A pilot study of cancer patients' use of traditional healers in the Radiotherapy Department, University College Hospital, Ibadan, Nigeria.

OBJECTIVE: This descriptive cross-sectional study assessed cancer patients' use of traditional healers, the association between delay in coming to this clinic and patients' use of traditional healers, reasons cancer patients use western medicine after trying traditional treatment and the cost of obtaining traditional treatment. METHODS: Participants were made of 400 consecutive and consenting new patients in the Department of Radiotherapy, University College Hospital (UCH), Ibadan. A validated interviewer-administered semi-structured questionnaire was used for data collection. Data was analyzed using descriptive and inferential statistics. Focus group discussions were held with some of the clients as well as the traditional healers. RESULTS: It showed that 34.5% of the patients patronized traditional healers, while 65.5% used only hospitals. The most common reason given among patients who patronized traditional healers for doing so was their desire to be healed and to be rid of pains (45.9%), while the most common reason they opt for western medicine afterwards was lack of improvement in their health condition (70.1%). The cost of traditional treatment for cancer ranged between no cost to N5,000 (that is approximately $31.25 @ $1 = N160) to be treated. The cost of orthodox care would range from a minimum of N40,000 to several millions of naira. CONCLUSIONS: Patients patronize traditional healers to be rid of pains; hence physicians should endeavor to control cancer-related symptoms, especially pains as the patients await diagnosis. Also, the low cost of obtaining traditional treatment, regular assurance of cure and other assistances given to them, could be an enticing factor in its use. Copyright © 2015 John Wiley & Sons, Ltd.

Radiation therapy interruption in a poor resource setting: causes and management..

BACKGROUND: Treatment interruption is the failure to execute approved treatment plan of a patient. This adversely affects treatment outcomeif not properly managed. This retrospective study causes and management of radiation treatment interruptions during High Dose Rate Brachytherapy(HDRB) for carcinoma of the cervix in a teaching hospital in Nigeria. METHODS: Five hundred patients with cervical carcinoma, who received HDRB, post external beam radiotherapy, between August, 2008 and July, 2013 were assessed. They were grouped into (A): those who experienced treatment interruption and (B): those who did not. Each patient was scheduled to receive three fractions of HDRB over 3 weeks. Those in groups A were assessed for the exact treatment fraction missed, the cause and duration of treatment interruption and the actions taken to compensate for non-execution of treatment. RESULTS: A total of 90 patients fall into group A and most (41) of them experienced interruptions in the third fraction of their treatment. The most frequent (44%) causes of treatment interruptions observed among them were patient-related. Record of compensation for treatment interruption was not found in patients' treatment folders. This action may be due to lack of functional procedures for managing treatment interruptions and insufficient follow-up of patients, who never came back for consideration for compensation. CONCLUSION: This study showed that radiation oncology centres need to review their policies for managing treatment interruptions and documentation. Also, the mechanism for patients' follow-up should be strengthened to a reasonable extent to achieve better radiotherapy care.

Pattern of oncologic emergencies seen in adult cancer patients attending the Radiotherapy and Oncology Centre, Ahmadu Bello University Teaching Hospital, Zaria - Nigeria.

AIMS AND OBJECTIVES: To evaluate the Pattern of Oncologic Emergencies seen in Adult cancer patients and the treatment modalities used. MATERIALS AND METHODS: Between January 2004 and December 2008, a total of 1824 (M:F = 1:1.8) new patients were seen. 196 (M:F = 1:1.4) consecutive patients with histologically confirmed malignancies presenting with or having oncologic emergencies were treated and have been reviewed. Patients' folders were reviewed retrospectively with a structured pro forma. Results were analysed using Epi Info soft ware Version 3.4.1; 2007 Edition. RESULTS: The median age was 49 years and mean age of 42 years (range, 15 - 82 years). M: F = 1:1.4. 162 patients had oncologic emergencies at presentation while 21 during treatments and 13 during follow up. At the time of diagnosis of oncologic emergency, 126 were not on any treatment, 42 patients on hormonal therapy and 28 patients were on diverse chemotherapy. All the patients presented late with 108 patients presenting with metastatic disease and 88 patients with locally advanced disease. Only 35 patients were treated within 1 week of onset of emergency. 59 patients had cervical cancer, 31 patients with breast cancer and 28 patients with prostate cancer. Tumour haemorrhage wass the commonest oncologic emergency seen in 107 patients followed by bone pain with imminent cord compression from bone metastases in 59 patients. Of 107 patients with tumour haemorrhage, 54 patients had cardiovascular collapse with 7 having acute renal failure. Similarly, of the 107 with tumour haemorrhage, 56 patients bled from cervical cancer, 12 patients from breast cancer and 8 patients from urinary bladder. 129 patients were treated with teletherapy, 31 patients had chemotherapy, 27 patients had emergency surgery and 5 patients had chemoradiation. Oncologic emergencies were corrected in 126 patients. CONCLUSION: Tumour haemorrhage is the commonest oncologic emergency in this environment and teletherapy is the commonest therapy used. More radiotherapy centres are needed for prompt treatment and their usefulness in managing emergencies should be made known. Oncologic emergencies are commonly seen in metastatic and locally advanced disease.

The pattern of chest radiographs findings in metastatic cancer patients seen in a tertiary hospital in northern Nigeria.

AIMS AND OBJECTIVES: To evaluate the pattern of chest radiographs findings in metastatic cancer patients at first presentation in a tertiary hospital in northern Nigeria with a view to contributing to existing literature and making recommendation for optimal patients care in Nigerian hospitals. PATIENTS AND METHODS: From January 2002 to December 2007, 712 new patients were seen and 688 patients' chest radiographs excluding children (below 16 yr) were reviewed of which 118 were considered abnormal due to pathology arising from primary cancer. Those Chest radiographs showing pathology not related to cancer were excluded. Results were analysed using EPI-Info, version 3.4.1. 2007. RESULTS: 118 (17%) patients' chest radiographs (CXR) were having evidence of metastases from primary cancer. The sex ratio is M: F = 1: 1.7 with a mean age of 48.1 years (Range 16 - 82 yrs). Breast cancer was the commonest cause of metastatic spread to the lungs seen in 44 (37.3%) patients followed by colorectal 10 (8.5%), soft tissue sarcoma 9 (7.6%), and bone sarcoma 8 (6.8%). Cervical cancer which was the commonest type of malignancies seen at presentation accounted only for 8 (6.7%) cases. Both lungs were involved in 62 (52.5%) patients, followed by right lung alone in 42 (35.6%) cases and left lung alone in 14 (11.9%) cases. The mid zone was the commonest site of lung metastases 102 (86.4%) followed by lower zone 42 (35.6%). Pleural effusion seen in 26 (22%) patients affected both lungs equally. Multiple lung metastases were the predominant pattern of metastases seen in 94 (80%) cases. Majority 82 (69.5%) of lungs metastases were of sizes less than 2cm. CONCLUSION: Multiple lung metastases were the commonest pattern of lung metastases. Both lungs and mid zone were mainly affected. Lung metastases were very common from breast, colorectal, bone sarcoma, prostate cancers but relatively rare from cervical, head and Neck cancers and lymphomas. Chest radiographs should be part of initial evaluation of all cancer patients.

Breast cancer in young women in Ibadan, Nigeria.

OBJECTIVE: This study was designed to determine the clinical and socio economic features of breast cancer in young females aged 40 years and below treated at the Radiotherapy Department of The University College Hospital, Ibadan Nigeria. METHODS: Records of female patients treated for breast cancer from 2003 to 2006 were reviewed. Records of patients aged 40 years and below were sorted out for further review. Information not available in the records was collected during follow up visits from the patients. RESULTS: A total of 763 cases were evaluated out of which 221 (28.96 %) were 40 years and below. Stage 1 disease was diagnosed in 5 (2%) of the patients while 29 (13%) had stage 11 disease. Stages 111 and 1V were diagnosed in 102 (46%) and 85(39%) of the patients respectively. Invasive ductal carcinoma was the predominant histological type diagnosed in 210(95%) of the cases. Only 5(2%) of the patients had positive family history of breast cancer and 189 (85%) were income earners, out of these, 132(70%) had monthly income less than 12,500.00 Nigerian Naira (∼100USD). The number of young patients who were married was 166 (75%) but 6 (4%) of the married ones had no children while the rest had at least one child. Sexual dysfunction in form of loss of libido was recorded in 77 (46%) of the married patients. All the patients had primary school education while 188 (85%) had secondary school education or above. The only source of financial support received by all the patients towards their treatment was from relatives. CONCLUSION: This study shows that we have a higher proportion of young females with breast cancer in our environment than in developed countries. Most of them present late and majority of the patients have very low income. Physicians should pay serious attention to breast lumps in young females and free health care services for these patients can promote early access to treatment.

The effect of dexamethasone, metronidazole and ascorbic acid on the morphological changes induced by gamma rays on the spinal cord of Wistar rats.

We studied the effects of dexamethasone, ascorbic acid, and metronidazole on the irradiated spinal cord of Wistar rats. Thirty adult Wistar rats were randomly assigned into 3 groups. Five rats served as the control group. Another group of 5 rats were irradiated in the neural axis with 2.5 Gy of gamma rays. The last group of 20 rats were irradiated and then divided into four subgroups of 5 rats each: one subgroup was administered dexamethasone alone, a second subgroup had metronidazole alone, a third subgroup was treated with dexamethasone and metronidazole combined, and a fourth subgroup had ascorbic acid alone, given intraperitoneally for 7 days before exposure to radiation, and also for 5 days after-irradiation. All irradiated animals demonstrated similar vascular changes in form of splitting of the smooth muscle layers of the arterioles of the anterior spinal arteries. Similarly, all the irradiated spinal cord demonstrated shrinkages as noted in the diminution of the neuronal sizes measured by a microscope with a micrometer embedded in the eye-piece objective. The drugs did not individually protect neurons from damage at the level of our investigation. However, the combination of dexamethasone and metronidazole produced a reduction of the degenerative effect of radiation on the neurons when the post-irradiation diameters of the neurons were compared with the control and those of the other experimental groups. We conclude that gamma ray induced damage in the spinal cord may be ameliorated by combining dexamethasone with metronidazole but not by individual treatment with any of the three drugs.

The management of metastatic bone pain in a developing country: the role of radiotherapy as an adjunct to weak opioids.

Bone pain secondary to metastatic cancer is the commonest intractable pain and is a major concern in most oncology units the world over. Cancer pain management is multidisciplinary in approach, so there is no universal or singular modality of treatment. In a developing country like Nigeria, only external radiotherapy and adjuvant weak opioids are readily available, so it is of interest to review the response of these patients to this management option. This is a retrospective review of 92 patients aged 16-80 years with radiologically confirmed metastatic bone disease associated with pain who received external radiotherapy and weak analgesics. The results showed that 23 (25%) patients had a complete response and 67 (73%) had a partial response within four weeks of treatment. Total response was over 90%, which suggests external radiotherapy has an effective palliative role. The study also demonstrated the pattern of bony involvement among the common cancers seen in our environment. The availability of strong opioids (e.g. morphine and pethidine) will obviously consolidate the gains achieved with external radiotherapy in the management of metastatic bone pain in our environment.

Radiotherapy in the management of early breast cancer in Ibadan: outcome of chest wall irradiation alone in clinically nodes free axilla.

The study was carried out to identify the group of patients with early breast cancer [stage I and II] after surgery in which chest wall irradiation alone was given without lymphatic irradiation thus reducing morbidity and also creating room for more patients on the available limited treatment facility. 92 patients with histologically confirmed early breast cancer that attended Radiotherapy clinic between June 1995 and May 1998 that satisfied selection criteria were studied. They all received External Radiotherapy to the chest wall, meadiasternum inclusive and breast if still in-situ. All also received cytotoxic chemotherapy. Majority of the patients 67 [84.8%] were recurrence free in 2 years while 12 [15.2%] had recurrent disease, the recurrent sites were axilla 4 [5.06%], chest wall 3 [3.80%] and supraclavicular 2 [2.52%]. Average time to recurrence was 3-12 months. In view of majority being recurrence free, chest wall irradiation alone in early breast cancer [stage I and II] could be encouraged, thus creating access to treatment for more patients in centers like ours with limited therapy facilities.

The temporalis muscle plus glabellar flap: handy local flaps for orbital repair after exenteration.

Primary tissue coverage of the orbit is desirable after orbital exenteration. This apart from reducing morbidity, is cost effective. Two patients who had immediate local flap reconstruction with temporalis muscle and glabellar skin, after major orbital resection are presented. The advantages of flap reconstruction over skin grafting are discussed.

Retinoblastomas in Ibadan Nigeria: II--Clinicopathologic features.

Retinoblastomas are primary malignant intraocular neoplasms of childhood displaying photoreceptor differentiation. The present study reviews clinicopathological features of these neoplasms in Ibadan, Nigeria. Clinical, surgical pathology, and histological material of 44 histologically verified cases of retinoblastoma indexed in the Cancer Registry, University of Ibadan were analyzed. Retinoblastomas accounted for 1.1% of all malignant neoplasms and were equally frequent in male and female children. The mean age of our patients at the time of diagnosis was 32.3 months, which exceeds a corresponding age of 16-21.5 months recorded among Caucasian children. Leukocoria was the most common clinical manifestation. Eighteen percent of our patients had bilateral neoplasms. These patients were significantly younger than those with unilateral retinoblastomas. Flexner-Wintersteiner rosettes occurred in 61% and optic nerve involvement in 78% of the cases and the sites of predilection were regional lymph nodes, scalp, jaw, brain, skull, long bones, and gum.

Advanced cervical carcinoma in Ibadan, Nigeria: an appraisal of radiation therapy.

This is a retrospective study of 500 patients with advanced cervical cancer (FIGO Stages IIB, III and IVA) who were seen and managed at the University College Hospital Ibadan between 1988 and 1992. External pelvic radiation therapy plus intractivary radioactive caesium brachytherapy was mainstay of treatment. Complete response to therapy was recorded in 68% of patients with stage IIB, 57% in stage III and 41.2% of patients in stage IVA. In patients with stage IIB, the local tumour control was 65%, in stage III patients 54% and in patients with stage IV 41%. The cumulative rates of survival at 5 years (for all the patients-with stage IIB, III and IVa) were 41.5%. The cumulative rates for disease-free survival at 5 years was 25.5%. Radiotherapy as the sole treatment modality in the management of advanced cervical cancer in Ibadan has yielded poor results as revealed in this study. There is an urgent need to evolve a new treatment policy with the aim of improving the response rate and survival in this group of patients.

Comparative evaluation of hypofractionated radiotherapy and conventional fractionated radiotherapy in the management of carcinoma of the cervix in Ibadan, Nigeria.

Four hundred and eighty patients with histologically confirmed carcinoma of the uterine cervix were randomized into 2 groups to either receive hypofractionated radiotherapy (HF--230 patients--study group) or conventional fractionated radiotherapy (CFR--250 patients--control group) between December 1988 and November 1992 at the Radiotherapy Department, University College Hospital, Ibadan. The 5-year survival rate for HF patients in Stages I, II, III and IV were, respectively, 91.3%, 67.2%, 40.2% and 18.0% while for CFR patients in Stages I, II, III and IV were respectively, 92.8%, 69.2%, 42.5% and 19.6%. Though early radiation adverse effects were similar in CFR and HF patients, marked late adverse radiation effects were observed in HF patients than in CFR patients. Complete response rate and local tumour controls were found to be similar in the HF and CFR patients. This study revealed that with similar 5-year survival, complete response rate and local tumour control in HF and CFR patients while a significantly higher late radiation adverse effects were recorded in HF patients, conventional fractionated radiotherapy is the preferred form of radiation therapy in the management of carcinoma of the uterine cervix. Administration of hypofractionated radiotherapy for cervical cancer patients with the aim of maximizing the use of few available radiotherapy facilities, as currently obtained in some radiotherapy centres in Nigeria will result in high post treatment morbidity.

The psychosocial burden of caring for some Nigerian women with breast cancer and cervical cancer.

In Nigeria, the rising incidence of cancer and the paucity of institutional facilities and specialist man-power implies that the burden of care rests largely on relatives. We assessed the severity of indices of psycho-social and economic burden among relatives of women with breast and cervical cancer; and its relationship with patients' psychosocial distress. Using a burden questionnaire, relatives of 73 women with cancer (41 cervical and 32 breast, mean age of caregivers 35.6 years) were interviewed, in out-patient clinics. While the caregivers admitted high frequency of all indices of 'objective' burden, emotional ties at home and social relationships in the neighbourhood seemed intact, indicating tolerance and lack of social stigma. The financial burden was more problematic than the effect of caring on family routines; and these two factors significantly predicted global rating of burden. The severity of patient's worries and psychopathological symptoms were not significantly correlated with care-giver global rating of burden. The tolerance shown by this group of relatives implies that they have strong potentials for playing useful roles in community care of patients.

The opinion of caregivers of some women with breast and cervical cancer on aspects of the disease.

RATIONALE: The paucity of institutional facilities and specialist manpower for treating cancer, implies great reliance on relatives, whose attitudes to the disease have not been explored. OBJECTIVES: To assess the attitudes and beliefs of relatives of women with breast and cervical cancer on aspects of the disease, the relationship of these variables to global rating of burden; and compare with responses of relatives of infertility cases. METHOD: In 1995, relatives of 73 women with cancer (41 patients with cervical and 32 with breast cancer, mean age of caregivers 35.6) and 33 women with infertility (mean age of caregivers 33.2 years) were interviewed in out-patient clinics at UCH, Ibadan. RESULTS: Supernatural aetiologies were the most commonly preferred by both groups (P > 0.05). Cancer commonly provoked feelings of depression among caregivers, though most of them felt glad with their caregiving roles (98.6%) and had positive attitudes towards hospital staff. Cancer seemed not to provoke feelings of social stigma. Most caregivers did not like patients institutionalised. Global rating of psychosocial burden was not significantly associated with variables explored. CONCLUSION: These relatives have the emotional disposition and social potentials for playing informal caregiving roles; hence there is a need to strengthen institutional capabilities for community-based treatment of cancer.

Human immunodeficiency virus antibody in patients with cancer of the uterine cervix undergoing radiotherapy: clinical stages, histological grade and outcome of radiotherapy.

One hundred and twenty consecutive patients with cancer of the uterine cervix were screened for human immunodeficiency virus (HIV) seropositivity before and after radiotherapy. The severity of the disease in terms of clinical staging and histological grading of HIV seropositive women was compared with that of seronegative women. The result showed a prevalence rate of 4.2% for HIV seropositivity which was similar to the rate quoted for the general populace in Nigeria. The HIV seropositive women presented with more severe disease state than the HIV seronegative women. The mean duration of remission was significantly shorter in the HIV seropositive women following radiotherapy (18.36+/3.96 vs. 24.24+/-6.3 months). It was concluded that HIV infection increases the severity and progression of cancer of the cervix in Nigerians. Radiotherapy has no effect on the patients' seropositivity and possibly no effect on the virus. A more aggressive treatment of carcinoma of the cervix and closer follow-up of HIV seropositive patients following treatment are necessary.

Complications following sedation of paediatric oncology patients undergoing radiotherapy.

Sedation is often required to achieve immobilisation of small children during radiotherapy to avoid irradiation of normal tissues during the course of treatment. At the University College Hospital, Ibadan radiotherapists provide sedation for such patients with administration of parenteral and/or oral promethazine, diazepam, chlorpromazine and paraldehyde. This retrospective review of 84 children aged 1 month to 6 years who received sedation for radiotherapy over a period of twenty-one to twenty-eight days showed that 48% had complications. These included injection cellulitis (85.3%), injection abscess (4.87%), paresis of the lower limb (7.3%), aspiration pneumonia (2.4%). Anaesthetists in developing countries should be encouraged to extend their expertise in caring and resuscitation of sedated or unconscious patients to the radiotherapy unit. This will allow for the use of a wider variety of sedative agents and better monitoring as well as minimise or eradicate complications.

Psychosocial concerns of Nigerian women with breast and cervical cancer.

Cancer has the potential to provoke worries which should be assessed in order to adequately respond to patients' problems. We highlight in this paper the problems that concerned 30 women with cervical cancer (mean age 51.2) and 76 with breast cancer (mean age 44.9), how these concerns affected their emotional lives, and the factors associated with these worries. They were interviewed with the 33-item modified version of a German questionnaire rating psychosocial concerns (FBS) by Sullwold, and Goldberg's General Health Questionnaire (GHQ-12) for psychopathological symptoms. Cervical cancer patients had significantly higher FBS and GHQ-12 scores than breast cancer. Breast cancer cases had FBS scores similar to those of women with sickle cell disease and insulin-dependent diabetes mellitus. The commonest recurrent worries in both groups were depression about their condition (45%), thoughts of death (37%), insomnia (33.3%), bodily odour (30%), impairment of work efficiency (30%) terrifying dreams (27%) and fear of illness being life-long (25%). Over 90% denied experience of worries indicating social stigma. FBS scores were significantly correlated with GHQ scores and both were negatively associated with adequacy of social contacts. These data suggest the need for psychosocial intervention in such cases in Nigeria.

Malignant haemangioendothelioma of bone in a HbSC disease patient--a case report.

We report here a 35-year-old man with sickle cell disease (SCD), who presented in 1989 with pain in the (R) hip of 7 years duration and swelling of the (R) calf of 3 months duration. Clinical examination revealed a hard tender mass in the (R) calf. Histology of the (R) calf mass revealed haemangioendothelioma (HE), similar to the histology of the (R) iliac bone mass obtained in another institution previously. He was treated with external radiotherapy with the 1.25 megavoltage beam to antero-posterior fields of the (R) hemipelvis and (R) calf, with good response. Chemotherapy was subsequently administered using 6 cycles of VAC regime. The patient remained in remission for 12 months. In 1991 he had lymphoedema of (R) lower limb and received further radiotherapy and chemotherapy after an isotope bone scan had revealed disease activity in the (R) hemipelvis, (R) femur and (L) upper tibia. He responded again with complete regression of the lymphoedema and remained well until April 1993 when the lymphoedema recurred. He died while being evaluated for further treatment. Although there is no evidence to suggest that SCD confers any protection from development of neoplasms, the co-existence of SCD with a neoplasm is not common. We consider the occurrence of HE of bone, a rare malignancy, in a HbSC patient worthy of reporting.