Chronic disease comorbidity and associated factors among cancer patients in eastern Ethiopia.

Background: The occurrence of long-lasting comorbidities makes cancer management and treatment challenging because of their overlapping poor prognosis. However, there are no data that show the burden of these chronic cases in patients with cancer in Ethiopia. Therefore, this study aimed to assess the burden of and the factors associated with chronic disease comorbidity among cancer patients in the eastern part of Ethiopia. Material and methods: A cross-sectional study was conducted on 422 patients with cancer admitted to the only cancer treatment center in eastern Ethiopia. A simple random sampling technique was employed to select the study participants. Data were extracted from the patients' medical records using a checklist. The collected data were entered into the Epi-Data statistical software version 3.1 and then exported to STATA version 17 for analysis. Bivariate and multivariate logistic regressions were used to assess the association between the outcomes and the independent variables. Finally, adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. The statistical significance of the factors was indicated at a p-value <0.05. Results: Of the 422 eligible medical records identified, 419 (99.3%) were included for analysis. A total of 230 (54.8%, 95%CI = 50.0%-59.6%) patients with cancer presented with one or more chronic diseases. Of these comorbidities, anemia, hypertension, and cardiovascular disease were the most common diseases reported. Obesity at admission (AOR = 1.91, 95%CI = 1.10-3.61) had a significant association with the occurrence of comorbidities among patients with cancer. Conclusion and recommendation: The overall prevalence of comorbidity among patients with cancer was relatively lower than that reported in previous studies. Being obese was significantly associated with the occurrence of comorbidities. Attention should be given to the burden of chronic comorbidities among patients with cancer through researching, formulating policies, and improving community literacy to manage comorbidities. Thus, interventions for weight reduction and the early detection and treatment of the comorbidities could limit further complications and lower the incidence of other comorbidities.

Radiotherapy Practice for Treatment of Bone Metastasis in Ethiopia.

PUROSE: Ethiopia has one cobalt radiotherapy (RT) machine to serve a population of more than 100 million. The purpose of this study was to report on patterns of palliative RT of bone metastasis in a severely low-capacity setting. PATIENTS AND METHODS: Patient and treatment characteristics of patients irradiated for palliation of symptomatic bone metastasis were extracted from a retrospective database of patients treated between May 2015 and January 2018. This database included a random sample of 1,823 of the estimated 4,000 patients who were treated with RT within in the study period. Associations between the applied RT schedule and patient and tumor characteristics were evaluated with the χ2 test. Hypothetical savings of RT sessions and time were compared in the case of a single-fraction policy. RESULTS: From the database, 234 patients (13%) were treated for bone metastasis. Most patients were ≤ 65 years of age (n = 189; 80%) and female (n = 125; 53%). The most common primary sites were breast (n = 82; 35%) and prostate (n = 36; 15%). Fractionated regimens were preferred over single fraction: 20 Gy in 5 fractions (n = 192; 82.1%), 30 Gy in 10 fractions (n = 7; 3%), and 8 Gy in 1 fraction (n = 28; 12%). Factors associated with single-fraction RT included nonaxial sites of bone metastasis (P < .01) and an address outside Addis Ababa (P ≤ .01). If single-fraction RT would have been given uniformly for bone metastasis, this would have resulted in a 78% reduction in the number of RT sessions and 76% reduction in total RT time. CONCLUSION: The pattern of palliative RT for bone metastasis in Ethiopia favors fractionated regimens over single fraction. Efforts should be made to adopt evidence-based and cost-effective guidelines.

Patterns of Care of Cancers and Radiotherapy in Ethiopia.

PURPOSE: Radiotherapy (RT) is an essential component of cancer treatment. There is a lack of RT services in sub-Saharan Africa as well as limited knowledge regarding clinical practices. The purpose of this study was to identify and describe the patterns for RT treatment in Ethiopia. METHODS AND MATERIALS: We performed a retrospective analysis of 1,823 patients treated with cobalt RT at a large referral hospital in Addis Ababa, Ethiopia, from May 2015 through January 2018. Paper charts were reviewed for patient and treatment characteristics. Descriptive statistics were computed using SPSS (IBM, Armonk, NY). RESULTS: Among patients treated for cancer, 98% (n = 1,784) were adults, 78% (n = 1,426) were female, 5% (n = 85) were HIV positive, 30% (n = 555) were from Addis Ababa, and the median age was 48 years (interquartile range [IQR], 38-58 years). Cervical cancer was the most frequent cancer treated (47%, n = 851), followed by breast cancer (15%, n = 274) and head and neck cancer (10%, n = 184). Seventy-three percent of patients (n = 1,339) presented at a late stage, and 62% (n = 1,138) received palliative RT. The wait times were the shortest for patients receiving palliative treatment (median, 0 days; IQR, 0-15 days; n = 1,138), whereas wait times were longer for patients receiving curative treatment (median, 150 days; IQR, 60-210 days; n = 685). Three percent of patients (n = 56) had documented grade 3 or 4 acute toxicity; of these, 59% (n = 33) were patients with head and neck cancer. CONCLUSION: Cervical cancer accounted for half of patients treated; thus, a majority of patients were adult females. Most patients had advanced-stage cancer, and goals of care were palliative. Wait times were long for patients with curative-intent cancer as a result of low capacity for RT services.