Oncology

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Admission Pattern and Treatment of Solid Tumors at Tikur Anbessa Specialized Hospital Radiotherapy Center from July 2020 to February 2021.
(Addis Ababa University, 2022-02) Hagos Gebrekirstos; Assefa Mathewos
Background: The incidence of cancer has increased dramatically worldwide in the last two decade. Cancer in sub-Saharan Africa (SSA) is on the rise caused by a rapid population growth, increased life expectancy and adoption of unhealthy lifestyles. In Ethiopia the incidence of cancer is increasing over years with an estimated 67, 573 new cases and over 46, 373 deaths in 2018. At TASH RT center there was no study that tried to evaluate admission pattern and intent of therapy of solid tumors. So this study was conducted to determine admission pattern and treatment intent of solid tumor in TASH radiotherapy (RT) center. Objective: To assess the admission pattern and treatment intent of Solid Tumors at TASH RT center from July 2020 to February 2021. Method: A cross sectional study was conducted to assess admission pattern and treatment of solid tumors among patients admitted for chemotherapy in TASH RT wards from July 2020 to February 2021 who fulfilled the inclusion criteria. Data was extracted from the Oncology Patient Registration System, then it was checked for completeness. Descriptive statistic was conducted using SPSS version 23. Association of patient address with cancer stage and intent of therapy was evaluated. Result: A total of 434 patients were admitted during the study period. Median age was 43.0 years, ranging from 18 years to 80 years. Almost half (50.5%) of the patients were females and most patients (87.6%) had no any known comorbidity and 7.4% had HIV infection. Most of the patients came from Addis Ababa City (44.5%), followed by Oromia region (30%) and Amhara region (11.8%). The most common anatomic sites of the cancers were GIT (37.1%), head and neck (25.6) and genito-urinary (15.0%). Based on histology, adenocarcinoma and SCC accounted for about 38.5% and 36.9% respectively. Most patients were admitted with stage IV (72.1%) and stage III accounts 21%. The treatment intent was palliative in 59.4%, neo-adjuvant in 23.3%, adjuvant in 14.3% and radical in 3%. Conclusion: Most patients presented with advanced stage and more than half of all the patients were treated with palliative intent.
Disparities in Receipt of Radiotherapy and Outcomes among Cervical Cancer Patients Seen in Tikur Anbessa Hospital, Ethiopia
(Addis Ababa University, 2018-05) Deressa Biniyam ; Assefa Mathewos; Jemal Ahmedin; Kantelhardt Eva Johanna
introduction: Ethiopia is among countries with the highest burden of cervical cancer worldwide. Up to 6,000 new cervical cancer patients are diagnosed each year. The primary objective of this study was to evaluate the survival of cervical cancer patients in general and compare the difference in survival, waiting time and stage migration among patients treated with radiotherapy in Tikur Anbessa Hospital on private wing and regular sides. Methodology: Women with histologically verified cervical cancer, who received radiotherapy in 2014, were included. All patient characteristics, tumor characteristics, and information concerning therapy and outcome were extracted from the patients’ medical record files. Vital status was obtained through telephone contact or patient cards. Result: Out of 249 patients treated in 2014, the patient file of 242 could be retrieved. 152 (63%) were treated on the regular service side and 90 (37%) were treated on Private wing side. The median age at diagnosis was 45 years and 48 years for patients with private wing side and regular service side. After first oncologist consultation private wing patients waited more (92 days) than regular side patients (39 days) to receive radiotherapy. During this time, stage migration was seen more in private wing (20%) than regular side (8.6%) patients. In general, the estimated of 52 months overall survival probabilities were 21.5% (14.6% in worst-case scenario). The median overall survival time was 21 months (18 months in worst-case scenario). The median survival was 23 months (19 months in worst-case) and 19 months (17 months in worst-case) between private wing and regular side patients, respectively. The FIGO stage, intension of radiotherapy, one-year tumor control rate, comorbidity and concurrent chemotherapy were the factors, which has found to be significant association with survival. Conclusion: The survival of cervical cancer patients remains low in Ethiopia, despite the higher cure rate of the disease. The reason for poor survival were advanced stage at presentation, very long waiting time for treatment and as a result stage migration, the old treatment machine and technique and absence of brachytherapy are some of the reason. Therefore, the parallel oriented efforts in all direction such as prevention, early detection and improving access to standardized care are required.
The Effect of COVID-19 on Cancer Patients Taking Chemotherapy at Tikur Anbessa Specialized Hospital Oncology Department.
(Addis Ababa University, 2021-03) Welekidan Hailemichael; Assefa Mathewos; Seife Edom; Jemal Ahmedin; Kantelhardt Eva
Background: Coronavirus disease 2019 (COVID-19) pandemic have caused hundreds of thousands deaths worldwide, with the first case in Ethiopia reported on March 13, 2020. Knowledge and awareness of mode of disease transmission, basic hygiene principles and measures in public health crisis are important for developing effective control measure. This pandemic and actions taken to prevent its spread is affecting the world population including cancer patients. In Ethiopia the COVID-19 awareness as well as its effect on cancer patients is not known. Objective: To evaluate awareness, experiences and effect of COVID 19 on cancer patients in receipt of chemotherapy from April 01 to June 30, 2020 in Ethiopia. Methods: Phone based cross-sectional survey was conducted among cancer patients attending day care or inpatient chemotherapy treatment from April 01 to June 30, 2020 at TASH, at the Department of Clinical Oncology. All patients taking chemotherapy in day care or ward admissions during the study period whose age was greater than 18 years, and who agreed to participate was included in the study. Descriptive statistics and further analysis for association was conducted using STATA version 16. The level of significance was obtained at P<0.05. Results: A total of 212 patients completed the questionnaire, with median age of 40 years (range 20-82), and 67.9% were females. 44.3% of participants were patients diagnosed with breast cancer and 41% of the participants were on palliative intent treatments. Delay, cancellation, or change in scheduling for receipt of treatment occurred in 78 patients (36.79%). Service interruption by providers accounted for the majority of the impacts (45 patients, 57.7%), followed by transportation difficulties (16, 20.5%), fear of virus exposure (14, 18.0%). Patients on palliative intent of treatment had more effect on treatment compared to adjuvant (P<0.001), and likelihood of not having enough medications to last for a month, not having a place to stay in nearby vicinity were associated with effect on treatment (P=0.009, and P=0.03 respectively). Patients’ knowledge and practice regarding COVID-19 and its prevention methods is good. Conclusion: The coronavirus outbreak or restrictions made in response to the outbreak impacted receipt of chemotherapy for a considerable proportion of patients at TASH.
Neoadjuvant Chemotherapy Response among Patients with Locally Advanced Breast Cancer at Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia.
(Addis Ababa University, 2020-10) Mulu Desta; Assefa Mathewos ; Kantelhardt Eva Johanna; Jemal Ahmedin
Background: Breast cancer is the leading cause of cancer death among females globally. In sub-Saharan African countries, a high proportion of breast cancers are locally advanced breast cancer (LABC) or metastatic at the time of diagnosis. LABC is primarily treated by neoadjuvant chemotherapy (NACT) before surgery. There is no data on response rate and resectability of LABC after NACT in Ethiopia. Objective: The objective of this study is to assess the rate of clinicopathologic response and rate of resectability of LABC after NACT at Tikur Anbessa Specialized Hospital (TASH), Ethiopia. Methods: This is a retrospective study which assesses response and resectability of LABC after NACT at TASH from September 2017 G.C to August 2019 G.C. Patients who were evaluated at breast multidisciplinary team (MDT) clinic by Breast surgeon and Oncologist and decided to receive upfront chemotherapy to downstage the tumor were included in this study. Patients were given 4 cycles of NACT with AC (doxorubicin + cyclophos phamide) or 8 cycles of NACT with AC – T (4 cycles of AC + 4 cycles of paclitaxel). After chemotherapy patients were revaluated at MDT for modified radical mastectomy (MRM). Data were collected from patient charts and filled on, cleared for completeness, analyzed using SPSS 25 software. Results: A total of 141 breast cancer patients were presented to the MDT. Of which 63 patients were decided to undergo upfront surgery and 78 patients to receive neoadjuvant therapy. Of the 78 patients who received neoadjuvant therapy only 51 patients were eligible for the study. The mean age of patients was 40.1 ± 9.96 SD years old (24-65). 11 patients (21.6 %) had complete clinical response (cCR), 31 patients (60.8 %) had clinical partial response (PR), 3 patients (5.9 %) had stable disease (SD) and 6 patients (11.8 %) had progressive disease (PD) after NACT. Forty-one patients (80.4 %) undergo mastectomy, 23 patients (56.1 %) had negative margins, 16 patients (39 %) had positive margins and in 2 patients (4.9 %) the surgical margin status was not mentioned. Only 4 patients (9.8 %) had complete pathologic response (pCR) after NACT. Patients who took AC – T (NACT) had a higher overall clinical response rate (p = 0.099) and cCR (p = 0.037) but not statistically significant compared to patients who took AC NACT. Older patients (> 50 years old) with LABC had higher complete pathologic response but not statistically significant after NACT during pathologic assessment compared to patients below the age of 50 years (p = 0.062). Conclusion: The study has shown administering neoadjuvant chemotherapy either with AC or AC – T has decreased the tumor size significantly to make it resectable with a clear margin. AC – T had a slightly higher overall response rate and complete clinical response rate.
Relative Dose Intensity and Myelotoxicity of FOLFOX4 Chemotherapy among Colorectal Cancer Patients at Tikur Anbessa Hospital
(Addis Ababa University, 2020-10) Seid Fahmi ; Assefa Mathewos
Background: Colorectal cancer (CRC) is a major global health problem and public health issue. Despite the improved outcome with cytotoxic treatment of CRC, outcomes are affected by adverse treatment effects and their sequel, often resulting in low Relative dose intensity (RDI), considerable, mortality, morbidity and costs. However, there are no previous studies conducted in our clinical practice setting describing the Relative dose intensity of FOLFOX4 or its predicters. Objective: Our main objective of the study was to determine FOLFOX4 regimen RDI and its predicters, describe incidence of dose delay and dose limiting neutropenia. Methods: We conducted a retrospective medical record review on 82 CRC patients treated at Tikur Anbessa hospital between May 2019 and July 2020 with FOLFOX4. RDI was calculated with Excel 2019 and entered in to SPSS 26.0 for summary statistics. Reason for delay were assessed through all the 12 cycles. Dose delay were categorized as > 7 days, 7 to 18 days, and more than 18 days. To identify predicters, sensitivity analyses was performed by categorizing RDI based on 25 th and 75 th percentile and covariates were entered in to multinomial logistic regression model for multivariate analysis. Results: We identified 82 patients receiving FOLFOX chemotherapy as first line treatment. The mean age was 45 years, and 42.7% were female. The average RDI was 48.6 %. The proportion of patients receiving average RDI less than 85% is 92.7% (N=76). Among stage II and III subgroups, the patients receiving RDI > 70%, are 22.2% and 19% respectively. Myelo suppression in particular Grade II to IV neutropoenias were dose delaying reason in 61.3% of the cases, while non cytopenia related dose delays were observed in 31.7%(n=26) of the patients. Dose schedule modification resulting in treatment prolongation more than 18 days were affecting 38.3% (N=239) of the cycles. The odds of receiving RDI less than 35% increases by 66%, for each decrease in the cycle number for nadir neutropenia count compared to above 60%; AOR=0.44(CI: 0.22, 0.89) at statistically significant p-value=0.02. Conclusion: Overall FOLFOX chemotherapy RDI was low. Dose limiting myelotoxicity were the main reason for dose modification and were observed at higher rate affecting majority of cycles, and patients. Cycle number for nadir neutropenia independently predicted the risk of falling in to 25 th RDI percentile compared 75 th percentile, on the sensitivity analysis.
Treatment Outcome and Associated Factors among Colorectal Cancer Patients in Tikur Anbessa Hospital, Ethiopia: A Prospective Cohort Study
(Addis Ababa University, 2023-01) Tessema Girum; Assefa Mathewos; Getachew Assefa; Jemal Ahmedin
Background: Colorectal cancer (CRC) is the third most common cancer death in both sexesworldwide. Several studies revealed that advanced-stage at diagnosis and treatment delaynegatively affects patient outcome. However, in Ethiopia, the treatment outcome, the time todiagnosis, and initiation of treatment have not been well studied before. Therefore, this studyaimed to evaluate the treatment outcome and the prognostic factors of CRC patients at TikurAnbessa Specialized Hospital. Methods and Materials: An institution-based prospective cohort study was carried out on 209 CRC patients at the Oncology Center of Tikur Anbessa Specialized Hospital (TASH) and those who met the eligibility criteria were included in our study from January 2020 to September2022. Patient interval, diagnosis interval, and treatment interval of more than 30, 14, and 30days were used to categorize patient, diagnosis, and treatment delays respectively. Simple descriptive analysis using frequency, proportion, mean with SD, and the median was applied for sociodemographic and clinical characteristics. For overall survival and progression-free survival, the Kaplan-Meier curve is applied. To see the one to one association betweendependent and independent variables, we used bivariate cox analysis and a p value of < 0.25used for further analysis. To find the prognostic indicators for survival, multivariate cox regression is performed, and a statistically significant value is P < 0.05. Result: The mean age of CRC diagnosis was 49.38(SD=15) years. More than half of the patients were male 119(56.9%). More than three fourth of the patients (79.4%) presented with advanced stage. Delay in a patient, diagnosis, surgery, and chemotherapy (CT) were seen in93.8%, 81.2%, 75.4%, and 85.4% of patients respectively. Overall mortality is 67.46% (95%CI: 61.0, 74.0) and the 1-year overall survival (OS) is 63.16% (95% CI: 56.23, 69.29). The median OS is 17 months and the median progression free survival (PFS) is 11 months. On multivariate cox regression, the poor prognostic factors for overall survival are; Age >40(HR=1.53, 1.02 - 2.29, P 0.040), Lower level of education (high school & below), (HR=2.20,1.24-3.90, P 0.007), poor performance status (HR=1.60, (1.03 - 2.48, P 0.035), Hgb ≤ 12.5 g/dl(HR=1.55,1.03-2.08, p 0.035), T-4 disease (HR=6.05, 2.28-16.02, p 0.000) and metastases atdiagnosis (HR= 8.53, 3.77-19.25, p 0.000). Conclusion: The overall survival rate of CRC patients’ is very poor. The advanced stage upon presentation, poor functional status, and a lack of timely treatment initiation are all key contributors to poor survival. Few patients were diagnosed and treated in a reasonable timeframe. We recommend that to improve CRC cancer awareness in the community, health professionals to avoid overlooking CRC in symptomatic patients and improve access to diagnostics and timely treatment. The health sector should prioritize the expansion of cancercenters with the goal of cure.

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