Cancer survival in sub-Saharan Africa (SURVCAN-3): a population-based study.

BACKGROUND: The Cancer Survival in Africa, Asia, and South America project (SURVCAN-3) of the International Agency for Research on Cancer aims to fill gaps in the availability of population-level cancer survival estimates from countries in these regions. Here, we analysed survival for 18 cancers using data from member registries of the African Cancer Registry Network across 11 countries in sub-Saharan Africa. METHODS: We included data on patients diagnosed with 18 cancer types between Jan 1, 2005, and Dec 31, 2014, from 13 population-based cancer registries in Cotonou (Benin), Abidjan (CÔte d'Ivoire), Addis Ababa (Ethiopia), Eldoret and Nairobi (Kenya), Bamako (Mali), Mauritius, Namibia, Seychelles, Eastern Cape (South Africa), Kampala (Uganda), and Bulawayo and Harare (Zimbabwe). Patients were followed up until Dec 31, 2018. Patient-level data including cancer topography and morphology, age and date at diagnosis, vital status, and date of death (if applicable) were collected. The follow-up (survival) time was measured from the date of incidence until the date of last contact, the date of death, or until the end of the study, whichever occurred first. We estimated the 1-year, 3-year, and 5-year survival (observed, net, and age-standardised net survival) by sex, cancer type, registry, country, and human development index (HDI). 1-year and 3-year survival data were available for all registries and all cancer sites, whereas availability of 5-year survival data was slightly more variable; thus to provide medium-term survival prospects, we have focused on 3-year survival in the Results section. FINDINGS: 10 500 individuals from 13 population-based cancer registries in 11 countries were included in the survival analyses. 9177 (87·4%) of 10 500 cases were morphologically verified. Survival from cancers with a high burden and amenable to prevention was poor: the 3-year age-standardised net survival was 52·3% (95% CI 49·4-55·0) for cervical cancer, 18·1% (11·5-25·9) for liver cancer, and 32·4% (27·5-37·3) for lung cancer. Less than half of the included patients were alive 3 years after a cancer diagnosis for eight cancer types (oral cavity, oesophagus, stomach, larynx, lung, liver, non-Hodgkin lymphoma, and leukaemia). There were differences in survival for some cancers by sex: survival was longer for females with stomach or lung cancer than males with stomach or lung cancer, and longer for males with non-Hodgkin lymphomas than females with non-Hodgkin lymphomas. Survival did not differ by country-level HDI for cancers of the oral cavity, oesophagus, liver, thyroid, and for Hodgkin lymphoma. INTERPRETATION: For cancers for which population-level prevention strategies exist, and with relatively poor prognosis, these estimates highlight the urgent need to upscale population-level prevention activities in sub-Saharan Africa. These data are vital for providing the knowledge base for advocacy to improve access to prevention, diagnosis, and care for patients with cancers in sub-Saharan Africa. FUNDING: Vital Strategies, the Martin-Luther-University Halle-Wittenberg, and the International Agency for Research on Cancer. TRANSLATIONS: For the French and Portuguese translations of the abstract see Supplementary Materials section.

Survival Status and Predictors Among Women with Advanced Stage of Cervical Cancer.

Background: Cervical cancer is one of the leading causes of cancer death in women, even though it is a preventable disease. Most deaths occur in low- and middle-income countries. In addition to early detection and receipt of standard treatments, survivorship is an important component of high quality of care across the cancer continuum. Objective: To assess the survival status of advanced-stage cervical cancer patients after cancer treatment has started. Methods and Materials: A one-year prospective cohort study was employed to assess the survival status of women with advanced stages of cervical cancer. A total of 180 cervical cancer patients were recruited, and the study was conducted from January 10, 2022, to September 20, 2023. Data entry and analysis were done in the SPSS 29 version. Descriptive statistics were used to examine participant characteristics. The Kaplan-Meier procedure and log rank test were used to estimate the duration of survival. Bivariate and multivariate Cox regression analyses were computed for predictor variables with survival status. Results: Patients receiving cancer treatment at FIGO stages IVA and IVB had survived by 56% and 24%, respectively, whereas patients receiving treatment at stages IIB and IIIA had survived by 100%. The estimated mean survival time at one-year follow-up was 5.706 months (95% CI: 3.785-7.627) for patients with FIGO stage IVB, but 11.537 months (95% CI: 11.199-11.887) for those with stages II and III (P < 0.001). Women over 60 years old had a 1.5-fold higher risk of death than those under 60 (HR: 1.482, P = 0.040). Conclusion: The one-year cumulative survival rate among advanced-stage cervical cancer patients was 77%. Major factors associated with survival were age, cancer stage, the presence of anemia, and waiting time for treatment.

Pre- and Post-Treatment Quality of Life Among Patients with Advanced Stage Cervical Cancer at Tikur Anbessa Specialized Hospital, Ethiopia.

Background: The development of health concepts beyond traditional markers of illness and death has made the evaluation of quality of life (QoL) crucial to patient care. Yet, there is little research evaluating the pre- and post-treatment QoL of cervical cancer survivors in Ethiopia. Objective: This study aimed to assess the pre- and post-treatment QoL of women diagnosed with advanced-stage cervical cancer. Methods and Materials: A cohort design was conducted at the Tikur Anbessa Specialized Hospital Oncology Center. A total of 166 cervical cancer patients were recruited consecutively. Data was collected through interviews with standardized questionnaires before and after treatment. The Wilcoxon rank test was used to assess the significant differences in pre-treatment and post-treatment quality of life. Additionally, the Mann-Whitney U-test was also employed. Statistical significance was determined with p-values <0.05 and a 95% confidence interval. Results: Women who were in stages IVA and IVB were 24.7% and 10.2%, respectively. Both the global health scale (66.67 [47.92-75] to 83.33 [66.67-83.33]) and the functional domain QoL (66.67 [40-80] to 70 [46.67-86.66]) showed statistically significant improvements from pre-treatment to post-treatment QoL. Women under the age of 45 were found to have higher global health QOL (P < 0.001) and functional domain QOL (P = 0.029). Women presented in stages II and III had comparatively higher global health QoL (P = 0.008) and functional domain QoL (P = 0.021). Conclusion: Global health QOL and the majority of functional quality of life significantly improved following six months of cancer treatment. But there was no discernible change in terms of sexual enjoyment, sexual function, or activity. Age, marital status, the duration since diagnosis, the stage of the cancer, and the presence of comorbidities were the factors that affected the improvement of post-treatment quality of life.

Vaccination of Adults With Cancer: ASCO Guideline.

PURPOSE: To guide the vaccination of adults with solid tumors or hematologic malignancies. METHODS: A systematic literature review identified systematic reviews, randomized controlled trials (RCTs), and nonrandomized studies on the efficacy and safety of vaccines used by adults with cancer or their household contacts. This review builds on a 2013 guideline by the Infectious Disease Society of America. PubMed and the Cochrane Library were searched from January 1, 2013, to February 16, 2023. ASCO convened an Expert Panel to review the evidence and formulate recommendations. RESULTS: A total of 102 publications were included in the systematic review: 24 systematic reviews, 14 RCTs, and 64 nonrandomized studies. The largest body of evidence addressed COVID-19 vaccines. RECOMMENDATIONS: The goal of vaccination is to limit the severity of infection and prevent infection where feasible. Optimizing vaccination status should be considered a key element in the care of patients with cancer. This approach includes the documentation of vaccination status at the time of the first patient visit; timely provision of recommended vaccines; and appropriate revaccination after hematopoietic stem-cell transplantation, chimeric antigen receptor T-cell therapy, or B-cell-depleting therapy. Active interaction and coordination among healthcare providers, including primary care practitioners, pharmacists, and nursing team members, are needed. Vaccination of household contacts will enhance protection for patients with cancer. Some vaccination and revaccination plans for patients with cancer may be affected by the underlying immune status and the anticancer therapy received. As a result, vaccine strategies may differ from the vaccine recommendations for the general healthy adult population vaccine.Additional information is available at www.asco.org/supportive-care-guidelines.

Outcome of Hypofractionated Palliative Radiotherapy Regimens for Patients With Advanced Head and Neck Cancer in Tikur Anbessa Hospital, Ethiopia: A Prospective Cohort Study.

PURPOSE: Head and neck cancers (HNCs) are the third most commonly treated cancer with radiation in Ethiopia. Most patients present with advanced stage and are not candidates for curative treatment. The objective of our study is to assess the outcome of hypofractionated palliative radiotherapy (RT) for advanced HNCs in a resource-limited setting. MATERIALS AND METHODS: Patients with histology-proven advanced HNC candidates for hypofractionated palliative RT were enrolled. Three regimens were allowed: 44.4 Gy in 12 fractions, 30 Gy in 10 fractions, and 20 Gy in five fractions. Response to treatment was assessed at baseline and at 4 weeks after treatment completion. The Kaplan-Meier curve was used to measure the survival. RESULTS: Between January 2022 and January 2023, 52 patients were enrolled and 25 patients were eligible for outcome assessment. Index symptoms include pain, bleeding, dysphagia, respiratory distress, and others in 25, 13, 10, 6, and 17 patients, respectively. Complete relief of the top three symptoms include pain in 52% of patients, hemostasis in 84% of patients, and dysphagia in 30% of patients. Objectively, 64% of patients attained partial response. For 48% of patients, their quality of life (QoL) improved in one parameter of the physical scores. Moreover, 64% of patients showed improvement in three parameters. The global functional score improved in 80% of patients. One patient had grade 3 xerostomia. At the end of the study period, 44% of patients died. The median survival after radiation was 9 months (95% CI, 7.2 to 10.8). CONCLUSION: All palliative hypofractionated regimens used were effective in terms of symptom control, tumor response rate, and QoL, and were well tolerated. This makes it appropriate for our setup because the majority of patients require palliation.

Survival of women with cervical cancer in East Africa: a systematic review and meta-analysis.

BACKGROUND: The prognosis for cervical cancer varies greatly between nations. The disparity in cancer survival rates within nations is largely a result of disparities in public knowledge, the accessibility of cancer services, diagnosis and treatment. The purpose of this systematic review and meta-analysis is to assess the survival rate and associated factors among cervical cancer patients in East Africa. METHODS: Literature search was carried out using Google scholar, PubMed/Medline, Embase and CINHAL. Covidence, a web-based program, was used to import studies for review process. PRISMA guidelines were followed. A total of 110 abstracts were identified from electronic sources. There were five duplicate articles removed. We looked at 105 papers' abstracts and titles, and we excluded 78 of them because they did not fit our inclusion criteria. We conducted a full-text analysis of the remaining 27 papers, leaving out 14 researches that did not fit our inclusion requirements. For final review, 13 studies were included. Using the Joanna Briggs Institute (JBI) assessment checklist, methodological quality was evaluated. RESULTS: The included articles were cohort studies. They were conducted in Ethiopia, Uganda, Zimbabwe, Kenya, Sudan, Tanzania and Rwanda. One-year, two-year, three-year, four-year and five-year overall survival rates ranged from 67% to 92%, 55% to 84%, 44% to 53%, 32% to 47%, and 26% to 43%, respectively. CONCLUSIONS: The pooled one-year, two-year, three-year, four-year and five-year survival rates of cervical cancer patients in East Africa were 84%, 71%, 50%, 39% and 36%, respectively. HIV status, late presentation, treatment modalities, older age and presence of comorbidities were the most commonly mentioned prognostic factors for survival. PROSPERO REGISTRATION NUMBER: CRD42023402551.

Most women in developing countries present with advanced disease, often untreatable or suitable only for palliation. In East Africa, cervical cancer makes up 40% of all cases of cancer detected in women. This largely highlights the inadequacy of national cancer control initiatives in most African nations, including immunization, screening, and early detection. Cervical cancer survival rates vary throughout the world and are commonly associated with the country's development status. The pooled five-year survival rate for cervical cancer patients in East Africa was 36%, according to this systematic review and meta-analysis, which is much lower than the rates in developed countries like the United States, Japan, and Australia but comparable to studies conducted in India.