Browsing by Author "Jemal Ahmedin"

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    Clinicopathology and Treatment Patterns of Head and Neck Cancer at Tikur Anbessa Specialized Hospital, Radiotherapy Center, Addis Ababa, Ethiopia.
    (Addis Ababa University, 2019-09) Wondwossen Nahom; Assefa Mathewoss; Kantelhardt Eva Johanna; Jemal Ahmedin
    Background: Breast cancer is a major public health problem with significant morbidity and mortality in women worldwide. Studies in Sub-Saharan Africa (SSA) have shown that the estimated 5-year survival in women with breast cancer is below 50%, which is significantly lower than those from developed countries. There is limited data on survival of patients treated for breast cancer in Ethiopia. Objective: The aim of this study is to asses the five-year survival of breast cancer patients treated at Oncology Department of Tikur Anbessa Specialized Hospital (TASH). Methods: This is a retrospective cohort study that asses the survival of and contributing factors of patients that were evaluated and treated at TASH between September 2014 and August 2015 G.C. Data was extracted from patient file by data collectors under the supervision of the primary investigator using structured questionnaire. Patients and/or their relatives were contacted through phone call and for those patients who were not available over the phone, the last date of follow up was used to calculate overall survival (OS). The data was analyzed using SPSS 22 software. Results: Out of a total of 249 patient charts collected based on HMIS data, 216 cases were found eligible for our study. On further evaluation of the 216 cases, only 181 patients were eligible for the final analysis as 35 patients had some data missing (error of date entry on excel) or were lost from follow up by more than 6 months and couldn’t be contacted over the phone. The mean age of presentation was 43 (SD) years. Most patients (38.1%) had a stage III disease at presentation followed by stage IV disease 31.5%. Only 4.4% of our patients were stage I. The median survival was 27 months where the 5-year OS was 44.2%. Stage at diagnosis, duration before the initiation of Adjuvant chemotherapy, number of chemotherapy cycles, the use of hormonal therapy and its duration were significantly associated with survival. Conclusion/recommendation: The outcome of stage III & IV patients in our study is very low by the western standards. We should devise a policy to increase public awareness, so that we can get these patients at an earlier stage. In addition, we have to increase access to recent treatment modalities and expand the available cancer centers.
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    The Clinicopathology, Treatment Pattern and Survival of Nasopharyngeal Carcinoma Patients at Tikur Anbessa Specialized Hospital, Oncology Department, Addis Ababa, Ethiopia.
    (Addis Ababa University, 2021-04) Shimeles Ruth; Woldemariam Aynalem ; Jemal Ahmedin; Kantelhardt Eva
    Background: Nasopharyngeal carcinoma is one of the most common head and neck cancers worldwide and its incidence is reported to be increasing both in developed and developing countries. There is, however, lack of published data on nasopharyngeal carcinoma in Ethiopia. Objective: To assess the clinicopathology, treatment patterns and median survival of patients diagnosed with nasopharyngeal carcinoma at Tikur Anbessa Specialized Hospital (TASH), Oncology Department, Ethiopia Methodology: A retrospective cohort study design of histopathologic proven nasopharyngeal carcinoma patients seen at the Oncology Department of TASH from September 11, 2014 and September 10, 2017 and followed for vital status up until October 2020. Descriptive statistics (mean, SD, frequency, percentage) were calculated and chi-square tests were performed using SPSS version 26, with P<05 for level of statistical significance. Survival curves were analyzed using the Kaplan-Meier method, and survival curves between groups of patients were compared using a log-rank test. A multivariable Cox proportional hazard model was used to identify prognostic factors. Results: A total of 170 patients with histopathological confirmed nasopharyngeal cancer were seen in the Oncology Department during the study period. The mean age of the patients was 37.73 ±17.7 SD years, with 2:1 male to female ratio. Majority 77 (56.6%) of the histology types were taken from Lymphnode with 36 (26.5%) showing secondary carcinoma from nasopharynx. Generally 113 (83.31%) of the patients presented with stage III-IV. 23.5 % of the patients did not take any form of treatment. Of those who received treatment, the most common form of treatment was induction chemotherapy (19.1%), followed by concurrent chemo radiotherapy (16.9%). Patients had to wait on average 3.24 months to get any types of treatment. The median waiting periods were 8.4 months for any form of radiation and 3.3 months for chemotherapy. The median followup period was 23.3 months, and the median survival was 33 months. Survival was statistically significantly associated with advancing age, keratinizing histologic type, lack of receipt of treatment, suboptimal dose of RT and nodal disease. However, Sex, Tumor stage, metastasis, group stage, waiting time to treatment and performance status were not significantly affecting the survival time of patients. Conclusion: Majority of patients with nasopharyngeal cancer seen at TASH in Addis Ababa are presented at advanced stage of the disease, and with exceedingly long waiting period for receipt of radiotherapy and poor survival outcomes. These findings underscore the need for development of public health plans for early diagnosis and treatment of nasopharyngeal cancer and for expansion of radiotherapy services in the country.
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    Demographic, Clinical, and Treatment Patterns of Non-small Cell Lung Cancer Patients seen in Tikur Anbessa Specialized Referral Hospital, Radiotherapy Center; Addis Ababa, Ethiopia, 2017-2020
    (Addis Ababa University, 2021-03) Asefa Amanuel; Tigeneh Wondimagegnehu; Jemal Ahmedin; Kantelhardt Eva
    Background: Lung cancer is the most commonly diagnosed cancer and the leading cause of cancer death worldwide. There are two main types of lung cancer, non–small cell lung cancer (NSCLC) and small-cell lung cancer (SCLC). Non–small cell lung cancer (NSCLC) accounts for 80% to 85% of lung cancer. Even though lung carcinoma is the 6th most frequent malignancy in male based on data from Addis Ababa city-based cancer registry, there is lack of published data on demographic, clinical, and treatment patterns of non small cell lung cancers in Ethiopia. Objective: To determine the demographic, clinical, and treatment patterns of non-small cell lung cancer patients seen in Tikur Anbessa Specialized Referral Hospital, Radiotherapy Center, Addis Ababa, Ethiopia, 2017-2020 Methodology: A retrospective cross-sectional study design on histo pathologically confirmed non small cell lung cancer patients treated from September 2017 to September 2020. Descriptive statistics (mean, SD, frequency, percentage, graph and table) and chi-square results were generated by using SPSS version 25. P-value of <0.05 was considered as significant. Result: 126 patients were enrolled in the study. There were 67 (53.2%) males and 59 (46.8%) females giving a male to female ratio of 1.14:1. The mean age at presentation was 52 years, ranged from 24 to 90 years. The majority of the patients presented with cough (103, 81.7%), followed by chest pain (40, 31.7%), haemoptysis (21, 16.7%), shortness of breath (18, 14.3%). According to AJCC staging of lung cancer 43.7% (55) and 32.5% (41) of the patients were diagnosed with stage IVb and IVa diseases, respectively. Ever cigarette smoking was reported in 20 (15.9%) patients. 20(15.9%) patients had associated co-morbid medical illnesses. Mostly the primary lesion was located peripherally in 73% of patients and centrally in 23.8%. The most common histology type was adenocarcinoma in 81(64.3%) patients, followed by squamous cell carcinoma in 34(27%). Metastasis at the time of diagnosis was recorded in 96(76.2%) of cases. Common sites of metastasis were pleura (27.8%) and bone (24.6%), followed by lung, liver, brain and adrenal in 15.9%, 14.3%, 9.5% and 5.6% of patients respectively. Chemotherapy was given in 87.3% of patients. The intent of chemotherapy was palliative in 93.6% patients, neoadjuvant in 3.6% patients and adjuvant in 2.7% patients. Radiotherapy was given in 23.2% of patients with the intent of palliative treatment. Conclusion and Recommendation: The majority of patients with NSCLC seen at TASH are presented at advanced stage of disease, with adenocarcinoma as the most common histology type and history of smoking in only 16% of the cases. Future studies should examine the causes of lung cancer in the country.
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    Demography and Clinico-Pathologic Pattern of Laryngeal Cancer at Tikur Anbessa Specialized Hospital: A Retrospective Cross Sectional Study
    (Addis Ababa University, 2021-04) Eshetu Natenael; Abreha Ayenalem ; Jemal Ahmedin; Kantelhardt Eva
    Background: Malignant laryngeal tumors are uncommon, yet invariably fatal neoplasms of the larynx. Late presentation of the disease may worsen management outcomes. Although the incidence of malignant tumors of the larynx is increasing in developing countries, like Ethiopia, there is a lack of evidence regarding the overall profile of laryngeal cancers in Ethiopia. Objectives: To assess the epidemiologic, clinico-histo-pathologic characteristics of laryngeal patients attending at oncology department of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Methods: A 3-year retrospective cross-sectional review of medical records of patients managed for malignant laryngeal tumors at the oncology department of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, was performed. The demographic, clinical & histopathologic characteristics of participants were computed by using descriptive statistics (mean, percentage, frequencies, and standard deviation). Finally, the study finding was presented using diagrams, tables, and figures. Results: Most of the laryngeal cancer patients who attended the oncology unit of Tikur Anbessa Specialized Hospital are elderly males, with a male to female ratio of 5.1:1, and the sixth decade being the most affected age stratum. The most common presenting symptom was dysphonia. The majority (88.8%) of patients presented with late stage of the disease and squamous cell carcinoma is by far the most common histopathology, occurring in 98.8% of the patients. Conclusion: Elderly men are the most affected age group of laryngeal neoplasms. Late disease presentation observed in the patients can lead to poor management outcomes and limited management options. Health education of the community on early features of laryngeal cancer, early symptom detection by clinicians, and policies targeted at reducing cigarette smoking and alcohol consumption is recommended.
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    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.
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    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.
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    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.
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    Survival of Nonmetastatic Nasopharyngeal Cancer Patients Treated Radically by Two Dimensional External Beam Radio Therapy at Tikur Anbessa Specialized Hospital, Radiotherapy Center, Addis Ababa, Ethiopia, 2020: a Retrospective Cohort Study.
    (Addis Ababa University, 2020-09) Gebreslassie Adonay; Seife Edom; Jemal Ahmedin; Kantelhardt Eva
    Introduction: Globally, an estimated 51,000 deaths from nasopharyngeal carcinoma were reported in 2012. In Africa, 8700 new nasopharyngeal cancer cases and 5500 deaths occurred in 2008. A 22 months median survival was seen in post concurrent chemoradiation Nigerian cases and two year cure rate of 16% was achieved in East African post radiotherapy cases. There are no, however, data on survival of nonmetastatic nasopharyngeal cancer in Ethiopia. Objective: To examine survival time of non-metastatic nasopharyngeal cancer patients treated radically by concurrent chemoradiation using 2 dimensional external beam radiotherapy at Tikur Anbessa Specialized Hospital, Radiotherapy Center, Ethiopia, 2020. Methodology: A retrospective cohort study was conducted among all nonmetastatic nasopharyngeal cancer cases treated radically by 2 dimensional external beam radiotherapy from January 2013 to August 2018 at Tikur Anbessa Specialized Hospital, Radiotherapy center. Descriptive and frequency analysis was done to calculate mean, median, standard deviation and percentile. Kaplan meier analysis was used for survival analysis. Bivariate and multivariate cox regression done to assess association between dependent and independent variables. Multicolinearity test (T<0.1, VIF < 10) was assessed among the variables with significant association on multivariate cox regression. Results: Mean age at diagnosis was 33± 16 years. Most patients (97.1%) presented with locoregionally advanced disease. The median survival was 31 months with 95% CI (27, 35) & overall survival rate of 37.9% after 31 months of median follow up. Patients who took 4 cycles of concurrent chemotherapy were more likely to have longer survival with Crude Hazard Ratio of 0.28, 95% CI (0.11, 0.72). Post treatment recurrence, distant metastasis or bone metastasis were associated with lower survival on multivariate cox regression. Conclusion/recommendation: Although the median overall survival outcome of our patients (37.9%) was low as compared to most reports of developed countries, it might be acceptable given the higher stages of most patients, technique of treatment delivery & long waiting list for treatment. So, we should design a policy to increase public awareness & expand cancer centers to increase access to recent treatment modalities.
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    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.