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Treatment of colorectal cancer in Sub‐Saharan Africa: Results from a prospective Nigerian hospital registry
Author(s) -
Sharma Avinash,
Alatise Olusegun I.,
Adisa Adewale O.,
Arowolo Olukayode A.,
Olasehinde Olalekan,
Famurewa Olusola C.,
Omisore Adeleye D.,
Komolafe A. O.,
Olaofe O.,
Katung Aba I.,
Ibikunle Ayoola D.,
Egberongbe Ayoola A.,
Olatoke Samuel A.,
Agodirin S. O.,
Adesiyun A. O.,
Adeyeye Ademola,
Ibrahim K.,
Kolawole O. A.,
Idris O. L.,
Adejumobi M. O.,
Ajayi Adebowale I.,
Olakanmi Akinwumi O.,
Constable Jeremy C.,
Seier Ken,
Gonen Mithat,
Brennan Murray F.,
Kingham T. Peter
Publication year - 2020
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25768
Subject(s) - medicine , colorectal cancer , incidence (geometry) , regimen , prospective cohort study , cancer , stage (stratigraphy) , disease , radiation therapy , surgery , paleontology , physics , optics , biology
Abstract Background Colorectal 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. Methods Between 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. Results Three 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). Conclusions A 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.