screening and Treatment Programs. Front Oncol 2015; 5:239. [PMID: 26579491 PMCID: PMC4630577 DOI: 10.3389/fonc.2015.00239] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [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: 07/14/2015] [Accepted: 10/09/2015] [Indexed: 12/03/2022] Open
Abstract
Botswana has a high burden of cervical cancer due to a limited screening program and high HIV prevalence. About 60% of the cervical cancer patients are HIV positive; most present with advanced cervical disease. Through initiatives by the Botswana Ministry of Health and various strategic partnerships, strides have been made in treatment of pre-invasive and invasive cancer. The See and Treat program for cervical cancer is expanding throughout the country. Starting in 2015, school-going girls will be vaccinated against HPV. In regards to treatment of invasive cancer, a multidisciplinary clinic has been initiated at the main oncology hospital to streamline care. However, challenges remain such as delays in treatment, lack of trained human personnel, limited follow-up care, and little patient education. Despite improvements in the care of pre-invasive and invasive cervical cancer patients, for declines in cervical cancer-related morbidity and mortality to be achieved, Botswana needs to continue to invest in decreasing the burden of disease and improving patient outcomes of patients with cervical cancer.
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Affiliation(s)
- Surbhi Grover
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA ; Botswana University of Pennsylvania Partnership , Gaborone , Botswana
| | - Mmakgomo Raesima
- National Cervical Cancer Prevention Programme, Ministry of Health , Gaborone , Botswana
| | | | | | - Dawn Balang
- Department of Oncology, Gaborone Private Hospital , Gaborone , Botswana
| | - Neo Tapela
- Princess Marina Hospital , Gaborone , Botswana ; Division of Global Health Equity, Brigham and Women's Hospital , Boston, MA , USA
| | - Onyinye Balogun
- Department of Radiation Oncology, New York University Perlmutter Cancer Center , New York, NY , USA
| | | | - Anthony H Russell
- Department of Radiation Oncology, Massachusetts General Hospital , Boston, MA , USA
| | - Barati Monare
- Botswana University of Pennsylvania Partnership , Gaborone , Botswana
| | - Senate Tanyala
- Botswana University of Pennsylvania Partnership , Gaborone , Botswana
| | - Jailakshmi Bhat
- Botswana University of Pennsylvania Partnership , Gaborone , Botswana
| | - Kealeboga Thipe
- Botswana University of Pennsylvania Partnership , Gaborone , Botswana
| | - Metlha Nchunga
- Botswana University of Pennsylvania Partnership , Gaborone , Botswana
| | - Susan Mayisela
- Botswana University of Pennsylvania Partnership , Gaborone , Botswana
| | - Balladiah Kizito
- Botswana University of Pennsylvania Partnership , Gaborone , Botswana
| | - Ari Ho-Foster
- Botswana University of Pennsylvania Partnership , Gaborone , Botswana ; Department of Medicine, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | | | | | - Jason A Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital , Boston, MA , USA
| | | | - Nicola Zetola
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Stephen M Hahn
- Division of Radiation Oncology, University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Erle S Robertson
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Lilie L Lin
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Chelsea Morroni
- Botswana University of Pennsylvania Partnership , Gaborone , Botswana ; Department of Medicine, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA ; School of Medicine, University of Botswana , Gaborone , Botswana ; Institute for Women's Health, University College London , London , UK ; Institute for Global Health, University College London , London , UK
| | - Doreen Ramogola-Masire
- Botswana University of Pennsylvania Partnership , Gaborone , Botswana ; Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA ; Department of Obstetrics and Gynecology, Faculty of Medicine, University of Botswana , Gaborone , Botswana
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