Lack of basic colorectal cancer care is costing lives

Most people with colorectal cancer in sub-Saharan Africa receive no treatment or only inadequate treatment, despite the disease being potentially curable. The life expectancy of many of those affected can be significantly improved through simple measures. These were the findings of a new study published in JNCCN - Journal of the National Comprehensive Cancer Network. The study was conducted by University Medicine Halle along with the American Cancer Society and various international institutes. The team analyzed the data of 653 people diagnosed with colorectal cancer. In light of the rising number of cases and low survival rates in the region, the authors underscore the need to improve diagnosis and treatment options.

“Our study aimed at establishing the amount of basic care that colorectal cancer patients are receiving in sub-Saharan Africa and how impactful the treatment is in terms of survival rates,” explains Lucia Hämmerl, lead author of the new study and research associate in the Global Health working group at University Medicine Halle. Guidelines are used to make appropriate treatment decisions and options depend on the availability of personnel and the infrastructure and vary widely around the world. “Our focus was on harmonized colorectal cancer guidelines that take into account the circumstances in sub-Saharan Africa,” explains Hämmerl.

The study looked at 653 people who had been diagnosed with colorectal cancer. The data was taken from eleven population-based cancer registries. Additional medical information was available in 356 cases (55%). Of these, non-metastatic colorectal cancer (stage I-III) was documented in 262 people and metastatic colorectal cancer (stage IV) in 94 people. Only eight people (3%) with non-metastatic and potentially curable disease received guideline-compliant treatment; over half received treatment with deviations and more than a third received no treatment at all. This resulted in a mortality rate that was up to 3.5-times higher in the regions studied. “Most of the patients with incomplete medical records presumably did not receive adequate treatment and that was why no clinical data was collected. In the remaining patients, the survival rate was significantly higher when the treatment was guideline-concordant or slightly deviated from the guideline. However, this occurred in less than one in twenty cases, even though adequate basic care can be provided without high-tech or costly solutions,” says Hämmerl.

Inequalities were also found when the data was compared globally. This was done using the Human Development Index (HDI), which takes life expectancy, education and income into account. The mortality rate of colorectal cancer patients in countries with low HDI scores, such as Ethiopia, Mali and the Congo, is two thirds higher than in countries with medium HDI scores, like Namibia and Kenya. “We saw an alarming gap between the recommendations of the harmonized guidelines and the treatment that was actually being provided, especially in patients with potentially curable disease. In light of the aging population in sub-Saharan Africa and the rising incidence of colorectal cancer, a great deal of suffering could be avoided through simple measures. The necessary strategies are available,” explains Professor Eva Kantelhardt, co-author of the study and head of the Global Health working group at University Medicine Halle.

“It is crucial that surgeons in particular are trained to perform radical cancer surgery. German hospitals can contribute by working in partnership to train specialists from African countries. In the case of gynecological oncology, where a similar problem exists, many colleagues from Ethiopia have already received further surgical training at University Medicine Halle,” says the expert on global health. As part of the BMBF-funded NORA research network, the study will be repeated and compared with the previous data.

Publication:

Hämmerl L. et al. Treatment and Survival Among Patients With Colorectal Cancer in Sub-Saharan Africa: A Multicentric Population-Based Follow-Up Study. J Natl Compr Canc Netw. 2023 Sep;21(9):924-933.e7. doi: 10.6004/jnccn.2023.7041.

More information on the assessed guidelines (Colon and Rectal Cancer):
Harmonized Guidelines (nccn.org)