A high proportion of patients with colorectal cancer in Sub-Saharan Africa may receive no treatment or inadequate treatment, regardless of the disease’s curability, according to a recent study published by Hämmerl et al in JNCCN–Journal of the National Comprehensive Cancer Network. The new findings indicated that the survival rates of this patient population may be significantly improved through simple measures.
Background
Guidelines are often used to make appropriate treatment decisions for patients with cancer—and options depend on the availability of personnel as well as the infrastructure and can vary widely around the world.
“Our study aimed [to establish] the amount of basic care that [patients with] colorectal cancer are receiving in Sub-Saharan Africa and how impactful the treatment is in terms of survival rates,” explained lead study author Lucia Hämmerl, MD, a research associate in the Global Health Working Group at the University Medicine Halle. “Our focus was on harmonized colorectal cancer guidelines that take into account the circumstances in Sub-Saharan Africa,” she added.
Study Methods and Results
In the new study, investigators used 11 population-based cancer registries to examine the data of 653 patients with colorectal cancer in Sub-Saharan Africa. Additional medical information was available in 55% (n = 356) of the cases. Among these patients, 262 had stages I to III colorectal cancer and 94 had stage IV colorectal cancer.
The investigators discovered that only 3% (n = 8) of the patients with nonmetastatic and potentially curable cancer received guideline-concordant treatment, whereas over 50% of them received treatment with deviations and more than 33% of them received no treatment at all. This resulted in a mortality rate that was up to 3.5 times higher in the regions studied.
“Most of the patients with incomplete medical records presumably did not receive adequate treatment, and that was why no clinical data was collected. In the remaining patients, the survival rate was significantly higher when the treatment was guideline-concordant or slightly deviated from the guideline. However, this occurred in less than 1 in 20 cases, even though adequate basic care can be provided without high-tech or costly solutions,” emphasized Dr. Hämmerl.
Inequalities were also found when the data were compared globally using the Human Development Index, which evaluated life expectancy, education, and income. The mortality rates of patients with colorectal cancer who resided in countries with low Human Development Index scores—including Ethiopia, Mali, and the Republic of the Congo—were two-thirds higher than the rates of patients residing in countries with medium Human Development Index scores such as Namibia and Kenya.
Conclusions
With worsening rates of colorectal cancer incidence and mortality in Sub-Saharan Africa, the investigators suggested that the diagnosis and treatment of the disease may require significant improvements.
“We saw an alarming gap between the recommendations of the harmonized guidelines and the treatment that was actually being provided, especially in patients with potentially curable disease. In light of the aging population in Sub-Saharan Africa and the rising incidence of colorectal cancer, a great deal of suffering could be avoided through simple measures. The necessary strategies are available,” underscored co–study author Eva Kantelhardt, MD, Professor and Head of the Global Health Working Group at the University Medicine Halle. “It is crucial that surgeons in particular are trained to perform radical cancer surgery. German hospitals can contribute by working in partnership to train specialists from African countries. In the case of gynecological oncology, where a similar problem exists, many colleagues from Ethiopia have already received further surgical training at University Medicine Halle,” he concluded.
Disclosure: For full disclosures of the study authors, visit jnccn.org.
