Treatment Outcome and Associated Factors among Colorectal Cancer Patients in Tikur Anbessa Hospital, Ethiopia: A Prospective Cohort Study
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Date
2023-01
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Addis Ababa University
Abstract
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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CRC Survival Ethiopia.