Colorectal cancer survival in sub-Saharan Africa by age, stage at diagnosis, and Human Development Index: A population-based registry study Pubblico
Gullickson, Cricket (Spring 2021)
Abstract
Background: Although colorectal cancer is the fifth most commonly diagnosed cancer in Africa and its burden is rising, there are limited population-level survival data for planning and assessing the effectiveness of local colorectal cancer control programs in the region. Herein, we provide the first estimates of population-based survival data for many countries in sub-Saharan Africa.
Methods: 1,707 persons diagnosed with colorectal cancer from 2005-2015 were randomly selected from 13 population-based cancer registries operating in 11 countries (Benin, Cote d’Ivoire, Ethiopia, Kenya, Mauritius, Mozambique, Namibia, Seychelles, South Africa, Uganda, and Zimbabwe) in sub-Saharan Africa. Vital status was ascertained from medical charts or through next of kin. 1-, 3-, and 5-years overall survival rates for all registries combined and for each registry were calculated using the Kaplan Meier estimator. Multivariable analysis was used to examine the associations of 5-year overall survival with age at diagnosis, stage, and country-level Human Development Index (HDI). All analyses were performed using Stata, and all statistical tests were two-sided and considered significant when P <0.05.
Results: Overall survival across all registries combined was 72.0% (95% CI 69.5-74.4%) at 1 year, 50.4% (95% CI 47.6-53.2%) at 3 years, and 43.5% (95% CI 40.6-46.3%) at 5 years. Factors associated with poorer survival included living within a country with lower HDI, late stage at diagnosis, and younger or older age at diagnosis (<50 or ≥70 years). For HDI, for example, the risk of death was 1.6 (95% CI 1.2-2.1) times higher for individuals residing in medium HDI countries and 2.7 (95% CI 2.2-3.4) times higher for individuals residing in low HDI countries compared to those residing in high HDI countries.
Conclusions: Survival for colorectal cancer remains considerably low in sub-Saharan African countries. Strengthening health systems to ensure access to prevention, early diagnosis, and appropriate treatment will likely be critical in improving outcomes in colorectal cancer in the region.
Table of Contents
Introduction
Methods
Results
Discussion
References
Tables and Figures
Table 1: Numbers of colorectal cancer diagnoses, included and excluded cases, and data quality indicators by cancer registry
Table 2. Patient characteristics: mean age at diagnosis, median years of follow-up, losses to follow up, and observed (all-cause) survival
Table 3. Multivariable Poisson regression models of colorectal cancer mortality in relation to country-level HDI, age at diagnosis, sex, and disease stage
Figure 1: Kaplan-Meier survival curves among colorectal cancer patients: 13 registries
Figure 2: Relative survival from colorectal cancer at 1, 3, and 5 years after diagnosis, by registry
Figure 3: Relative survival by country HDI and stage at diagnosis
Supplemental Figures
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