Addis Ababa population-based pattern of cancer therapy, Ethiopia

Cancer in Sub-Saharan Africa is becoming an important challenge for health services due to rising numbers of patients. In Addis Ababa with around 3.5 million inhabitants, more than 2000 cases are diagnosed annually. In this retrospective population-based cohort study we assessed completeness of and waiting time for cancer-therapy among patients registered in the Addis Ababa City Cancer Registry (AACCR), Ethiopia. Patient hospital files were retrieved to complete the data from AACCR. A total of 588 files were found (51% of those diagnosed from January to March 2012 and 2014). We analyzed completeness and waiting time of chemotherapy and radiotherapy; with completeness defined as ≥85% therapy received according to local guidelines. Analysis was done for the five most common cancer-types commonly treated with chemotherapy (breast, colorectal, non-Hodgkin`s lymphoma, lung and ovarian) and the four most common cancer-types commonly treated with radiotherapy (breast, cervical, head and neck and rectal). In our study, half of the patients (54.1%) received adequately dosed chemotherapy and 24.5% of patients received adequately dosed radiotherapy. The median waiting time was 2.1 months (Range: 0 to 20.72) for chemotherapy and 7 months (Range: 0.17 to 21.8) for radiotherapy. This study underscores the need for health system measures to improve cancer-directed therapy in Ethiopia, especially concerning radiotherapy.

[1]  V. McCormack,et al.  Stage at diagnosis of breast cancer in sub-Saharan Africa: a systematic review and meta-analysis. , 2016, The Lancet. Global health.

[2]  I. Magrath,et al.  Structural Barriers to Diagnosis and Treatment of Cancer in Low- and Middle-Income Countries: The Urgent Need for Scaling Up. , 2016, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[3]  Umberto Veronesi,et al.  Global cancer surgery: delivering safe, affordable, and timely cancer surgery. , 2015, The Lancet. Oncology.

[4]  M. Frommer,et al.  Role of radiotherapy in cancer control in low-income and middle-income countries. , 2006, The Lancet. Oncology.

[5]  A. Stang,et al.  Cervical cancer in Ethiopia: survival of 1,059 patients who received oncologic therapy. , 2014, The oncologist.

[6]  W. Mackillop,et al.  Radiotherapy utilization in developing countries: An IAEA study. , 2018, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[7]  A. Jemal,et al.  Knowledge about cervical cancer and barriers toward cervical cancer screening among HIV‐positive women attending public health centers in Addis Ababa city, Ethiopia , 2018, Cancer medicine.

[8]  S. Gupta,et al.  Abandonment of treatment for childhood cancer: position statement of a SIOP PODC Working Group. , 2011, The Lancet. Oncology.

[9]  B. Tayo,et al.  Factors Associated With Waiting Time for Breast Cancer Treatment in a Teaching Hospital in Ghana , 2016, Health education & behavior : the official publication of the Society for Public Health Education.

[10]  A. Jemal,et al.  Survival of breast cancer patients in rural Ethiopia , 2018, Breast Cancer Research and Treatment.

[11]  Hermann Brenner,et al.  Provider delay among patients with breast cancer in Germany: a population-based study. , 2003, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[12]  I. Higginson,et al.  The prevalence and burden of symptoms amongst cancer patients attending palliative care in two African countries. , 2011, European journal of cancer.

[13]  O. Olopade,et al.  Treatment of cancer in sub-Saharan Africa. , 2013, The Lancet. Oncology.

[14]  A. Wienke,et al.  Factors associated with time to first healthcare visit, diagnosis and treatment, and their impact on survival among breast cancer patients in Mali , 2018, PloS one.

[15]  E. Zubizarreta,et al.  Status of radiotherapy resources in Africa: an International Atomic Energy Agency analysis. , 2013, The Lancet. Oncology.

[16]  Y. Woldeamanuel,et al.  Cancer in Ethiopia. , 2013, The Lancet. Oncology.

[17]  A. Jemal,et al.  Breast cancer survival in Ethiopia: A cohort study of 1,070 women , 2014, International journal of cancer.

[18]  K. Mutai,et al.  Delayed presentation of breast cancer patients. , 2010, East African medical journal.

[19]  T. Deressa,et al.  Complex care systems in developing countries , 2010, Cancer.

[20]  Tilahun Teklehaymanot,et al.  The contribution of traditional healers' clinics to public health care system in Addis Ababa, Ethiopia: a cross-sectional study , 2011, Journal of ethnobiology and ethnomedicine.

[21]  S. Sanjosé,et al.  Interventions to close the divide for women with breast and cervical cancer between low-income and middle-income countries and high-income countries , 2017, The Lancet.

[22]  A. Deribew,et al.  Health seeking behavior for cervical cancer in Ethiopia: a qualitative study , 2012, International Journal for Equity in Health.

[23]  Helena Carreira,et al.  Global surveillance of cancer survival 1995–2009: analysis of individual data for 25 676 887 patients from 279 population-based registries in 67 countries (CONCORD-2) , 2015, The Lancet.

[24]  G. Bonadonna,et al.  Adjuvant cyclophosphamide, methotrexate, and fluorouracil in node-positive breast cancer: the results of 20 years of follow-up. , 1995, The New England journal of medicine.

[25]  M. Brennan,et al.  Cancer surgery in low-income countries: an unmet need. , 2012, Archives of surgery.

[26]  Geoff Delaney,et al.  The role of radiotherapy in cancer treatment , 2005, Cancer.

[27]  P. Dhillon,et al.  Patient Factors Associated With Delays in Obtaining Cancer Care in Botswana , 2018, Journal of global oncology.

[28]  J. Harford,et al.  Barriers to overcome for effective cancer control in Africa. , 2015, The Lancet. Oncology.

[29]  K. Grosse Frie,et al.  Why Do Women with Breast Cancer Get Diagnosed and Treated Late in Sub-Saharan Africa Perspectives from Women and Patients in Bamako, Mali , 2018, Breast Care.

[30]  A. Jemal,et al.  First data from a population based cancer registry in Ethiopia. , 2018, Cancer epidemiology.