Oncology

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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 Tefera; Dr.Assefa, Mathewos( MD, FC Rad Onc (SA), Internist); Dr. Jemal, Ahmedin(DVM, PHD); Dr. 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.
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; Dr.Assefa, Mathewoss; Dr. Kantelhardt, Eva Johanna; Dr. 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.
Clinicopathology and treatment patterns of head and neck cancers at Tikur anbessa specialized hospital, radiotherapy center, Addis Abeba, Ethiopia.
(Addis Ababa University, 2019-09) Fekadu, Adugna; Tigeneh, Wondimagegnehu(MD, MMsc (RT) FCR oncology)
Background: Head and neck cancer (HNC) is one of the most common cancers worldwide and its incidence is reported to be increasing both in developed and developing countries. There is lack of published data on clinicopathology and treatment patterns of head and neck cancers in Ethiopia. Objective: To assess clinicopathology and treatment patterns of head and neck cancers at Tikur Anbessa Specialized Hospital, Radiotherapy Center, Ethiopia Methodology: A retrospective cross-sectional study design and simple random sampling technique was used to select the required sample size. Descriptive statistics (mean, SD, frequency, percentage, graph and table) and chi-square results were generated by using SPSS version 21. The level of significance was obtained at 0.05. Results: Four hundred twenty two (422) histopathologically confirmed head and neck cancers that were treated at TASH from 2014 to 2017 G.C were analyzed in this study. The male to female ratio (M: F) was 1.98: 1. The most common primary site of head and neck cancers was pharynx 156 (37%) and the major histologic type was carcinoma which accounted 358 (84.81%). From carcinomas, squamous cell histologies were 330 (92.12%). Majority of the cases had advanced disease at diagnosis (89.29%). There was unacceptable delay between diagnosis and initiation of treatment. Conclusion/recommendation: This study showed that head and neck cancers treated at this hospital presented at advanced stage of the disease. Only small proportion of patients took concurrent chemo radiotherapy and there was long duration between diagnosis and initiations of treatments. These all might have reduced the curability of the disease. Majority of cases were males and relatively young at diagnosis. The awareness of the society on head and neck cancers should be increased as it helps to diagnose at early stages of the disease. The government and other stakeholders should expand cancer centers to reduce the treatment delay and increase quality of care of these cancers. Further studies are very important on head and neck cancers to optimize treatment out come
Patterns of Gastric Cancer in Tikur Anbessa Specialized University Hospital Radiotherapy Unit from 2012 to 2017
(Addis Ababa University, 2020-05) Dandena, Yonas; Dr.Tigeneh, Wondimagegnehu(MD, MSc (RT) FCR oncology;consultant oncologist, Associate Professor of Medicine, AAU, CHS)
Background: Gastric cancer is one of the most common alimentary tract cancers. Due to environmental and dietary factors, its incidence is on the rise, especially in the developing world. There is a lack of published studies on gastric cancer in Ethiopia. Objective: To evaluate pattern of gastric cancer among patients coming to Tikur Anbessa Specialized Hospital, Radiotherapy Center from 2012-2107 G.C. Methodology: The record of all patients taken from the departments inpatient and outpatient log book who were registered in the department from January 2012- December 2017 was taken as the source population and those patients who were labeled as gastric cancer was taken as the study population. The information was collected by the principal investigator. Data were compiled and analyzed using IBM SPSS version 22 software and presented using tables and figures. Results- A total of 42 patients who fulfilled the inclusion criteria were enrolled in the study. The male to female ratio was 2:1. Patient ages ranged from 24 to 75 years. The majority (42%) of the patients aged 45-60. Abdominal pain was the most common initial clinical presentation accounting for (45.2%) of the cases. The majority (83.3%) had stage 4 disease at the time of the initial presentation. ECOG performance status 2 was recorded in (59.5%) of the patients. Known risk factors like alcohol and cigarette smoking were recorded in 14.3% and 2.4 % respectively. Antrum was the most common tumor site involved in 35.7% of the patients. The majority of the patients were evaluated with upper GI endoscopy (95.2%). Of the surgical procedures done on the study population palliative bypass gastrojejunostomy was the most frequent procedure (50%). Palliative combination chemotherapy was given to (69%) of the patients. Pain medications were given to (50%) of the patients. Conclusion/recommendation: The study has shown gastric cancer affects a diverse group of patients in terms of age, sex, place of living, marital status, and religion. The majority of the patients had an advanced stage of disease after presenting with a protracted duration of symptoms were palliative combination chemotherapy was the only treatment option. We recommend proper pathological and clinical documentation.
Prevalence and Factors Associated with Parental Complementary and Alternative Medicine Utilization for Children with Cancer in Pediatric Oncology at Tikur Anbessa Specialized Hospital,Addis Ababa ,Ethiopia, 2020.
(Addis Ababa University, 2020-06) Seife, Habtamu; Murugan, Rajalakshmi (PHD); Wondwassen, Kalkidan(MSc )
Background: Complementary and Alternative medicine is a group of various medical and health‑care systems, practices, and products that are not currently part of conventional medicine. The use of complementary and alternative medicine among cancer patients has grown rapidly worldwide. Yet, In Ethiopia studies conducted on pediatrics cancer patients so far are very limited. This study aimed at assessing the prevalence and factors associated with parental complementary and alternative medicine utilization for children with cancer. Objective: To assess the Prevalence and factors associated with parental Complementary and Alternative Medicine Utilization for children with cancer in the Pediatric oncology unit at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. Methodology: Institutional-based cross-sectional study design was used. Data was collected using structured interviewer-administered questionnaire. The study was conducted among 126 Parents of the child among those who were visited black lion Hospital pediatric oncology between April 13- May 12. Descriptive and logistic regression analysis were used to present the data. Result: It was found that 59.5 % of parents had used CAM for their children with cancer. The top therapies used were spiritual healing 79.3% (special prayer sittings,45.3%), Tsebel (33.3%) and lighting candle 1.33% followed by Biological based methods 17.3(used herbs, 16%, and Honey 1.3%) and Manipulative therapies (Relaxation, 2.7%) Residence who live in a rural area were [AOR= 0.34 (P. 0.04, (0.12-0.97], Region, educational level Presence of Health problems (co-morbidity) [AOR=4.76 (P.0.06, (4.76(1.57--14.4)] were associated with parental CAM use for children with cancer. Conclusion and recommendation: There were high parental CAM utilization for children in this study (59.3%). Residence parents, region, educational status of parents, comorbidity of the child with cancer were associated with parental CAM use. Examine the coordination of services between these two diverse systems of health care; factors related to use and the outcomes of patients with cancer who use CAM. Further study is needed to determine the effect of independent self-treatment with CAM on the use of conventional health services and treatment for cancer.
Coping Strategies of Stress in Breast Cancer Patients at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2020: a cross-sectional study.
(Addis Ababa University, 2020-06) Assefa, Bethlehem; Tadele, Niguse (MSc, Assistant Professor); Getahun, Negalign (BSC, MSN)
Background-Diagnosis of breast cancer can be stressful, impacting on multiple domain of life, affecting physical status, emotional and spiritual well-being and personal relationships for the patient and mostly affects woman’s body image, sexuality leads to stress. In order to adapt, the patient used different coping methods. Variations may occur from one person to another person due to individual coping strategies, personality factors, and the level of social support available to them. In Ethiopia studies conducted so far are very limited. Objectives-To identify Coping Strategies of Stress in Breast Cancer Patienst at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, 2020 Methods-Institution based cross-sectional study design was conducted from February to April 2020 at Tikur Anbessa Specialized Hospital. Quantitative approach convenient sampling technique was used and sample sizes of 264 are participated in the study. The data was collected using structured and semi structured questionnaire and analyzed using SPSS version 25. The statistical analysis was done at 95% confidence and p-value of <0.05 was considered to declare statically significance. Descriptive statistics, Bivariate and multivariable binary logistic regression analysis was employed for data analysis and tables, figures and pie charts are used to present data results. Result- The mean of practicing positive coping strategies for breast cancer stress is 25.48 +3. And therefore, is negative coping stress. Around 64% of the participants solve their problems by confrontive stress coping strategy. More than 73% participants solve their problems by distancing stress coping strategy. In the self- controlling coping mechanisms of stress, the higher participants do most of the activities for positive coping strategy. Conclusion- Being uneducated, working in governmental organizations, 1-3 times of diagnosis for breast cancer, being taking combination chemotherapy and having social support have been associated with outcome of stress coping strategies. Recommendation- Better to take special attention on the accessibility of cancer treatment and social support in order to address the use different coping strategies.
Parental Role in Pediatric Cancer Treatment Decision Making at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia: 2020,G.C. (Mixed method study)
(Addis Ababa University, 2020-06) Betemariel, Daniel; Deribe, Leul (PHD student, MPH/RH); Hailu, Aklile (MSC, BSc)
Background: In medical scenarios like cancer parents level of participation in treatment decision for their child to enhance a better outcome is significant. Though in Ethiopia little is known about the decisional role of parents. Due to that this study aimed to clarify the extent to which parents involve in treatment decision making for their child and also explores different factors that determine the treatment decisional role. Objective: To assess parental role and associated factors in pediatric cancer treatment decision making at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia 2020 GC. Methods: A total of 167 parents were enrolled in the cross sectional study using a census method and additional 11 parents were purposively selected for the qualitative phenomenological study. The study was employed from April to May 2020 G.C. at Tikur Anbessa Specialized Hospital Pediatric Oncology department. Quantitative data was entered to EpiData version 4.6 and exported to SPSS version 25 for analysis. Descriptive frequencies and percents were used and binary logistic regression assessed statistical association. After the qualitative in-depth interview the data was transcribed and translated to Amharic then analyzed using thematic analysis method. ATLAS .ti 7 software was employed to aid coding process. Result: The actual role of parents in treatment decision making was 129(77.2%) for passive, 37(22.2%) for collaborative and 1(0.6%) for active. Also 138 (82.6%) of the participants reported having their preferred role. Interpersonal trust and parental informational preference were statistically significant factors. Three broad themes were identified for factors affecting parental role in treatment decisional role in the qualitative study which are parent health care provider relationship factor, parental factors and clinical factors. Conclusion and recommendation : Parental role in treatment decision making was found to be passive and multitude of factors were identified affecting their roles so there needs to be improvements in enhancing more roles for parents.
Relationship Between Perceived patient satisfaction and Emotional Intelligence of Nurses working in Oncology Units at TASH, Zewiditu Memorial Hospital and St.paul Referral Hospitals Addis Ababa, Ethiopia
(Addis Ababa University, 2020-06) Asrat, Rahel; Tadele, Niguse (MSN, Assistant Professor); Mulugeta, Tefera (MSN,Lecturer)
Background: - Emotional intelligence skills have been related with perceived patient satisfaction and emotional Intelligence skills of nurses. Nursing professional increase by emotional skill was explored and application of emotional intelligence ideas will be applied to the career of nursing. In Ethiopia there is scarcity of oncology nurses this led to higher load which can purpose burnout in the nurse that remain. Due to expertise hole on the working surroundings decrease their perception on affected person delight directly influence nurses’ performances and retention. General Objective: To assess the relationship between perceived patient satisfaction and emotional intelligence of nurses working in oncology unit at selected Hospitals in Addis Ababa, Ethiopia, 2020 Materials and Methods: An Institution based cross-sectional study design was conducted from February 20- April 20, 2020. With a sample size of 121 nurses working in oncology units at selected hospitals. SPSS version 23 was used to analyze data. Bi-variable and multi variable analysis was used to see the association between each independent variable and the outcome variable, Crude and Adjusted OR was used to compute considering p<0.05 to be statistically significant. Results: Among participants 73 (60.3 %) were reported having good emotional intelligence skills, Fifty three percent of the participants had good perception on patient satisfaction. Service year {(AOR=3.7 ;( 2.22, 5.22)} and monthly income {(AOR=4.01 ;( 1.22, 13.17)} were significantly associated to emotional intelligence. Good emotional intelligence was associated {AOR=3.8; CI (1.64-8.8)} with perceived patient satisfaction. Conclusion and recommendation: The study found that there was a relatively not good emotional intelligence skill. There is a need to design emotional intelligence skill increasing intervention plan and implementation.
Knowledge Towards Cervical Cancer Screening and Factors Associated Among Urban Female Health Extension Workers at Health Centers in Addis Ababa, Ethiopia, 2020.
(Addis Ababa University, 2020-06) Ararsa, Tiruneh; Tadele, Niguse(Ass professor); Ayalew, Yohannes(BSc, MSc)
Background: Cervical cancer is preventable and remains a leading cause of avoidable death among women in the world. In developing country, the knowledge of screening for cervical cancer behavior still very low, the converge of cervical cancer screening was from 2.0% to 20.2% in urban areas and from 0.4% to 14.0% in rural areas. Previous findings of research were indicated that the magnitude of screening for cervical cancer in Ethiopia is very low, which is about 0.6%, this indicated the knowledge of women is low because, of the women did not come to screened for cervical cancer. Materials and Methods: A cross-sectional study design was used. Data were collected using a structured self-administered questionnaire. Analysis was conducted using SPSS version 23. Results: About 312 urban health extension workers were included in this study. The mean age (±) standard deviation) of the study participant was 20.41 years ± SD, 3.73 years). Based on this finding, about 48.4% of the participants have good level of knowledge about cervical cancer screening and about 43.3% of the participant who were source of information were health professionals. A multiple logistic regression were performed to identify the existence and significance of association, work experience and monthly income were significantly associated [AOR = 4.32, 95% CI: (1.71, 10.94], monthly income [AOR = 3.75, 95% CI: (1.49, 9.41) and (A0R= 3.08 95% CI: (1.06, 8.98) were associated. Conclusion: This study has revealed that the knowledge towards cervical cancer screening was poor among urban health extension workers of Addis Ababa, health centers. Generally, information could be subordinate than seems in this explore. In conclusion, knowledge towards cervical cancer screening and when should be screening showed several misunderstandings. Based on this misunderstanding, continuing delivering information to encourage screening including health extension workers to raise the knowledge of women.
Assessment of Caregiver Strain and Associated Factors Among Family Caregivers of Children with Cancer Attending Tikur Anbessa Specialized Hospital in 2020
(Addis Ababa University, 2020-06) Lemessa, Kalkidan; Deribe, Leul(Assistant Professor, PhD student ); Getahun, Negalign(MSC)
Background: High levels of strain are potential contributors to develop a sign and symptoms of depression, anxiety, poor marital satisfaction and increase risk mortality. Caregivers with strain have limited capacity to provide the care that the patient needs. The aim of this study was to assess caregiver strain and associated factors among family caregivers of childhood cancer patients in TASH Addis Ababa, Ethiopia, 2020. Methods: a cross sectional study design was carried out among 153 family caregivers of children with cancer attending Tikur Anbessa specialized hospital using interviewer administrated. Multidimensional scale of perceived social support and modified caregiver strain was used to assess perceived social support and caregiver strain respectively. the data collection period was from April 15 to May 15 2020. The collected data was entered and cleaned using Epi-data 4.6 and then analyzed using SPSS version 25. Multiple linear regression was conducted to identify variables at P<0.05. Result: From 153 family caregivers 81(52.9%) were male and 72(47.1%) were between age group 35-49. Seventy-two (47.1%) of them had moderate level of perceived social support. The multiple linear regressions show a significant and association between caregiver strain and caregiver‟s age, duration of caregiving and perceived social support with P-value of 0.007, 0.006, and 0.003 respectively. Conclusion: The mean score of caregiver strain was 20.915 with standard deviation of 3.6417, One hundred forty (91.5%) of family caregivers report financial strain. Caregiver‟s age, duration of caregiving and perceived social support were significantly associated with caregiver strain. Recommendation: Focus must be given on family caregivers and make caregiver strain a routine nursing activity along with improving the socioeconomic status of the family caregivers.
Prevalence of Compassion Fatigue and Associated Factors Among Nurses Working in Cancer Centers of Selected Hospitals in Ethiopia.
(Addis Ababa University, 2020-06) Mirutse, Almaz; Mengistu, Zuriash (Bsc,Msc,Phd Fellow); Bizuwork, Ketema(Bsc,Msc)
Background: - oncology nurses are exposed to stressors that may contribute to compassion fatigue, leading to high rates of turnover, potential financial implications for organizations, and concerns for patient safety and employee well-being. Therefore the aim of this study to assess the prevalence of compassion fatigue and associated factors among nurses working in cancer centres of selected hospitals in Ethiopia. Objective: -The aim of this study was to assess the prevalence of compassion fatigue and associated factors among nurses working in cancer centres of selected hospitals in Ethiopia. Methods: - Institution based cross-sectional study were conducted in nurses who were working in oncology unit of public Hospitals of Ethiopia. Total sample sizes of 230 nurses were participated in the study. Data was coded and entered into EPi data software and exported to SPSS version 23 for analysis. Descriptive statistics such as frequencies and percentiles were computed to describe the study population in relation to relevant variables. Multiple linear regression models were employed. Variables p value <0.05 at 95 confidence interval were considered statically significant. Results: - Majority of the respondents 154 (67%) were females. One hundred forty seven of the respondents (63.9%) were in the age group of 24-34yrs and 66.09% of the participants had moderate compassion fatigue. Discussion: - The average compassion fatigue mean score among all study participants was 35.8 (SD = 7.78). Educational status, significant other support, family support, Consciousness and openness were the variables negatively associated and work over load, income, friend support and neuroticism were the variables positively associated with compassion fatigue in oncology nurses respectively. Conclusion:-The average compassion fatigue mean score among all study participants was 35.8 (SD = 7.78). Educational status, work over load, income, significant other support, family support, friend support, Consciousness, neuroticism and openness were the factors that affect the compassion fatigue of oncology nurses.
Nurses Knowledge and Care Practice for Infection Prevention in Patients with Neutropenia in Addis Ababa Government Hospitals, Ethiopia, 2020
(Addis Ababa University, 2020-06) Ayele, Alemkanchi; Tsige, Yosief (Assistant Professor); Boka, Abdisa(Lecturer)
Background: Neutropenia is one of the most common risk factors of infections in patients with poor immune competency. Sever neutropenia is major causes of morbidity, treatment disturbances and dose reductions in patients taking chemotherapy. Preventing infections is extremely important for a successful chemotherapy outcome. Nurses play an important role in the prevention, detection and management of neutropenia, as well teaching facts to patients for better cancer care. Objective: To assess nurse’s knowledge and care practice for infection prevention on chemotherapy induced neutropenia in Addis Ababa governmental hospitals with oncology units, Addis Ababa Ethiopia, 2020. Method: Institutional based cross-sectional study design using quantitative methods was conducted. Neutropenia knowledge questions (developed by Ertem) was used among 134 randomly selected nurses by lottery method. Data analysis was included descriptive statistics, including frequency, percentage, and mean. The statistical association between knowledge and practice and the explanatory variables were tested by binary logistic regression. Multivariable logistic regression was used to control confounding effects. The magnitude of the association between the different independent variables in relation to dependent variable were measured using 95% confidence interval and p-values below 0.05 considered as statistically significant. Result: From the total of 132 respondents 79 (59.8%) were female and 77 (58.3%) were at the age range between 22 to 30 years. The mean age of the participants was 30.6 years old. The nurse’s infection prevention care practices need improvement. Taking in service training, being a master’s degree holder and having education on neutropenia management were independent predictors of knowledge and practice about chemotherapy induced neutropenia infection prevention. Conclusion: nurses working in governmental hospitals of Addis Ababa have poor knowledge and care practice about chemotherapy induced neutropenia infection prevention. Recommendation: In service training regarding chemotherapy induced neutropenia infection prevention should be given to nurses who are working in cancer centers.
Awareness of Colorectal Cancer and its Associated Factors Among Adult Patients Attending Jimma University Medical Center South-West, Ethiopia, 2020.
(Addis Ababa University, 2020-06) Hamza, Abdulmenan; Argaw, Zeleke (MSc, Assi’t professor); Gela, Debela(MSc)
Background: Colorectal cancer (CRC) is the first commonest diagnosed cancer in men and the fourth commonest in women in Ethiopia. The most significant factors that may increase the risk of having CRC were modifiable. These factors were prevented by increasing awareness of the population. Objective: This study aimed to assess the awareness of CRC and its associated factors among adult patients attending Jimma University Medical Center, South-West Ethiopia, 2020. Methods: The institution-based quantitative cross-sectional study design was conducted among 422 patients at Jimma University Medical Center from March 8 to April 30, 2020. The study participants were recruited by a systematic random sampling method and data was collected semi-structured interviewer-administered questionnaires. The collected data were entered into Epi data version 4.6.0 and transferred to SPSS version 25. Descriptive, Bivariate and multivariate logistic regression were implemented. The strength of association was determined by using AOR, 95% CI. The statistical level of significance was stated at P<0.05. Result: A 100% response rate in this study was recorded. More than half (57.6%) of the study participants had low awareness of CRC. The first common and least common risk factors that were known by participants were smoking (78.2%) and aging (32.5%) whereas the most common and least common symptoms were blood in the stool (49.3%) and abdomen lump (33.9%). There is significant association between awareness of colorectal cancer and gender [AOR=1.86; 95% CI (1.26, 2.75)], residency [AOR= 0.45; 95% CI (0.30, 0.67)], monthly income [AOR=4.72; 95% CI (3.11, 7.15)], level of education [AOR=2.83; 95% CI (1.49, 5.37)], information sources [AOR=2.51; 95% CI (1.18,5.37)], and heard about CRC [AOR=4.48; 95%CI (2.90,6.93)]. Conclusion and recommendation: Results showed that awareness of patients towards CRC was inadequate. However, the majority of patients had better awareness of colorectal cancer risk factors. Similarly, participants with high levels of education and females had better awareness of CRC than the reverse. Therefore, there is a need for campaigns and educational programs, from health care authorities, a higher educational institution for the general public and patients.
Job Stress, Coping Strategy, and Associated Factors Among Nurses Working in Cancer Units of Selected Governmental Hospitals at Addis Ababa, Ethiopia, 2020.
(Addis Ababa University, 2020-06) Amduka, Redwan; Mengistu, Daneil(BSc, MSc, Assist prof); Habte, Teshome(BSc,MSc, lecturer )
Introduction: Job stress is a prevalent problem among nurses working in cancer units as they deal with a large number of patients with various conditions and work overload. Therefore, if it is not properly managed stress leads to high levels of employee illness, absenteeism, high turnover, and decreased productivity which compromises the provision of quality service to clients. Coping is a cognitive and behavioral effort one uses to face a stressful situation. There is no recorded data on job stress and coping strategies in our country specifically in the cancer unit. Objective: To assess job stress, coping strategy, and associated factors among nurses working in cancer units of selected governmental hospitals at Addis Ababa, Ethiopia, 2020. Method: the institution-based cross-sectional study was conducted from March-April 2020. Structured self-administered questionnaires were used to collect data from the study participant. The study population was all nurses who are working in cancer units of selected governmental hospitals in Addis Ababa and the sample size was 124 from three hospitals. The data were entered and analyzed by the SPSS window software 25 version. Descriptive statistics such as frequency distribution and measure of central tendency and variability were computed. Bivariate and multiple logistic regressions were used to identify the association between dependent and independent variables. Result: A total of 124 nurses working in the cancer unit of public hospitals were given the questionnaire, and the response rate was 97.6 % (121). The study showed that 52% (63) of nurses had job stress whereas 48% (58) were not stressed. Death and dying, workload, and uncertainty concerning treatment are the most sources of stress with average means 2.9, 2.73, and 2.67 respectively. Individual factors like respondents’ sex (AOR 0.33,95%, CI: 0.167-.0.882) was significantly associated with job-related stress score. Conclusion and Recommendations, in this crosssectional study half of the nurses, were occupationally stressful. Individual factors like respondents’ sex were significantly associated with overall job-related stress scores. To prevent occupational stress among nurses, policymakers, and different stakeholders should come up with strategies and develop exercise coping mechanisms that will help reduce stress for hospital-based nurses especially in special units like the oncology unit.
Resilience and its Predictors Among Parents of Children i | P a g e with Cancer at Jimma Medical Center, 2020.
(Addis Ababa University, 2020-06) Mezgebu, Esubalew; Deribe, Leul(Assistant Professor); Berhan, Emebet (MSc, Lecturer)
Background: Resilience is an ability to overcome adversities in response to a potentially traumatic event. Resilience relieves parents’ discomfort; it also helps to build personal capacity while they face in a stressful situation like children with cancer. Despite having this importance, the magnitude and its predictors of resilience among parents of children with cancer were unknown at Jimma medical center. Objective: To assess the magnitude of resilience and its predictors among the Parents of Children with Cancer at Jimma medical center, 2020. Method: An institutional-based cross-sectional design was employed on 126 parents of children with cancer at Jimma medical center. All study population who attend the hospital from February 25-April 25, 2020 and fulfills the inclusion criteria were included in the study. Data were collected by face-to-face interviews using a pretested structured questionnaire. Data were entered into Epi data version 4.6.0.2 and analyzed by SPSS version 25. Descriptive analysis was used to describe the study variables, Furthermore, linear regression analysis was calculated to assess predictors of resilience. Result: A total of 126 parents of children with cancer were interviewed yielding response rate of 96.8%. Little more than half (54.1%) of the respondents were mothers. The level of resilience among parents’ children with cancer were a mean scored 51.41±12.02. In this study, factors associated with resilience were; receiving support from friends (β=5.67, 95%CI=1.58, 9.77; and receiving health information from health care professionals (β=6.37; 95%CI= (1.75, 11.00), and parents depression (β= -0.827, 95%CI (-1.619,-0.034). Conclusion. The magnitude of resilience among parents of children with cancer was low. Support from friends and receiving health information from health care professionals were positively associated with resilience. Whereas, parents’ depression was negatively associated with resilience. Therefore, we recommended Jimma medical center health care providers including psychologists, Ministry of health and researchers should understand different factors and should give concern, to identify vulnerable parents and preparing and providing educational and psychological supports to improve parents’ health.
Risk Factors of Breast Cancer Among Patients Attending Tikur Anbessa Specialized Hospital and St.paul’s Hospital Millennium Medical College, Addis Abeba,Ethiopia:a Case Control Study.
(Addis Ababa University, 2020-06) Tolessa, Lidia; Dr.Gemechu, Endalew (Ass. Prof); Getahun, Negalign(MSC)
Introduction: Breast cancer is the leading cause of cancer- related death in women worldwide. In Ethiopia its incidence is rising, causing high rates of morbidity and mortality currently in the country. There is a variation in the prevalence of underlying risk factors among different countries. However, study that examines the local risk factors of breast cancer among women is limited in Ethiopia. Objective: To assess risk factors of breast cancer among patients attending Tikur Anbessa Specialized Hospital and St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia, 2020. Methods: Institutional-based case-control study was conducted with a sample of 272 women (136 cases and 136 controls). Cases and controls were selected by a systematic random sampling technique. Data was collected by interviewer administered questionnaire and the collected data was cleaned for incompleteness using Epi dataversion 4.6. Data analysis was carried out using SPSS version 25. Descriptive statistics wereemployed and bivariate and multivariate analysis using Odds ratio (OR) were utilized to evaluate the association between dependent and independent variables. A p-value of less than 0.05 was considered as a level of significance for associations. Results: In this study, a total of 272 participants with 136 cases and equal number of controls were participated. The mean (+SD) age of the participants was 42.7(±11.3) and 40.7(±14.6) for the cases and controls respectively. Increased risk of breast cancer was associated with early onset of menarche (AOR=7.9; 95% CI (1.959-31.905)) and use of packed food or drinks (AOR=4.4; 95% CI (1.481-13.218)). Living in urban areas (AOR=0.1; 95% CI (0.016-0.712)) and increased parity (AOR=0.750; 95% CI 0.567-0.992) were associated with reduced risk of breast cancer. Conclusion and recommendation: According to the finding of this study, place of residence, age at menarche, parity and use of packed food or drinks were associated with breast cancer. Therefore, attention should be given on specific risk factors, to reduce the increasing burden of the disease in our country.
Initiation of Cancer Rehabilitation Service in Tikur Anbessa Specialized Hospital: Challenges and Opportunities: Health Workers Perspective.
(Addis Ababa University, 2020-06) Gamene, Meseret; Menigstu, Mrdanel(PHD Fellow)
Background:Early diagnosis and improved cancer treatments have increased the number of cancer survivors. Accordingly, cancer rehabilitation has been increasingly recognized as a key factor in the management of cancer survivors. In Ethiopia, the number of cancer cases increases from year to year Tikur Anbessa Specialized Hospital is the only hospital in the country that render a comprehensive cancer therapy receiving patients from all over the country. However, the hospital has no cancer rehabilitation center. This overload can lead to inadequate care and also decrease quality of life and survival rate of the cancer patients. Hence, this study was to explored the initiation of cancer rehabilitation service with its challenges and potential opportunities from the health workers perspectives. Methods: qualitative study was conducted among health workers at TikurAnbessa Specialized Hospital, Addis Ababa, Ethiopia using the purposive sampling that includes_eighthealth workers. Data were collected through in-depth interview. The data analysis was performed using Atlas-tisoft wear version 7.5.16. Result:The result of the analysis led to established under the following threethemes and eleven sub-theme which are perspective of participant initiation cancer rehabilitation,Participants perspective of challenges for Cancer Rehabilitation service and participants perspective of existing / potential opportunities for the initiation of cancer rehabilitation.in this study the health worker perceived for initiation of cancer rehabilitation health policy, organizational ,health professional, perceived patient and family related challenges and opportunities.A graphic representation of the interaction was created for these categories and how they affect the initiation of rehabilitation services for cancer patients. Conclusion: findings of the study is that the government is not giving adequate attention for cancer as a general and rehabilitation service in particular. This can be seen easily as it drafts any policy or guide line and also did not allocate any budget. The other major finding is that institutional problems like workload, lack of working space and manpower. These findings can inform the government and stakeholders should consider the vitality of since cancer is spreading dramatically
Disease Control After Delayed Adjuvant Radio Therapy Among Locally Advanced Breast Cancer Patients Treated After One Year Mastectomy at Tikur Anbessa Specialized Hospital in 2016 G.C.
(Addis Ababa University, 2020-09) Tafesse, Ephrem; Dr.Seife, Edom(consultant oncologist, Assistance Professor of Medicine, AAU); Dr. Kantelhardt, Eva Johanna
Introduction – Nearly more than half of post mastectomy patient needs adjuvant radiotherapy. Adjuvant radiotherapy should be given according to clinical recommended indication, dose and time to reduce risk of loco-regional tumor recurrence. Most post mastectomy patients do not get adjuvant radiotherapy due to long radiotherapy waiting time at the centers. Delayed initiation of adjuvant radiotherapy associated with increased risk of tumor recurrence. Radiotherapy waiting time at TASH oncology center is unknown and expected to be more than a year. All high risk post mastectomypatients will be registered and wait for adjuvant radiotherapy. Benefit of giving delayed adjuvant chest wall irradiation is unknown. Despite our routine clinical practice, such treatment delay should be evaluated. Objective – The main objective of study was to assess the clinical benefit of delayed adjuvant radiotherapy delivery after 1 year of post mastectomy. Methods – Institutional based retrospective cross-sectional used to assess tumor control rate among post mastectomy breast cancer patients registered at TASH radiotherapy center for the indication of adjuvant chest wall irradiation. Result- In 2016 at TASH radiotherapy center, total of 274 high risk post mastectomy patients had registered for adjuvant chest wall irradiation. At 1year of post mastectomy, among radiotherapy registered 67.5%(185) patients had stable disease. Nearly 38.6% (106)patients did not take adjuvant radiotherapy and 28.8% (79) patients had took sequentially adjuvant chemotherapy and radiotherapy. The mean radiotherapy waiting time was 8.8±1.4months .Among those who took delayed adjuvant radiotherapy, the mean post mastectomy adjuvant radiotherapy delivery time was 10.4 ±1.9 months. At 4 years follow up,62.7%(116) patients are alive, 27.6%(52) had died and 9.7%(17) had unknown status. Tumor recurrenceconfirmed in 28.6% (53) patients. Among sub-groups, 34.1% (27) and 24.5% (26) patients had tumor recurrence among those who took and did not tookdelayed adjuvant radiotherapy respectively. Adjuvant radiotherapy was not found to be association with tumor control (COR=1.5, 95% CI=0.83-3.03, P-0.16). On multivariate analysis only advanced nodal tumor showed statically significant for tumor recurrence. N2 and N3 stage patients were found to be 3.8 and 4.3 times morelikely to develop recurrence as compared to Nx& N1 patients respectively (AOR, 3.86, CI 1.72-8.65, AOR 4.34, CI 1.54-12.26) Conclusion- Delayed adjuvant radiotherapy after median 10.4 months of post mastectomy did not associate with improved tumor control. According to our finding, most unnecessary delivery of delayed adjuvant radiotherapy can be omitted and delayed adjuvant chest wall irradiation should be given among patients having one of those poor prognostic factors age less than 55 years or advanced nodal tumor disease (N2 and N3). Recommendations– Radiotherapy waiting time at TASH oncology center can be improved through avoiding unnecessary delayed radiotherapy delivery among breast cancer patients. since TASH oncology center is the only center having single cobalt-60 machines for the whole country, the available energy source should be used effectively and efficiently without compromising treatment quality.
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; Dr.Seife, Edom(MD; Clinical oncologist ); Dr. Jemal, Ahmedin(American Cancer Society, Atlanta, GA); Dr. Kantelhardt, Eva Johanna(Department of Gynecology, Martin Luther University, Halle an der Saale, Germany)
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.
Relative Dose Intensity and Myelotoxicity of FOLFOX4 Chemotherapy Among Colorectal Cancer Patients at Tikur Anbessa Hospital
(Addis Ababa University, 2020-10) Seid, Fahmi Usman; Dr.Assefa, Mathewos(MD, Associate Professor of Clinical Oncology)
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.

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