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Mezger NCS, Hämmerl L, Griesel M, Seraphin TP, Joko-Fru YW, Feuchtner J, Zietsman A, Péko JF, Tadesse F, Buziba NG, Wabinga H, Nyanchama M, Chokunonga E, Kéita M, N’da G, Lorenzoni CF, Akele-Akpo MT, Mezger JM, Binder M, Liu B, Bauer M, Henke O, Jemal A, Kantelhardt EJ. Guideline Concordance of Treatment and Outcomes Among Adult Non-Hodgkin Lymphoma Patients in Sub-Saharan Africa: A Multinational, Population-Based Cohort. Oncologist 2023; 28:e1017-e1030. [PMID: 37368350 PMCID: PMC10628567 DOI: 10.1093/oncolo/oyad157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 04/24/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Although non-Hodgkin lymphoma (NHL) is the 6th most common malignancy in Sub-Saharan Africa (SSA), little is known about its management and outcome. Herein, we examined treatment patterns and survival among NHL patients. METHODS We obtained a random sample of adult patients diagnosed between 2011 and 2015 from 11 population-based cancer registries in 10 SSA countries. Descriptive statistics for lymphoma-directed therapy (LDT) and degree of concordance with National Comprehensive Cancer Network (NCCN) guidelines were calculated, and survival rates were estimated. FINDINGS Of 516 patients included in the study, sub-classification was available for 42.1% (121 high-grade and 64 low-grade B-cell lymphoma, 15 T-cell lymphoma and 17 otherwise sub-classified NHL), whilst the remaining 57.9% were unclassified. Any LDT was identified for 195 of all patients (37.8%). NCCN guideline-recommended treatment was initiated in 21 patients. This corresponds to 4.1% of all 516 patients, and to 11.7% of 180 patients with sub-classified B-cell lymphoma and NCCN guidelines available. Deviations from guideline-recommended treatment were initiated in another 49 (9.5% of 516, 27.2% of 180). By registry, the proportion of all patients receiving guideline-concordant LDT ranged from 30.8% in Namibia to 0% in Maputo and Bamako. Concordance with treatment recommendations was not assessable in 75.1% of patients (records not traced (43.2%), traced but no sub-classification identified (27.8%), traced but no guidelines available (4.1%)). By registry, diagnostic work-up was in part importantly limited, thus impeding guideline evaluation significantly. Overall 1-year survival was 61.2% (95%CI 55.3%-67.1%). Poor ECOG performance status, advanced stage, less than 5 cycles and absence of chemo (immuno-) therapy were associated with unfavorable survival, while HIV status, age, and gender did not impact survival. In diffuse large B-cell lymphoma, initiation of guideline-concordant treatment was associated with favorable survival. INTERPRETATION This study shows that a majority of NHL patients in SSA are untreated or undertreated, resulting in unfavorable survival. Investments in enhanced diagnostic services, provision of chemo(immuno-)therapy and supportive care will likely improve outcomes in the region.
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Affiliation(s)
- Nikolaus Christian Simon Mezger
- Global Health Working Group, Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Lucia Hämmerl
- Global Health Working Group, Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Mirko Griesel
- Global Health Working Group, Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Tobias Paul Seraphin
- Global Health Working Group, Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Yvonne Walburga Joko-Fru
- African Cancer Registry Network, Oxford, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jana Feuchtner
- Global Health Working Group, Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Annelle Zietsman
- African Cancer Registry Network, Oxford, UK
- Dr AB May Cancer Care Centre, Windhoek, Namibia
| | - Jean-Félix Péko
- African Cancer Registry Network, Oxford, UK
- Registre des cancers de Brazzaville, Brazzaville, Republic of the Congo
| | - Fisihatsion Tadesse
- African Cancer Registry Network, Oxford, UK
- Division of Hematology, Department of Internal Medicine, University and Black Lion Hospital, Addis Ababa, Ethiopia
| | - Nathan Gyabi Buziba
- African Cancer Registry Network, Oxford, UK
- Eldoret Cancer Registry, School of Medicine, Moi University, Eldoret, Kenya
| | - Henry Wabinga
- African Cancer Registry Network, Oxford, UK
- Kampala Cancer Registry, Makerere University School of Medicine, Kampala, Uganda
| | - Mary Nyanchama
- African Cancer Registry Network, Oxford, UK
- National Cancer Registry, Kenya Medical Research Institute, Nairobi, Kenya
| | - Eric Chokunonga
- African Cancer Registry Network, Oxford, UK
- Zimbabwe National Cancer Registry, Harare, Zimbabwe
| | - Mamadou Kéita
- African Cancer Registry Network, Oxford, UK
- Service du Laboratoire d’Anatomie et Cytologie Pathologique, Bamako, Mali
- CHU du point G , Bamako, Mali
| | - Guy N’da
- African Cancer Registry Network, Oxford, UK
- Registre des cancers d’Abidjan, Abidjan, Côte d’Ivoire
| | - Cesaltina Ferreira Lorenzoni
- African Cancer Registry Network, Oxford, UK
- Departamento de Patologia, Faculdade de Medicina, Universidade Eduardo Mondlane, Hospital Central de Maputo, Mozambique
- Registo de Cancro, Ministério da Saúde, Maputo, Mozambique
| | - Marie-Thérèse Akele-Akpo
- African Cancer Registry Network, Oxford, UK
- Département d’anatomo-pathologie, Faculté des Sciences de la Santé, Cotonou, Benin
| | | | - Mascha Binder
- Department of Internal Medicine IV, Oncology/Hematology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Biying Liu
- African Cancer Registry Network, Oxford, UK
| | - Marcus Bauer
- Institute of Pathology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Oliver Henke
- Section Global Health, Institute for Public Health and Hygiene, University Hospital Bonn, Germany
| | - Ahmedin Jemal
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, USA
| | - Eva Johanna Kantelhardt
- Global Health Working Group, Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
- Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
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Seraphin TP, Joko-Fru WY, Hämmerl L, Griesel M, Mezger NCS, Feuchtner JC, Adoubi I, Egué MDD, Okerosi N, Wabinga H, Hansen R, Vuma S, Lorenzoni C, Coulibaly B, Odzebe SW, Buziba NG, Aynalem A, Liu B, Medenwald D, Mikolajczyk RT, Efstathiou JA, Parkin DM, Jemal A, Kantelhardt EJ. Presentation, patterns of care, and outcomes of patients with prostate cancer in sub-Saharan Africa: A population-based registry study. Cancer 2021; 127:4221-4232. [PMID: 34328216 DOI: 10.1002/cncr.33818] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 10/31/2020] [Revised: 04/17/2021] [Accepted: 05/18/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Although prostate cancer (PCa) is the most commonly diagnosed cancer in men of sub-Saharan Africa (SSA), little is known about its management and survival. The objective of the current study was to describe the presentation, patterns of diagnosis, treatment, and survival of patients with PCa in 10 countries of SSA. METHODS In this observational registry study with data collection from 2010 to 2018, the authors drew a random sample of 738 patients with PCa who were registered in 11 population-based cancer registries. They described proportions of patients receiving recommended care and presented survival estimates. Multivariable Cox regression was used to calculate hazard ratios comparing the survival of patients with and without cancer-directed therapies (CDTs). RESULTS The study included 693 patients, and tumor characteristics and treatment information were available for 365 patients, 37.3% of whom had metastatic disease. Only 11.2% had a complete diagnostic workup for risk stratification. Among the nonmetastatic patients, 17.5% received curative-intent therapy, and 27.5% received no CDT. Among the metastatic patients, 59.6% received androgen deprivation therapy. The 3- and 5-year age-standardized relative survival for 491 patients with survival time information was 58.8% (95% confidence interval [CI], 48.5%-67.7%) and 56.9% (95% CI, 39.8%-70.9%), respectively. In a multivariable analysis, survival was considerably poorer among patients without CDT versus those with therapy. CONCLUSIONS This study shows that a large proportion of patients with PCa in SSA are not staged or are insufficiently staged and undertreated, and this results in unfavorable survival. These findings reemphasize the need for improving diagnostic workup and access to care in SSA in order to mitigate the heavy burden of the disease in the region.
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Affiliation(s)
- Tobias Paul Seraphin
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Walburga Yvonne Joko-Fru
- African Cancer Registry Network, International Network for Cancer Treatment and Research African Registry Programme, Oxford, United Kingdom
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Lucia Hämmerl
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Mirko Griesel
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Nikolaus Christian Simon Mezger
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Jana Cathrin Feuchtner
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Innocent Adoubi
- Department of Immunology, Haematology and Oncology, University of Felix Houphouet-Boigny, Abidjan, Côte d'Ivoire
- Abidjan Cancer Registry, Programme National de Lutte contre le Cancer, Ministry of Health, Abidjan, Côte d'Ivoire
| | | | - Nathan Okerosi
- National Cancer Registry, Kenya Medical Research Institute, Nairobi, Kenya
| | - Henry Wabinga
- Kampala Cancer Registry, Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rolf Hansen
- Namibia National Cancer Registry, Cancer Association of Namibia, Windhoek, Namibia
| | - Samukeliso Vuma
- Bulawayo Cancer Registry, Department of Radiotherapy, Mpilo Hospital, Bulawayo, Zimbabwe
| | - Cesaltina Lorenzoni
- National Cancer Control Programme, Ministry of Health, Maputo, Mozambique
- Maputo Cancer Registry, Department of Pathology, Hospital Central de Maputo, Maputo, Mozambique
| | - Bourama Coulibaly
- Cancer Registry of Bamako, Hôpital National du Point G, Bamako, Mali
| | - Sévérin W Odzebe
- Cancer Registry of Brazzaville, University Hospital Brazzaville, Brazzaville, Republic of Congo
| | - Nathan Gyabi Buziba
- Eldoret Cancer Registry, Moi Teaching Hospital, Eldoret, Kenya
- Department of Haematology and Blood Transfusion, Moi University School of Medicine, Eldoret, Kenya
| | - Abreha Aynalem
- Addis Ababa City Cancer Registry, Radiotherapy Center, Addis-Ababa-University, Addis Ababa, Ethiopia
| | - Biying Liu
- African Cancer Registry Network, International Network for Cancer Treatment and Research African Registry Programme, Oxford, United Kingdom
| | - Daniel Medenwald
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Rafael T Mikolajczyk
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Jason Alexander Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
- Claire and John Bertucci Center for Genitourinary Cancers Multidisciplinary Clinic, Massachusetts General Hospital, Boston, Massachusetts
| | - Donald Maxwell Parkin
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Cancer Surveillance Unit, International Agency for Research on Cancer, Lyon, France
| | - Ahmedin Jemal
- Surveillance & Health Equity Science Department, American Cancer Society, Atlanta, Georgia
| | - Eva Johanna Kantelhardt
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Department of Gynecology, University Hospital Halle, Martin Luther University Halle-Wittenberg, Halle, Germany
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Gullickson C, Goodman M, Joko-Fru YW, Gnangnon FHR, N'Da G, Woldegeorgis MA, Buziba NG, Karugu C, Manraj SS, Lorenzoni CF, Hansen R, Finesse A, Somdyala NIM, Bukirwa P, Chingonzoh T, Chokunonga E, Liu B, Kantelhardt E, Parkin DM, Jemal A. Colorectal cancer survival in sub-Saharan Africa by age, stage at diagnosis and Human Development Index: A population-based registry study. Int J Cancer 2021; 149:1553-1563. [PMID: 34164808 DOI: 10.1002/ijc.33715] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/06/2021] [Accepted: 06/08/2021] [Indexed: 02/05/2023]
Abstract
There are limited population-based survival data for colorectal cancer (CRC) in sub-Saharan Africa. Here, 1707 persons diagnosed with CRC from 2005 to 2015 were randomly selected from 13 population-based cancer registries operating in 11 countries in sub-Saharan Africa. Vital status was ascertained from medical charts or through next of kin. 1-, 3- and 5-year overall and relative survival rates for all registries and for each registry were calculated using the Kaplan-Meier estimator. Multivariable analysis was used to examine the associations of 5-year relative survival with age at diagnosis, stage and country-level Human Development Index (HDI). Observed survival for 1448 patients with CRC across all registries combined was 72.0% (95% CI 69.5-74.4%) at 1 year, 50.4% (95% CI 47.6-53.2%) at 3 years and 43.5% (95% CI 40.6-46.3%) at 5 years. We estimate that relative survival at 5 years in these registry populations is 48.2%. Factors associated with poorer survival included living in a country with lower HDI, late stage at diagnosis and younger or older age at diagnosis (<50 or ≥70 years). For example, the risk of death was 1.6 (95% CI 1.2-2.1) times higher for patients residing in medium-HDI and 2.7 (95% CI 2.2-3.4) times higher for patients residing in low-HDI compared to those residing in high-HDI countries. Survival for CRC remains low in sub-Saharan African countries, though estimates vary considerably by HDI. Strengthening health systems to ensure access to prevention, early diagnosis and appropriate treatment is critical in improving outcomes of CRC in the region.
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Affiliation(s)
- Cricket Gullickson
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael Goodman
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Yvonne W Joko-Fru
- The African Cancer Registry Network, INCTR African Registry Programme, Oxford, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Guy N'Da
- Abidjan Cancer Registry, Abidjan, Côte d'Ivoire
| | | | | | | | - Shyam S Manraj
- Mauritius National Cancer Registry, Port Louis, Mauritius
| | | | | | - Anne Finesse
- Seychelles National Cancer Registry, Victoria, Seychelles
| | | | | | | | | | - Biying Liu
- The African Cancer Registry Network, INCTR African Registry Programme, Oxford, UK
| | - Eva Kantelhardt
- Institute of Medical Epidemiology, Biostatistics and Informatics, Martin Luther University Halle-Wittenberg, Halle, Germany
- Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Donald M Parkin
- The African Cancer Registry Network, INCTR African Registry Programme, Oxford, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Cancer Surveillance Unit, International Agency for Research on Cancer, Lyon, France
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Jedy-Agba E, Joko WY, Liu B, Buziba NG, Borok M, Korir A, Masamba L, Manraj SS, Finesse A, Wabinga H, Somdyala N, Parkin DM. Trends in cervical cancer incidence in sub-Saharan Africa. Br J Cancer 2020; 123:148-154. [PMID: 32336751 PMCID: PMC7341858 DOI: 10.1038/s41416-020-0831-9] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 02/17/2020] [Accepted: 03/18/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cervical cancer is the second most common cancer and the leading cause of cancer death in women in sub-Saharan Africa (SSA). METHODS Trends in the incidence of cervical cancer are examined for a period of 10-25 years in 10 population-based cancer registries across eight SSA countries (Gambia, Kenya, Malawi, Mauritius, Seychelles, South Africa, Uganda and Zimbabwe). A total of 21,990 cases of cervical cancer were included in the analyses. RESULTS Incidence rates had increased in all registries for some or all of the periods studied, except for Mauritius with a constant annual 2.5% decline. Eastern Cape and Blantyre (Malawi) registries showed significant increases over time, with the most rapid being in Blantyre (7.9% annually). In Kampala (Uganda), a significant increase was noted (2.2%) until 2006, followed by a non-significant decline. In Eldoret, a decrease (1998-2002) was followed by a significant increase (9.5%) from 2002 to 2016. CONCLUSION Overall, cervical cancer incidence has been increasing in SSA. The current high-level advocacy to reduce the burden of cervical cancer in SSA needs to be translated into support for prevention (vaccination against human papillomavirus and population-wide screening), with careful monitoring of results through population-based registries.
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Affiliation(s)
- Elima Jedy-Agba
- International Research Center of Excellence, Institute of Human Virology, Abuja, Nigeria.
| | - Walburga Yvonne Joko
- Clinical Trials Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Biying Liu
- African Cancer Registry Network, Prama House, 267 Banbury Road, Oxford, UK
| | | | - Margaret Borok
- Zimbabwe National Cancer Registry, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Anne Korir
- Nairobi Cancer Registry, Kenya Medical Research Institute, Nairobi, Kenya
| | - Leo Masamba
- University of Malawi College of Medicine and Queen Elizabeth Central Hospital Cancer Unit, Blantyre, Malawi
| | - Shyam Shunker Manraj
- Mauritius National Cancer Registry, Mauritius Institute of Health, Pamplemousses, Mauritius
| | - Anne Finesse
- Seychelles National Cancer Registry, Ministry of Health, Victoria, Seychelles
| | - Henry Wabinga
- Department of Pathology, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Nontuthuzelo Somdyala
- Eastern Cape Cancer Registry, Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Donald Maxwell Parkin
- Clinical Trials Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- International Agency for Research on Cancer, Lyon, France
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Mostert S, Njuguna F, van de Ven PM, Olbara G, Kemps LJPA, Musimbi J, Strother RM, Aluoch LM, Skiles J, Buziba NG, Sitaresmi MN, Vreeman RC, Kaspers GJL. Influence of health-insurance access and hospital retention policies on childhood cancer treatment in Kenya. Pediatr Blood Cancer 2014; 61:913-8. [PMID: 24347434 DOI: 10.1002/pbc.24896] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [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: 10/03/2013] [Accepted: 11/15/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND Kenyan national policies for public hospitals dictate that patients are retained on hospital wards until their hospital bills are paid, but this payment process differs for patients with or without access to National Hospital Insurance Fund (NHIF) at diagnosis. Whether these differences impact treatment outcomes has not been described. Our study explores whether childhood cancer treatment outcomes in Kenya are influenced by health-insurance status and hospital retention policies. PROCEDURE This study combined retrospective review of medical records with an illustrative case report. We identified children diagnosed with malignancies at a large Kenyan academic hospital between 2007 and 2009, their treatment outcomes, and health-insurance status at diagnosis. RESULTS Between 2007 and 2009, 222 children were diagnosed with malignancies. Among 180 patients with documented treatment outcome, 54% abandoned treatment, 22% had treatment-related death, 4% progressive/relapsed disease, and 19% event-free survival. Health-insurance status at diagnosis was recorded in 148 children: 23% had NHIF and 77% had no NHIF. For children whose families had NHIF compared with those who did not, the relative risk for treatment abandonment relative to event-free survival was significantly smaller (relative-risk ratio = 0.31, 95% CI = 0.12-0.81, P = 0.016). The case report illustrates difficulties that Kenyan families might face when their child is diagnosed with cancer, has no NHIF, and is retained in hospital. CONCLUSIONS Children with NHIF at diagnosis had significantly lower chance of abandoning treatment and higher chance of survival. Childhood cancer treatment outcomes could be improved by interventions that prevent treatment abandonment and improve access to NHIF. Hospital retention of patients over unpaid medical bills must stop.
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Affiliation(s)
- S Mostert
- Department of Pediatric Oncology-Hematology and Doctor 2 Doctor Program, VU University Medical Center, Amsterdam, The Netherlands
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Abstract
BACKGROUND Cancer regisries worldwide have evolved to provide useful information on the burden and diversity of the patterns of cancer, information that is vital for establishing appropriate programmes for disease management. Population based data on cancer in western Kenya as captured in the Eldoret cancer registry established in 1999 is analysed and reported in this paper. OBJECTIVE To determine the burden and pattern of cancer in Western Kenya by use of data from the Eldoret cancer registry. DESIGN Retrospective study. SETTING The cancer registry located in the Department of Haematology at the Moi University, School of Medicine situated at the Moi Teaching and Referral Hospital, Eldoret, Kenya. The hospital has a catchment population of 13 to 15 million people forming about 40% of the Kenyan population. RESULTS A total of 5,366 patients were diagnosed to have cancer and attended to at the MTRH and other hospitals in Eldoret during the period between January 1999 and December 2006 giving an average of 671 cases per year. Among those treated 2,699 were males and 2,667 were females giving a M: F ratio of 1:1. About 21% of the patients had haematological malignancies with non-Hodgkins lymphoma being the most common. Another 79% of the patients had solid tumours with cancer of the oesophagus being the commonest. Cancer of the cervix and prostrate were the commonest among the females and males respectively. A general increase in the number of patients with Kaposis sarcoma associated with HIV/AIDS pandemic was observed. CONCLUSION The burden of cancer is a significant health problem in western Kenya and there is need for the development of a comprehensive cancer care programme in the region to address the growing problem.
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Affiliation(s)
- C N Tenge
- Department of Child Health and Paediatrics, School of Medicine, Moi University, P.O. Box 4606-30100, Eldoret, Kenya
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Were EO, Buziba NG. Presentation and health care seeking behaviour of patients with cervical cancer seen at Moi Teaching and Referral Hospital, Eldoret, Kenya. E Af Med Jrnl 2001; 78:55-9. [PMID: 11682945 DOI: 10.4314/eamj.v78i2.9088] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the clinicopathological characteristics and health care seeking behaviour of cervical cancer patients seen at Moi Teaching and Referral Hospital (MTRH). DESIGN Prospective cross-sectional study. SETTING Gynaecology Unit, Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya. SUBJECTS Forty-two consecutive cervical cancer patients seen at MTRH gynaecology unit between May 1998 and November 1999. RESULTS The mean age of the patients was 49.4 years (95% CI 45.4 to 53.3 years) range 24 to 80 years. All had been married and 42.9% had been in polygamous unions. Slightly more than seventy six per cent had had five or more confirmed pregnancies. Contraceptive everuse was 22%. The mean duration of clinical symptoms on presentation at MTRH was 8.2 months (95% CI 6.5 to 9.8 months) range 1 to 24 months. Female relatives and husbands were the first to be told about the symptoms by 90.3% of the patients and husbands alone by 48.8% of the patients. More than ninety per cent of patients sought health for the first time at a facility manned by trained health worker, with 39% visiting a dispensary or health centre first. More than 95% of patients had tumour stage 2 and above. Histopathologically, 80.9% of the tumours were squamous cell carcinoma, 11.9% were adenocarcinoma while the rest were anaplastic. CONCLUSION Patients with cervical cancer present late for treatment at MTRH. They are most likely to have discussed their illness with their female relatives and husbands and to have first visited peripheral facilities manned by trained healthcare workers. Interventions to improve health care seeking behaviour among cervical cancer patients need to include education of husbands in addition to increasing awareness of the disease among private medical practitioners and health workers at dispensary and health centre level.
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Affiliation(s)
- E O Were
- Department of Reproductive Health, College of Health Sciences, Moi University, Eldoret, Kenya
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