Data on histological characteristics, survival patterns and determinants of mortality among colorectal, esophageal and prostate cancer patients in Ethiopia

This article describes data collected retrospectively on a cohort of esophageal, colorectal and prostate cancer patients registered in the patient log book of Tikur Anbessa Specialized Hospital, Ethiopia, from January 1, 2012 to December 31, 2017. The key variables studied include histological characteristics of each type of cancer, clinical and TNM stages, baseline laboratory results (Carcinoembryonic antigen (CEA) for colorectal cancer, Prostate-Specific Antigen (PSA) for prostate cancer, hemoglobin level, etc.), clinical characteristics including sign and symptoms, family history of cancer, diagnostic and treatment modalities a patient received for each type of cancer. The event status (death) was also collected using death certificates (whenever available) and supplemented by telephone interviews with the patient or attendant. Furthermore, lifestyle characteristics of patients including tobacco use, alcohol consumption, khat (‘Catha edulis’) chewing, etc. and socioeconomic characteristics including age, sex, region of residence, marital status, and educational level were also collected. The aim that led to conduct the study that generated these data was to describe clinical presentation, histological characteristics, survival pattern, and to identify determinants of mortality among cancer patients in Ethiopia. Thus, independent survival analyzes were performed using Kaplan-Meier estimates and life table analysis. Furthermore, Cox’s proportional hazards regression was developed to investigate the survival pattern and determinants of cancer specific mortality among colorectal, esophageal and prostate cancer patients.

Practical considerations for prostate hypofractionation in the developing world

External beam radiotherapy is an effective curative treatment option for localized prostate cancer, the most common cancer in men worldwide. However, conventionally fractionated courses of curative external beam radiotherapy are usually 8–9 weeks long, resulting in a substantial burden to patients and the health-care system. This problem is exacerbated in low-income and middle-income countries where health-care resources might be scarce and patient funds limited. Trials have shown a clinical equipoise between hypofractionated schedules of radiotherapy and conventionally fractionated treatments, with the advantage of drastically shortening treatment durations with the use of hypofractionation. The hypofractionated schedules are supported by modern consensus guidelines for implementation in clinical practice. Furthermore, several economic evaluations have shown improved cost effectiveness of hypofractionated therapy compared with conventional schedules. However, these techniques demand complex infrastructure and advanced personnel training. Thus, a number of practical considerations must be borne in mind when implementing hypofractionation in low-income and middle-income countries, but the potential gain in the treatment of this patient population is substantial.

Consensus on Treatment and Follow-Up for Biochemical Recurrence in Castration-Sensitive Prostate Cancer: A Report From the First Global Prostate Cancer Consensus Conference for Developing Countries

PURPOSE
To present a summary of the treatment and follow-up recommendations for the biochemical recurrence in castration-sensitive prostate cancer (PCa) acquired through a questionnaire administered to 99 PCa experts from developing countries during the Prostate Cancer Consensus Conference for Developing Countries.

METHODS
A total of 27 questions were identified as related to this topic from more than 300 questions. The clinician’s responses were tallied and presented in a percentage format. Topics included the use of imaging for staging biochemical recurrence, treatment recommendations for three different clinical scenarios, the field of radiation recommended, and follow-up. Each question had 5-7 relevant response options, including “abstain” and/or “unqualified to answer,” and investigated not only recommendations but also if a limitation in resources would change the recommendation.

RESULTS
For most questions, a clear majority (> 50%) of clinicians agreed on a recommended treatment for imaging, treatment scenarios, and follow-up, although only a few topics reached a consensus > 75%. Limited resources did affect several areas of treatment, although in many cases, they reinforced more stringent criteria for treatment such as prostate-specific antigen values > 0.2 ng/mL and STAMPEDE inclusion criteria as a basis for recommending treatment.

CONCLUSION
A majority of clinicians working in developing countries with limited resources use similar cutoff points and selection criteria to manage patients treated for biochemically recurrent castration-sensitive PCa.

Prostate Cancer Survival and Mortality according to a 13-year retrospective cohort study in Brazil: Competing-Risk Analysis

Objective: To analyze cancer-specific mortality (CSM) and other-cause mortality (OCM) among patients with prostate cancer that initiated treatment in the Brazilian Unified Health System (SUS), between 2002 and 2010, in Brazil.

Methods: Retrospective observational study that used the National Oncological Database, which was developed by record-linkage techniques used to integrate data from SUS Information Systems, namely: Outpatient (SIA-SUS), Hospital (SIH-SUS), and Mortality (SIM-SUS). Cancer-specific and other-cause survival probabilities were estimated by the time elapsed between the date of the first treatment until the patients’ deaths or the end of the study, from 2002 until 2015. The Fine-Gray model for competing risk was used to estimate factors associated with patients’ risk of death.

Results: Of the 112,856 studied patients, the average age was 70.5 years, 21% died due to prostate cancer, and 25% due to other causes. Specific survival in 160 months was 75%, and other-cause survival was 67%. For CSM, the main factors associated with patients’ risk of death were: stage IV (AHR = 2.91; 95%CI 2.73 – 3.11), systemic treatment (AHR = 2.10; 95%CI 2.00 – 2.22), and combined surgery (AHR = 2.30, 95%CI 2.18 – 2.42). As for OCM, the main factors associated with patients’ risk of death were age and comorbidities.

Conclusion: The analyzed patients with prostate cancer were older and died mainly from other causes, probably due to the presence of comorbidities associated with the tumor.