Few with CRC in sub-Saharan Africa receive guideline-concordant care

Fewer than one in 20 patients diagnosed with colorectal cancer (CRC) in Sub-Saharan Africa (SSA) receive guideline-concordant treatment, according to a study published in the September issue of the Journal of the National Comprehensive Cancer Network.

Lucia Hämmerl, M.D., from Martin Luther University Halle-Wittenberg in Germany, and colleagues assessed concordance of CRC treatment with National Comprehensive Cancer Network Harmonized Guidelines for SSA. A random sample of 653 patients with CRC diagnosed from 2011 to 2015 from 11 population-based cancer registries in SSA was obtained. For 54% of the patients (traced cohort), information on clinical characteristics, treatment, and/or vital status was collected from medical records in treating hospitals.

The researchers found that 52.8% of the traced patients were from countries with a low human development index (HDI). Overall, 55.1% and 73.6% of patients had colon cancer and nonmetastatic (M0) disease, respectively. Only 3.1% of those with M0 disease received guideline-concordant treatment, while 20.6, 31.7, and 35.1% received treatment with minor deviations, treatment with major deviations, or no treatment, respectively.

In patients who received no cancer-directed therapy, the risk for death was 3.49 times higher than in patients who received standard treatment or treatment with minor deviations. The risk for death was 1.67 times higher for patients from countries with a low versus a medium HDI. Overall survival was 70.9% and 45.3% at one and three years, respectively.

"For policymakers and institutions in SSA, we hope our study results can be an important basis for targeted and meaningful investments and measures to improve the outcomes and survival of patients with CRC in the region," senior author Ahmedin Jemal, Ph.D., from the American Cancer Society in Atlanta, said in a statement.

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