Treatment of colorectal cancer in Sub‐Saharan Africa: Results from a prospective Nigerian hospital registry

Abstract

BackgroundColorectal cancer (CRC) is the third most common cancer worldwide. Mortality for CRC is improving in high income countries, but in low and middle income countries, rates of disease and death from disease are rising. In Sub‐Saharan Africa, the ratio of CRC mortality to incidence is the highest in the world. This study investigated the nature of CRC treatment currently being offered and received in Nigeria.MethodsBetween April 2013 and October 2017, a prospective study of consecutively diagnosed cases of CRC was conducted. Patient demographics, clinical features, and treatment recommended and received was recorded for each case. Patients were followed during the study period every 3 months or until death.ResultsThree hundred patients were included in our analysis. Seventy‐one percent of patients received a recommended surgical operation. Of those that didn't undergo surgery as recommended, 37% cited cost as the main reason, 30% declined due to personal reasons, and less than 5% absconded or were lost to follow up. Approximately half of patients (50.5%) received a chemotherapy regimen when it was recommended, and 4.1% received radiotherapy when this was advised as optimal treatment. With therapy, the median overall survival for patients diagnosed with stage III and stage IV CRC was 24 and 10.5 months respectively. Overall, we found significantly better median survival for patients that received the recommended treatment (25 vs 7 months; P < .01).ConclusionsA number of patients were unable to receive the recommended treatment, reflecting some of the burden of untreated CRC in the region. Receiving the recommended treatment was associated with a significant difference in outcome. Improved healthcare financing, literacy, training, access, and a better understanding of tumor biology will be necessary to address this discrepancy.

Demographic, clinical and pathological characterisation of patients with colorectal and anal cancer followed between 2013 and 2016 at Maputo Central Hospital, Mozambique

“…The relatively low rate of histological confirmation occurred because a considerable number of patients were not biopsied because they presented with an advanced stage of the disease at the time of diagnosis, with extremely poor performance status and needed the best supportive care. Similar situations occurred in other African countries, where a high number of patients are not deemed fit for treatment at the time of diagnosis [17]. In Africa, cancer of the anus is associated with HIV [9] and we also noted a higher prevalence of HIV in these patients in our series.…”

“…Late diagnosis is a major issue in SSA. In 300 consecutive patients that were enrolled in a recent Nigerian study, most of them were also at an advanced stage with distant metastases [ 17 ]. It is widely believed that the incidence of CRC in SSA countries still does not justify the establishment of organised screening.…”

Treatment and Outcomes of Colorectal Cancer in Armenia: A Real-World Experience From a Developing Country

“…Nevertheless, these therapeutic modalities were found to improve survival when incorporated in the treatment plan. 25 , 27 , 28 , 29 Five-year survival rates in some of these regions are much lower than in the developed world. 25…”

Prognostic significance of BIRC7/Livin, Bcl-2, p53, Annexin V, PD-L1, DARC, MSH2 and PMS2 in colorectal cancer treated with FOLFOX chemotherapy with or without aspirin

“…However, in sub-Saharan Africa, where cancer registries may lack sufficient resources and there exists a paucity in cancer research, CRC disproportionately presents with advanced stage at diagnosis and a high mortality rate compared to the Western world [ 2 , 3 ]. These CRC disparities are due in part to issues that include grossly inadequate resources [ 4 ] and decreased prioritization of research that focuses on understanding the biology and clinicopathologic features of the disease. These challenges present an urgent need to advance our understanding of CRC in Black Africans in Africa in order to improve prevention, early diagnosis and address treatment resistance for better disease outcomes.…”