PURPOSE In the past 20 years, the burden of anal cancer (AC) increased by 60% in the United States and over three-fold in Africa. Rates of AC have increased by 20× in people living with HIV and the highest (50×) in men with HIV who have sex with men. However, in sub-Saharan Africa (SSA) where HIV is endemic, data on clinicopathological characteristics and outcomes of patients with AC are lacking. To address this, we have investigated AC disease presentation, treatment outcomes, and its predictors in a cohort of patients who were either HIV-infected or HIV-uninfected in SSA. METHODS We conducted a retrospective cohort study of patients with anal squamous cell carcinoma (SCC) treated at Ocean Road Cancer Institute in Dar es Salaam, Tanzania from January 2014 to December 2019. Associations between the study outcomes and their predictors were analyzed using univariate and multivariate analysis models. RESULTS A total of 59 patients with anal SCC were retrieved and had at least 2-year follow-up. The mean age was 53.9 (standard deviation ±10.5) years. While none of the patients presented with stage I disease, 64.4% had locally advanced disease. HIV infection was the major comorbidity (64.4%). The rate of complete remission at the end of treatment was at 49% while the 2-year overall survival (OS) and local recurrence-free survival were 86.4% and 91.3%, respectively. Despite high HIV coinfection in the cohort, AC treatment outcomes were not significantly associated with HIV status. Disease stage ( P = .012) and grade ( P = .030) were significantly associated with 2-year OS. CONCLUSION Patients with anal SCC in Tanzania present mainly with locally advanced disease associated with high HIV prevalence. In this cohort, the SCC grade was independently associated with treatment outcomes unlike other factors such as HIV coinfection.
INTRODUCTION: In East Africa, the estimated incidence of breast cancer is second only to cervical cancer. Supraclavicular irradiation post-modified mastectomy is crucial to breast cancer management, as it improves local control and overall survival. However, this is associated with adverse effects, including hypothyroidism (HT), which is usually under-reported. This study aim was to evaluate radiation-induced thyroid gland functional changes following treatment of supraclavicular lymph nodes in breast cancer patients.METHODS: This was a prospective descriptive study of patients with breast cancer from May 1, 2017, to May 30, 2018. Pre and post-treatment TSH, fT4, and fT3 values were compared using a Wilcoxon signed-rank test.RESULTS: A total of 42 patients were recruited for this study, with a mean age of 55.7 years (32-71). The mean baseline TSH level was 2.90 (±6.37), with a normal range of 0.27-4.2 uIU/mL. The mean T4 and T3 level were 15.77 (±4.83), with normal ranges of 10.16-22 pmol/l for T4, and 3.46 (±6.22), with a normal range of 1.06-3.3 nmol/l for T3. A Wilcoxon signed-rank test indicated that there was a statistically significant increase in mean TSH levels over baseline when measured at three, six-, and nine-months post-treatment, with p-values of 0.0047, 0.0002, and <0.0001, respectively. In total, four patients (10%) had thyroid function tests outside the normal ranges. Zero patients developed clinical HT during the time period studied.CONCLUSION: As hypothesized, supraclavicular radiation led to subclinical HT, but the incidence of clinical HT over time remains unknown.
Abstract Background Colorectal cancer (CRC) is one of the leading malignancies globally and chemotherapy forms the bulk of its management. Oxaliplatin is one of the standard drugs used for management of colorectal cancer. Oxaliplatin induced peripheral neuropathy (OIPN) is one of the most debilitating toxicities encountered which lead to dose modification and premature treatment discontinuation with a great impact on quality of life. Therefore, we armed to determine the prevalence, severity and factors associated with OIPN among colorectal cancer patients treated in Tanzania. Methods This was a cross-sectional study conducted at Ocean Road Cancer Institute (ORCI) to all histologically confirmed CRC patients who were on oxaliplatin-based chemotherapy regimens. Data was collected using EORT-QLQ CIPN20 questionnaire and analysis was done using SPSS version 23 and p value < 0.05 was considered statistically significant. Results A total of 62 patients were recruited, the prevalence of OIPN was 71% and 59.7% for acute and chronic symptoms respectively. Obese patients were 21.66 times higher at risk of suffering from chronic OIPN compared to individuals who have normal body weight (p < 0.05). Cumulative Dose ≤ 780 showed a protective effect (p < 0.005) in development of OIPN. For the severity of acute OIPN, it was found that 4.8% had grade 4 symptoms, while 8.1% had grade 3 symptoms, and 69.4% had grade 2 symptoms, and 17.7% of the patients had grade 1. In patients with chronic OIPN, 13.5% had grade 3 neuropathies, 24.3% had grade 2 and 62.2% had grade 1 neuropathy. Conclusion The prevalence of acute and chronic OIPN among colorectal cancer patients managed at ORCI was 71.0% and 59.7% respectively, with most patients developing grade 1 and 2 neuropathy for both acute and chronic symptoms. Number of cycles, cumulative dose and BMI were the major factors associated with the neuropathy.
Background: The majority of breast cancer patients in Tanzania present with advanced disease, and a significant proportion has metastatic breast cancer (MBC) on presentation or develops it during the course of their follow-up. With few treatment options to choose from, such patients often benefit from empathic support and access to information to help them make treatment decisions based on their individual circumstances and needs. Patients with MBC have been shown to present with unique physical, social and psychological needs that require additional time, counselling and availability of health care providers in addition to the routine options available to other patients. In resource-limited settings, the needs of such patients are often unknown and unaddressed, which adds to the anxiety associated with the diagnosis and its treatment. Materials and methods: This descriptive qualitative study was conducted using 3 focus group discussions with a total of 17 participants with metastatic breast cancer (MBC) attending Ocean Road Cancer Institute in Dar es Salaam, Tanzania. Participants were purposively selected for the study from outpatient clinics and inpatient wards. A semi-structured FGD guide was used to moderate discussions and analysis was done using a thematic approach. Results: The median age of participants was 51 (range 33 - 81 years) with an average of 4 months (range 1 - 12 months) from diagnosis of BC to the interview. 4 (24%) were diagnosed with MBC on first presentation (denovo). Participants spoke about the importance of accurate BC-related information in allowing timely referral and treatment both in the community and within the health system. They recognized the role of mass and social media in increasing awareness about BC and identified myths surrounding cancer treatment especially mastectomy. Correct and timely information at points of care, through media platforms and via ambassadors/patient support groups was perceived as a means to avoiding delays and securing early and effective treatment. Conclusion: Patients with MBC in Tanzania have many unmet informational needs in relation to their disease. Accurate BC-related information is important in allowing early detection and diagnosis. At the community level, provision of information through established media platforms and the use of patient advocates may help to enable early referral and treatment of patients.
Abstract Background Growing prevalence and aggressiveness of breast cancer (BC) among East African women strongly indicate that the genetic risk factor implicated in the etiology of the disease may have a key role. Germline pathogenic variants in BRCA1 and BRCA2 ( BRCA1/2 ) are known to increase the lifetime risk of BC. This study investigated the prevalence and spectrum of germline single nucleotide variant/insertion and deletion (SNV/indel), and copy number variations (CNVs) in BRCA1/2 among Tanzanian BC patients, and evaluated the associations of identified variants with patient's socio‐demographic and histopathological characteristics. Methods One hundred BC patients were examined for BRCA1/2 variants using next‐generation sequencing (NGS). Sanger sequencing and multiplex ligation‐dependent probe amplification (MLPA) assay were performed for the confirmation of SNV/indel and CNVs, respectively. Results Six germline SNV/indel pathogenic variants were detected from six unrelated patients. Five of these variants were identified in BRCA1 , and one in BRCA2 . We also identified, in one patient, one variant of uncertain clinical significance (VUS). CNV was not detected in any of the BC patients. Furthermore, we found that in our cohort, BRCA1/2 variant carriers were triple‐negative BC patients ( p = 0.019). Conclusions Our study provides first insight into BC genetic landscape by the use of NGS in the under‐represented East African Tanzanian populations. Our findings support the importance of genetic risk factors in BC etiology in Tanzania and showed a relatively high overall prevalence (6%) of germline BRCA1/2 pathogenic variants in BC patients. Therefore, our results indicate that BRCA1/2 pathogenic variants may well contribute to BC incidence in Tanzania. Thus, the identification of frequent variants in BRCA1/2 genes will enable implementation of rapid, inexpensive population‐specific BRCA1/2 genetic testing, particularly for triple‐negative BC patients known for their high prevalence in Tanzania. This will, in turn, greatly contributes to provide effective therapeutic strategies.
The ecancer Choosing Wisely conference was held for the second time in Africa in Dar es Salaam, Tanzania, from the 9th to 10th of February 2023. ecancer in collaboration with the Tanzania Oncology Society organised this conference which was attended by more than 150 local and international delegates. During the 2 days of the conference, more than ten speakers from different specialties in the field of oncology gave insights into Choosing Wisely in oncology. Topics from all fields linked to cancer care such as radiation oncology, medical oncology, prevention, oncological surgery, palliative care, patient advocacy, pathology, radiology, clinical trials, research and training were presented to share and bring awareness to professionals in oncology, on how to choose wisely in their approach to their daily practice, based on the available resources, while trying to offer the maximum benefit to the patient. This report, therefore, shares the highlights of this conference.
Background: During cancer growth, immunosuppressive microenvironment is created that enables tumour cells to evade an eliminative immune response and hence manage to grow into malignancy. HLA-G, existing as either membrane-bound (mHLA-G) or soluble (sHLA-G) molecule is thought to be immunosuppressive and produced more by tumor cells. The +3142G/C polymorphism in HLA-G gene affects its expression, and G allele is considered to be a protective mutant allele associated with less expression of HLA-G. The implication of HLA-G in cancer development has been reported in different cancers and populations. But, its implication in most African populations has not yet been investigated. The aim of this study was to determine the possible associations of soluble HLA-G and HLA-G +3142G/C SNP with breast cancer. Materials and Methods: 75 breast cancer patients and 84 normal controls were recruited in this study. The genotyping of HLA-G +3142G/C polymorphism was determined by LightSNiP typing assay using quantitative Real-Time PCR and sHLA-G levels were determined by ELISA. Results: The sHLA-G levels were significantly lower in breast cancer patients than in controls (p<0.001). Also, they were significantly lower in mastectomized patients compared to non-mastectomized patients (p=0.018). The ROC analysis revealed a significant ability of sHLA-G to differentiate breast cancer patients versus normal controls (AUC=0.697, 95% CI= 0.619-0.767, p<0.001) and identify mastectomized patients (AUC=0.667, 95% CI= 0.549 to 0.772, p=0.041). The assessment of +3142G/C polymorphism revealed a relatively similar distribution of frequencies of genotypes and alleles between breast cancer patients and normal controls (p>0.05) and was neither associated with sHLA-G levels. Conclusion: While the +3142G/C SNP was found not to be relevant to breast cancer, the changes of sHLA-G levels in response to medical interventions such as mastectomy may be translated into its potential prognostic utility for breast cancer. More studies are needed to provide clear evidence of sHLA-G as a diagnostic and prognostic marker of breast cancer in Tanzania.
Abstract Background Sub-Saharan Africa is simultaneously facing a rising incidence of cancer and a dearth of medical professionals because of insufficient training numbers and emigration, creating a growing shortage of cancer care. To combat this, Massachusetts General Hospital and Beth Israel Deaconess Medical Center partnered with institutions in South Africa, Tanzania, and Rwanda to develop a fellowship exchange program to supplement the training of African oncologists practicing in their home countries. Methods In its initial year, 2018, the Program for Enhanced Training in Cancer (POETIC) hosted a pilot cohort of seven fellows for 3-week observerships in their areas of interest. Researchers distributed questionnaires for program evaluation to participants prior to arrival and upon departure; additionally, three participated in semistructured interviews. Results Five themes emerged from the qualitative data: expectations of POETIC, differences between oncology in the U.S. and in sub-Saharan Africa, positive elements of the program, areas for improvement, and potential impact. Fellows identified several elements of Western health care that will inform their practice: patient-centered care; clinical trials; and collaboration among medical, radiation, and surgical oncologists. From the quantitative data, feedback was primarily around logistical areas for improvement. Conclusion POETIC was found to be feasible and valuable. The results from the pilot year justify the program's continuation in hopes of strengthening global health partnerships to support oncology training in Africa. One weakness is the small number of fellows, which will limit the impact of the study and the relevance of its conclusions. Future research will report on the expansion of the program and follow-up with former participants. Implications for Practice This work presents a novel model for fellowship exchange between lower- and higher-resourced areas. The program is a short-term observership with tumor boards and didactic teaching sessions incorporated. By attracting oncologists who aim to practice in their home countries, it facilitates international collaboration without contributing to the preexisting lack of medical professionals in low- and middle-income countries.
Background and context: Breast cancer is a common type of cancer among women worldwide, with about 2 million new cases diagnosed in the yearly. It is the second common cancer and leading cause of cancer mortality among women in Tanzania, after cervical cancer. More than 70% of breast cancer patients in developed countries are diagnosed at early stages, whereas in low and middle-income countries, only 20%–60% of patients are diagnosed early. Physician in developed countries consults on average 15-20 breast cancer patients daily, while in developing countries the number triples. This high load does not allow a treating physician to spend ample time with patients explaining hence leaving patients not informed about their diagnosis, side effects of treatments and even living with the physical, emotional and psychological challenges of their disease. Residents at the Ocean Road Cancer Institute (ORCI), initiated a patient support group targeting breast cancer patients for feasibility. Aim: Provide forum for patients with same diagnosis to share common challenges Provide peer emotional, psychosocial support and cancer education Organize activities that will help to spread awareness to the community Initiate projects to improve socioeconomic status of breast cancer survivors in Tanzania Strategy/Tactics: Involved the ORCI administration from the beginning Involved the academic and research unit of ORCI Residents prepared session curriculum and teaching materials Sessions took place once a month Sessions were two hours long divided into three components, where the first is introduction of participants, then survivors led discussions or lectures prepared by an expert in the topic and lastly closing remarks by a physician Breakfast was provided Program/Policy process: Open membership for all breast cancer patients Physician lead face to face peer discussions Institutional acknowledgment of the support group Provision of primary registry of patients for follow-up Provision of a link to other social organizations Outcomes: Increase knowledge of cancer in general and breast cancer in particular A total of seven sessions were held to date For each session, participation ranged from 30-50 breast cancer survivors, and on average attendance was 4 sessions out of 7 Topics covered over a period of seven months included Coping with a cancer diagnosis and treatment Living with cancer and its changes to daily life Exercise Nutrition Breast cancer general knowledge Collaboration with other stake holders including IST secondary school students who initiated breast prosthesis knitting club What was learned: A need to reach out and give psycho-social support to ORCI patients Through education we can improve treatment adherence Possible partners are available if we reach out Exist a need to address misconceptions in the community so as to avoid stigma to patients.
PURPOSE Tracheostomy and gastrostomy tube interventions are common procedures for patients with head and neck and esophageal cancer, which are both highly prevalent at Muhimbili National Hospital (MNH), the largest referral hospital in Tanzania. Reported complications lead to unplanned hospital readmissions and increased disease burden, negatively impacting patient outcomes. While there are described approaches to quality improvement for complications in these procedures, these have mostly been in high-income countries. We aimed to study patients at MNH in Tanzania to tailor interventions to low-middle-income country (LMIC) settings. This project is part of the pre-intervention phase of a longitudinal multifaceted implementation science study with the MNH Global Cancer Program. METHODS Two patient surveys aimed to study indications for, and complications of tracheostomy and gastrostomy tubes were created. The surveys, created in English but translated to the local language Swahili, inform on the patient's social drivers of health, clinical characteristics, caregiver support, complication and readmission rates, and quality of life. Survey administration was piloted and optimized for data entry to REDCap while minimizing clinical burden in a resource-constrained healthcare system. An automated study tracker was also created to facilitate follow-up for the enrolled patients. RESULTS The surveys enable the collection of important patient data that will ultimately determine the direction of the multifaceted intervention to address complication rates with tracheostomy and gastrostomy tube care at MNH in Tanzania. These surveys, the REDCap database, and the study tracker were all created in a context-appropriate manner to promote independent sustainability of data collection and maintenance for the team at MNH. Additionally, stakeholder meetings were held with the General Surgery and Otolaryngology Departments to ensure partnership with the healthcare teams at MNH. These highlighted important areas to refine the proposed interventions to fit the local context. Data collection has begun and is expected to continue in the coming months. CONCLUSION This project, to our knowledge, will be the first to apply an implementation science framework to adopt quality improvement strategies for tracheostomy and gastrostomy tube care in an LMIC setting. The tools developed and this multifaceted approach can be adopted regionally and by other LMICs.
