Colorectal Cancer Patients in Sub-Saharan Africa Receiving Inadequate Care; Survival After Diagnosis Poor, New Study Shows

Newswise — ATLANTA, September 6, 2023 — In new findings led by researchers at the American Cancer Society (ACS), Martin-Luther University in Germany, and many other institutes worldwide, fewer than one in 20 patients diagnosed with potentially curable colorectal cancer (CRC) received standard of care in Sub-Saharan Africa (SSA). The study showed that 55% of CRC patients in SSA survived two years after a diagnosis of their disease, compared to 84% of patients in the United States, and the risk of dying from CRC was 67% higher in patients diagnosed in low-income countries than those diagnosed in middle-income countries. The findings are published today in JNCCN—Journal of the National Comprehensive Cancer Network.

“The burden of colorectal cancer is increasing in Sub-Saharan Africa, however, little was known about treatment and survival in the region,” said Dr. Ahmedin Jemal, senior vice president, surveillance & health equity science at the American Cancer Society and senior author of the paper. “These findings underline the urgent need to improve healthcare infrastructure, including the oncology and surgical workforce, and drug availability in the region to increase survival for CRC and other cancer patients.”

For the study, researchers examined a random sample of 653 patients with CRC diagnosed from 2011 to 2015 obtained from 11 regional population-based cancer registries in SSA. The registries included Abidjan (Ivory Coast), Addis Ababa (Ethiopia), Bamako (Mali), Brazzaville (Congo), Bulawayo (Zimbabwe), Cotonou (Benin), Eldoret (Kenya), Kampala (Uganda), Maputo (Mozambique), Nairobi (Kenya), and Namibia. Information on clinical characteristics, treatment, and/or vital status was obtained from medical records in treating hospitals for 356 (54%) of the patients (“traced cohort”). The authors assessed whether receipt of treatment for CRC in SSA met the National Comprehensive Cancer Network® (NCCN®) Harmonized Guidelines™ for the region, and whether overall survival after a diagnosis of CRC differs between low-income and middle-income countries in SSA.

Of the 356 patients with CRC for whom medical charts were obtained, 51.7% were male, 52.8% were from low-income countries, 55.6% had colon cancer, and 73.6% were diagnosed with nonmetastatic disease. Among the patients with non-metastatic disease, however, only 3.1% received guideline-concordant or standard-of-care treatment, 20.6% received treatment with minor deviations, 31.7% received treatment with major deviations, and 35.1% received no treatment. The risk of death in patients who received no cancer-directed therapy was 3.49 times higher than in patients who received standard treatment or treatment with minor deviations. Similarly, the risk of death in patients from low-income countries was 1.67 times higher than in those from middle-income countries.

“To our knowledge, this is the first study to examine receipt of treatment and survival among patients with CRC in a population-based setting and from multiple centers in SSA,” added Jemal. “For policymakers and institutions in SSA, we hope our study results can be an important basis for targeted and meaningful investments and measures to improve the outcomes and survival of patients with CRC in the region.”

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