Colorectal Cancer Treatment Characteristics and Concordance With Guidelines in Sri Lanka: Results From a Hospital-Based Cancer Registry.

PURPOSE: Colorectal cancer (CRC) ranks among the top five incident cancers in Sri Lanka (SL). Here, we describe disease characteristics and treatment patterns of patients with CRC in SL. METHODS: All adult patients (age > 18 years) diagnosed with CRC during 2016-2020 were identified from the National Cancer Institute SL cancer registry. Cancer stage at diagnosis was defined according to the seventh edition of the TNM staging system. Concordance between recommendations for adjuvant therapy and actual rates of delivery was also analyzed. Descriptive statistics were used to describe the study cohort and treatment patterns. RESULTS: A total of 1,578 patients were diagnosed with CRC during the study period, 53% (n = 830) with colon cancer and 47% (n = 748) with rectal cancer. Mean age was 61 (range, 18-91) years. Stage distribution was 13%, 28%, 46%, and 12% for stage I, II, III, and IV cancers, respectively. Adjuvant chemotherapy was delivered to 82% of patients with stage III colon cancer. There was a lack of concordance with delivery of neoadjuvant chemoradiotherapy, which was only delivered to 50% of patients with stage III rectal cancer for whom this treatment was indicated. CONCLUSION: Aging population and advanced stage of CRC at diagnosis will continue to challenge the provision of high-quality CRC care in SL. Further quantitative and qualitative research may help better understand the nonconcordance with treatment guidelines. Such information would help ease the burden of advanced-stage CRC in SL.

Demographic, tumour, and treatment characteristics of female patients with breast cancer in Sri Lanka; results from a hospital-based cancer registry.

BACKGROUND: Although breast cancer is the most common cancer among Sri Lankan women, there is little published data on patient characteristics and treatment in the local context. We aimed to describe disease characteristics and management in a large contemporary cohort of women with breast cancer at the National Cancer Institute of Sri Lanka (NCISL). METHODS: All women with invasive primary breast cancers diagnosed during 2016-2020 were identified from the NCISL breast cancer registry. The NCISL sees approximately 40% of all cancer patients in Sri Lanka. Cancer stage at diagnosis was defined according to the Tumour, Node, and Metastasis (TNM) staging system and the Estrogen (ER) and progesterone (PR) receptor status was determined based on the results of immunohistochemistry tests. Descriptive statistics were used to describe the study cohort and treatment patterns. RESULTS: Over 5100 patients were diagnosed with breast cancer during the study period at the NCISL. The mean age of the women was 56 (SD 12) years. Common co-morbidities were hypertension (n = 1566, 30%) and diabetes mellitus (n = 1196, 23%). Two thirds (66%) of the cancers were early stage (stage I & II) at diagnosis. ER/PR positivity rate was 72% and HER-2 positivity rate was 22%. Two thirds of the women had undergone mastectomy while 68% had undergone axillary clearance. The rate of chemotherapy delivery was 91% for women with node positive disease while 77% of eligible women (i.e., after wide local excision or with > 3 positive lymph nodes) had received adjuvant radiotherapy. Endocrine therapy was initiated in 88% of eligible women with hormone receptor positive disease while rate of trastuzumab use was 59% among women with HER2 positive breast cancer. CONCLUSIONS: High percentage of advanced breast cancer at diagnosis and high prevalence of comorbidities are some of the major challenges faced in the management of breast cancer in Sri Lanka. Given that stage at diagnosis is the most important prognostic factor determining survival, greater efforts are needed to promote early diagnosis of breast cancer. Considerable lapses in the concordance between guideline recommendations and the delivery of cancer care warrants closer assessment and intervention.

Healthcare delivery for non-communicable diseases among breast cancer survivors in Sri Lanka: Is there a missed opportunity?

PURPOSE: Breast cancer is the most common cancer globally as well as in Sri Lanka. Improvements in cancer care have allowed patients to live to an older age. With advancing age, incidence of non-communicable diseases (NCDs) increases. Cancer diagnoses tend to take attention away from the treatment of other comorbidities, given its importance. The objective of this study was to describe healthcare delivery for NCDs among female breast cancer survivors treated at the National Cancer Institute of Sri Lanka (NCISL) and identify opportunities to optimise non-cancer medical care in this cohort. METHODS: A total of 420 women were identified from the breast cancer database at the NCISL, who were 50-80 years at the time of their breast cancer diagnosis, were within 12-24 months from the date of diagnosis, had completed their active cancer treatment and were in complete remission. Of this population, 228 (54%) women who had documented NCDs at the time of diagnosis were identified and were followed-up via telephone to collect details regarding existing comorbidities and the screening and development of new comorbidities. RESULTS: At the time of cancer diagnosis, 216/228 (95%) of patients had hypertension, 104/228 (46%) had type 2 diabetes and 17/228 (8%) had ischaemic heart disease (IHD). The prevalence of other comorbidities was very low. During the post diagnosis period, 11 patients developed type 2 diabetes, while 2 developed IHD. Osteoporosis screening using dual-energy X-ray absorptiometry scanning was very low at diagnosis 21/228 (9%) but improved in post cancer treatment follow-up 112/228 (49%, p < 0.001). Only 95/228 (42%) were screened for other cancers. CONCLUSIONS: Hypertension was the most prevalent comorbidity while type 2 diabetes and dyslipidaemia were the most common diagnoses post-treatment. In these patients, screening for osteoporosis and other cancers remains very low, emphasising a missed opportunity.