Geburtshilfe Frauenheilkd 2022; 82(06): e12
DOI: 10.1055/s-0042-1749695
Abstracts | MGFG

NCCN guideline-concordant cancer care in Sub-Saharan Africa. A population-based multicountry study on five entities

Authors

  • NC S Mezger

    1   Inst. of Med. Epidem., Biometr. and Informat., Martin-Luther-University Halle-Wittenberg, Halle, Germany

  • R Richter

    1   Inst. of Med. Epidem., Biometr. and Informat., Martin-Luther-University Halle-Wittenberg, Halle, Germany

  • F J Péko

    2   African Cancer Registry Network, Oxford, United Kingdom and Registre des cancers de Brazzaville, Brazzaville, Republic of the Congo

  • A Zietsman

    3   African Cancer Registry Network, Oxford, United Kingdom and Dr AB May Cancer Care Centre, Windhoek, Namibia

  • D M Parkin

    4   African Cancer Registry Network, Oxford, United Kingdom

  • E J Kantelhardt

    5   Dept. of Gynaecology and Inst. of Med. Epidem., Biometr. and Informat., Martin-Luther-University Halle-Wittenberg, Halle, Germany
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    Purpose We aim to assess uptake of care concordant with the National Comprehensive Cancer Network (NCCN) Harmonized Guidelines for Sub-Saharan Africa (SSA).

    Methods Our observational study covered eleven population-based cancer registries in ten countries. Per registry, random samples of 8–125 patients diagnosed from 2010 to 2015 were selected for the leading cancer entities in the region: breast (BCa), cervical, prostate (PCa), colorectal cancer and non-Hodgkin lymphoma (NHL). Registry data were actively updated assessing hospital records. Diagnostics and cancer-directed therapy (CDT) were evaluated for degree of concordance to the NCCN Harmonized Guidelines.

    Results Of 3251 patients diagnosed with one of the five cancer entities, hospital records could be “traced” for 58%. Early and advanced disease stage was found in four and metastatic stage in one of five when excluding NHL. HIV infection was found in two of five patients tested, and ECOG PS of two or higher in half of all patients assessed. Diagnostic parameters directly relevant for therapy were missing in a considerable number of patients “traced”; e.g. Gleason score for half of PCa, hormone receptor status for four in five BCa, and subtype for six in ten NHL patients. Any cancer-directed therapy was identified in two of three traced patients. In patients eligible (n=906), guideline-concordant therapy was found in one of nine, with minor deviation in two, major deviation in three, and no therapy in two of nine. In multivariable logistic regression, patients with breast and cervical cancer were more likely to access guideline concordant care. Furthermore, early stage, low ECOG PS and origin from a country with medium HDI were associated with uptake of guideline concordant care.

    Discussion With cancer currently leading to over half a million deaths in the region and the expected number rising up to one million by 2040 annually, population-based and multinational data on current status of quality of care are urgently needed. Though a considerable number of patients in our cohort presented with potentially curable disease, overall access to diagnostics and treatment was low compared to hospital-based cohorts.

    Conclusion This real-world population-based data shows the need for timely, quality assured and affordable oncology service in addition to awareness in the population. Our study informs clinicians and policy-makers on overall and entity-specific opportunities for improvement of cancer care in SSA.


     

    Publication History

    Article published online:
    10 June 2022

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