Cancer Treatment in Malawi: A Disease of Palliation

Abstract

BackgroundWorldwide, new cancer cases will nearly double in the next 20 years while disproportionately affecting low and middle income countries (LMICs). Cancer outcomes in LMICs also remain bleaker than other regions of the world. Despite this, little is known about cancer epidemiology and surgical treatment in LMICs. To address this we sought to describe the characteristics of cancer patients presenting to the Surgery Department at Kamuzu Central Hospital in Lilongwe, Malawi.MethodsWe conducted a retrospective review of adult (18 years or older) surgical oncology services at Kamuzu Central Hospital in Lilongwe, Malawi from 2007 - 2010. Data obtained from the operating theatre logs included patient demographics, indication for operative procedure, procedure performed, and operative procedures (curative, palliative, or staging).ResultsOf all the general surgery procedures performed during this time period (7,076 in total), 16% (406 cases) involved cancer therapy. The mean age of male and female patients in this study population was 52 years and 47 years, respectively. Breast cancer, colorectal cancer, gastric cancer, and melanoma were the most common cancers among women, whereas prostate, colorectal, pancreatic, and, gastric were the most common cancers in men. Although more than 50% of breast cancer operations were performed with curative intent, most procedures were palliative including prostate cancer (98%), colorectal cancer (69%), gastric cancer (71%), and pancreatic cancer (94%). Patients with colorectal, gastric, esophageal, pancreatic, and breast cancer presented at surprisingly young ages.ConclusionThe paucity of procedures with curative intent and young age at presentation reveals that many Malawians miss opportunities for cure and many potential years of life are lost. Though KCH now has pathology services, a cancer registry and a surgical training program, the focus of surgical care remains palliative. Further research should address other methods of increasing early cancer detection and treatment in such populations.

Surgical oncology at a major referral center in Ghana: Burden, staging, and outcomes

“…Our findings demonstrate a substantial burden of cancer patients in Ghana requiring general surgery admission. Similar to other reports in the literature from SSA, the most common cancer types seen here were breast, colorectal, and foregut . Majority of all admitted patients went on to undergo surgery (208, 61%) which is slightly higher than rates previously reported from Rwanda, where 46% of patients presenting for surgical evaluation underwent an operation .…”

“…In addition, most patients in our study who underwent surgery did so with curative intent (124, 60%). This differs from accounts in Malawi where, apart from breast operations, 70% to 94% of cancer procedures were with palliative intent . These findings may be a reflection of the need for building cancer‐specific surgical capacity aimed at improving outcomes for the increasing number of cancer patients in SSA.…”

“…Similar to other reports in the literature from SSA, the most common cancer types seen here were breast, colorectal, and foregut. [21][22][23] Majority of all admitted patients went on to undergo surgery (208, 61%) which is slightly higher than rates previously reported from Rwanda, where 46% of patients presenting for surgical evaluation underwent an operation. 24 In addition, most patients in our study who underwent surgery did so with curative intent (124, 60%…”

“…Hash marks indicate points of censorship, due to participants being lost to follow-up of cancer procedures were with palliative intent. 22 These findings may be a reflection of the need for building cancer-specific surgical capacity aimed at improving outcomes for the increasing number of cancer patients in SSA. They may also be the consequence of the often documented late-stage presentation among cancer patients in SSA.…”

Supply the demand: Assessment of the feasibility of local non-urologists in relieving the burden of chronic indwelling catheters in a low-income country

“…Patients with co-incidental malignancy were treated according to local standards and underwent bilateral orchiectomies one month following prostatectomy. 11 Of the remaining two patients, one patient had severe acute prostatitis and another patient had prostatic urethritis with ulceration. Interestingly, these patients were distinct from the two patients suffering from chronic UTIs pre-operatively.…”