Academic literature on the topic 'Uganda Cancer Institute'

Introduction. Limited data suggest that children with cancer in sub-Saharan Africa have poor survival. We aimed to describe the presentation, treatment outcomes, and factors associated with survival among children with cancer managed at Uganda Cancer Institute. Methods. We retrospectively evaluated patients with childhood cancer (age ≤19 years) from Kyadondo County treated at Uganda Cancer Institute from 2006 to 2009. Cox’s regression and Kaplan-Meier methods were used to study 1-year survival. Results. Among 310 patients studied, median age was 7 years (range = 0.25-19 years), 64% were boys, and 92% had histological confirmation of cancer diagnosis. The commonest diagnoses were Burkitt lymphoma (BL, N = 87), Kaposi sarcoma (KS, N = 68), non-BL non-Hodgkin lymphoma (NHL, N = 32), acute lymphoblastic leukemia (ALL, N = 28), Wilms (N = 28), and Hodgkin disease (HD, N = 20). Advanced disease at diagnosis was common for all cancers (ranging from 45% for KS to 83% for non-BL NHL). Overall, 33.2% abandoned treatment. One-year survival was 68% for HD (95% confidence interval [CI] = 11.3-40.6), 67% for KS (95% CI = 52.1-77.9), 55% for BL (95% CI = 42-66.9), 44% for Wilms (95% CI = 22.5-63), 43% for non-BL NHL (95% CI = 23.3-61.3), and 20% for ALL (95% CI = 6.4-38.7). In univariate and multivariate analysis, anemia and thrombocytopenia were associated with mortality for several cancers. Conclusion. Survival among children with cancer in Uganda is poor. Advanced stage disease and loss to follow-up likely contribute to poor outcomes. Anemia and thrombocytopenia may augment traditional staging methods to provide better prognostic factors in Uganda and warrant further evaluation.

Purpose In Uganda, the incidence of prostate cancer is increasing at a rate of 5.2% annually. Data describing presentation and outcomes for patients with prostate cancer are lacking. Methods A retrospective review of medical records for men with histologically confirmed prostate cancer at the Uganda Cancer Institute (UCI) from January 1 to December 17, 2012, was performed. Results Our sample included 182 men whose mean age was 69.5 years (standard deviation, 9.0 years). Patients who presented to the UCI had lower urinary tract symptoms (73%; n = 131), bone pain (18%; n = 32), increased prostate-specific antigen (PSA; 3%; n = 5), and other symptoms (6%; n = 11). Median baseline PSA was 91.3 ng/mL (interquartile range, 19.5-311.3 ng/mL), and 51.1% of the patients (n = 92) had a PSA value above 100 ng/mL. Gleason score was 9 or 10 in 66.7% of the patients (n = 120). Ninety percent (n = 136) had stage IV disease, and metastatic sites included bone (73%; n = 102), viscera (21%; n = 29), and lymph nodes (4%; n = 5). Spinal cord compression occurred in 30.9% (n = 55), and 5.6% (n = 10) experienced a fracture. A total of 14.9% (n = 27) underwent prostatectomy, and 17.7% (n = 32) received radiotherapy. Gonadotropin-releasing hormone agonist was given to 45.3% (n = 82), 29.2% (n = 53) received diethylstilbestrol, and 26% (n = 47) underwent orchiectomy. Chemotherapy was administered to 21.6% (n = 39), and 52.5% (n = 95) received bisphosphonates. During the 12 months of study, 23.8% of the men (n = 43) died, and 54.4% (n = 98) were lost to follow-up. Conclusion UCI patients commonly present with high PSA, aggressive Gleason scores, and stage IV disease. The primary treatments are hormonal manipulation and chemotherapy. Almost 25% of patients succumb within a year of presentation, and a large number of patients are lost to follow-up.

Purpose HIV increases cancer incidence and mortality. In Uganda, the HIV epidemic has led to an elevated incidence of AIDS-defining cancers (ADCs) and non–AIDS-defining cancers (NADCs). Limited information exists about how frequently HIV infection complicates the presentation and manifestations of cancer in sub-Saharan Africa. Methods We abstracted medical records from patients with cancer who were age 18 years or older who registered at the Uganda Cancer Institute from June through September 2015 to determine the burden of HIV. We used χ2 tests and generalized linear models to evaluate factors associated with HIV positivity. A sensitivity analysis estimated HIV prevalence in those untested. Results Among 1,137 patients with cancer, 23% were HIV infected, 48% were HIV negative, and 29% had no recorded HIV status. Of those with recorded HIV status, 32% were HIV positive. Forty-two percent (149 of 361 patients) with ADCs were documented as HIV infected (51% of those with documented status) compared with 14% (108 of 776 patients) of those with NADCs (21% of those with documented status). In multivariable analysis, HIV infection was associated with ADC diagnosis (adjusted prevalence ratio [aPR] compared with NADC, 2.2; 95% CI, 1.5 to 3.0), younger age (aPR, 0.9 per decade increase; 95% CI, 0.8 to 1.0), and worse performance status scores (aPR, 1.2 per point ECOG increase; 95% CI, 1.0 to 1.5). When sensitivity analysis accounted for undocumented HIV status, the expected prevalence of HIV infection was 29% (range, 23% to 32%), and almost one fourth of expected HIV cases were undiagnosed or unrecorded. Conclusion The prevalence of HIV infection among Ugandan patients with cancer is substantially higher than in the general population. Patients with cancer and HIV tend to be younger and have poorer performance status. Greater awareness of the dual burden of cancer and HIV in Uganda and universal testing of patients with cancer may improve outcomes of HIV-associated malignancies.

246 Background: In Uganda prostate cancer is the most common cancer and the incidence is increasing 5.2% annually. This burden is seen without screening programs in a country with limited access to cancer care. Data describing patient presentation and outcomes are lacking. Methods: Retrospective chart review for men with histologically-confirmed prostate cancer at the UCI from January 1 to December 17, 2012. Patient characteristics, treatments, and survival data were obtained. Results: There were 181 men with confirmed prostate cancer [C1] . Mean age was 69.5 (SD 9.0) with a median age of 70 (IQR: 64-75). Men presented with symptoms of lower urinary tract symptoms 73% (n=131), bone pain in 18% (n=32), elevated PSA 3% (n=5) and other causes 6% (n=11). Median baseline PSA was 91.3 ng/ml (IQR: 19.5-311.3 ng/ml) and upon presentation 51.1% (n=92) had a PSA value over 100 ng/ml. Gleason Score was 9 or 10 in 66.7% (n=120), Gleason Score 7 to 8 in 23.4% (n=44), and Gleason six or lower in 10% (n=18). Ninety percent (n=136) of patients had stage IV disease, 6.5% (n=11) were stage III, 11.9% were (n= 20) stage II, and 1 individual (0.6%) had stage I. Common sites of metastases included bone 73% (n=102), visceral metastases 21% (n=29), and lymph node involvement 4% (n=5). Spinal cord compression occurred in 30.9% (n=55) and 5.6% (n=10) experienced a fracture. A total of 14.9% (n=27) patients underwent radical prostatectomy and 17.7% (n=32) received radiotherapy. GNRH agonist was given to 45.3% (n=82) of patients, 29.2% (n=53) of men received diethylstilbestrol, and 26% (n=47) underwent bilateral orchiectomy. Chemotherapy was administered to 21.6% (n=39) and 52.5% (n=95) received bisphosphonates. During the 12 months of study 23.8% (n=43) of men experienced death and 54.4% (n=98) were lost to follow up. Conclusions: UCI patients present with significant symptoms, high PSA, and aggressive Gleason Scores. 90% present with stage IV disease and almost 33% develop spinal cord compression. Prostatectomy and radiotherapy are infrequently given and the primary treatments are hormonal manipulation and chemotherapy. Almost 25% of patients succumb within a year of presentation and there is a high rate of patients lost to follow up.

Purpose The HIV epidemic has contributed to the increasing incidence of cancer in sub-Saharan Africa, where most patients with cancer present at an advanced stage. However, improved access to HIV care and treatment centers in sub-Saharan Africa may facilitate earlier diagnosis of cancer among patients who are HIV positive. To test this hypothesis, we characterized the stage of cancer and evaluated the factors associated with advanced stage at presentation among patients in Uganda. Methods We conducted a retrospective analysis of adult patients with any of four specific cancers who presented for care in Kampala, Uganda, between 2003 and 2010. Demographic, clinical, and laboratory data were abstracted from the medical record, together with the outcome measure of advanced stage of disease (clinical stage III or IV). We identified measures for inclusion in a multivariate logistic regression model. Results We analyzed 731 patients with both AIDS-defining cancers (cervical [43.1%], and non-Hodgkin lymphoma [18.3%]), and non–AIDS-defining cancers (breast [30.0%] and Hodgkin lymphoma [8.6%]). Nearly 80% of all patients presented at an advanced stage and 37% had HIV infection. More than 90% of patients were symptomatic and the median duration of symptoms before presentation was 5 months. In the multivariate model, HIV-positive patients were less likely to present at an advanced stage as were patients with higher hemoglobin and fewer symptoms. Conclusion Patients with limited access to primary care may present with advanced cancer because of a delay in diagnosis. However, patients with HIV now have better access to clinical care. Use of this growing infrastructure to increase cancer screening and referral is promising and deserves continued support, because the prognosis of HIV-positive patients with advanced cancer is characterized by poor survival globally.

Introduction: Lung cancer is a major global public health burden constituting 11.6% of all new cancer diagnoses and 18.4% of all cancer-related mortality. Purpose: To describe the clinical profile and initial treatment of non-small cell lung cancer in Uganda. Methods: We reviewed charts of a cohort of patients with a histologically confirmed diagnosis of non-small cell lung cancer, treated between January 2013 and November 2015 at the Uganda Cancer Institute. Results: A total of 74 patients met the inclusion criteria. The median age was 56 years (IQR 47-70), with 16.2% below the age 45 years, and 51% were female. Only 10 percent were active smokers and the most frequent histological subtype was adenocarcinoma (71%). The majority (91.9%) had stage IV disease at diagnosis and frequent metastases to contralateral lung, liver, and bones. Twenty-seven (27) patients received platinum-based chemotherapy, while 27 patients received erlotinib, and only 4 patients received palliative thoracic radiotherapy. The median survival time was 12.4 months, and the overall response rate was 32.7%. There was no survival difference by type of systemic treatment, and on multivariate analysis, poor performance status was predictive of adverse outcomes (p < 0.001). Conclusions: Patients with non-small cell lung cancer in Uganda frequently presented with late-stage disease at diagnosis. The majority of patients were female, never-smokers, and had predominantly adenocarcinoma subtype. Keywords: Non-small cell lung cancer; Uganda; erlotinib; lung cancer; Uganda Cancer Institute.

The Uganda Cancer Institute, the sole national comprehensive cancer center in Uganda, has a long and rich history of clinical investigation and locally relevant cancer research. Given the increasing burden of breast cancer in Uganda and elsewhere in sub-Saharan Africa (SSA) and driven by the limited availability of immunohistochemistry (IHC), we launched a clinical trial aimed at evaluating locally available diagnostics to detect the presence of hormone receptors (estrogen receptor and progesterone receptor) and human epidermal growth factor receptor 2. Preliminary data from 32 women in the diagnostic component of the study reveal high sensitivity and specificity for estrogen receptor and progesterone receptor and high specificity for human epidermal growth factor receptor 2 when comparing reverse transcriptase polymerase chain reaction with the gold standard (IHC). Innovative diagnostic and treatment strategies are required to address the burden of breast cancer that is increasing throughout SSA. Given the costs, infrastructure, and trained personnel associated with IHC, alternative testing options (including reverse transcriptase polymerase chain reaction as tested in our study) may provide an expedited and cost-effective method to determine receptor testing in breast cancer. Clinical trials conducted in the local setting are critical to determining optimal strategies for effective breast cancer management in SSA.

Abstract Introduction It is estimated that nearly half a million people will die of cancer in sub-Saharan Africa (SSA) in 2020, and that the incidence of cancer will increase more than 40% between now and then. Unfortunately, treatment options in SSA are often hampered by a sub-optimal health care infrastructure resulting in advanced disease at presentation and the limited availability of effective, but cost prohibitive, chemotherapy. Consequently patient outcomes are typically poor and there is an unmet need to identify those cancer patients who would benefit most from the limited resources available. In resource-abundant areas, low hemoglobin [hgb], advanced disease stage, and poor patient performance status (PS) are associated with a poor prognosis and often serve to direct cancer care towards palliation instead of cure. Similarly, the international prognostic index (IPI) provides prognostic information among patients with non-Hodgkin lymphoma (NHL). However, the utility of such measures in therapeutic decision making in resource-poor areas is less studied. Here we describe characteristics of patients with a new diagnosis of NHL presenting for care in Uganda and identify factors associated with those patients recommended to receive cancer-directed therapy. Methods We conducted a retrospective analysis of all patients > 18 at the time of diagnosis of NHL between 2003 and 2010 who were residents of Kyandondo County (Uganda). Cases were identified from the Kampala Cancer Registry (KCR), a national population-based cancer registry. Patient lists from the KCR were transferred to the Uganda Cancer Institute (UCI), the nation's sole cancer center and Mulago Hospital, a university teaching hospital located in Kampala. Additionally, eligible patients who had not yet been recorded in the KCR were identified from patient records at the UCI or Mulago Hospital. Medical records were reviewed for all eligible patients. Patients determined to have a prior malignancy were excluded from this analysis. Demographic, clinical, and laboratory data were abstracted from the medical record. PS data were not routinely recorded in the medical record. The outcome measure was whether chemotherapy was recommended by clinical staff. We assessed whether demographic, clinical, and laboratory measurements were associated with the recommendation for treatment with chemotherapy. Those variable which were associated with the recommendation for chemotherapy (p <0.20) were included in the multivariate analysis. Results A total of 134 patients met our inclusion criteria. 48% of the patients were female with a median age of all patients of 40.7 years (range 19-82 years). Over half of the patients (57.5%) were HIV positive. Nearly 90% of the patients presented with stage 3 or stage 4 disease. The vast majority of patients (97.0%) reported at least 1 symptom. Fever (55.8%), a palpable mass (79.7%), and wasting (52.3%) were the most common symptoms reported at presentation. Approximately three-fourths of the patients had at least 1 comorbidity. The median baseline hgb level was 10.8 g/dl; 10% had a hgb <7g/dl. The median LDH level was elevated at 416 IU/L, however data were only obtained for 66 (49%) patients. Chemotherapy was recommended to 91.2% of the patients. In the multivariate logistic regression model, older age (p=.02), lower stage of disease (p <.001), and fewer comorbidities (p=.01) were associated with the failure to recommend for cancer-directed therapy. Conclusion Given their independent effect on response to therapy and overall survival, clinical prognostic indices are often used in resource-abundant countries to identify which patients will derive a benefit from cancer-directed therapy and which patients are better served by supportive measures. In our analysis, the recommendation for cancer-directed therapy was nearly universal. Collecting complete prospective data on IPI variables and follow-up data can validate the IPI in Uganda, allow Ugandan clinicians to determine whether such measures inform survival, and potentially optimize treatment decisions among patients with NHL. In resource-poor areas, the allocation of scarce health care resources to those patients that will be most likely to derive a meaningful benefit is imperative. Targeting therapy will not only save limited resources, it will also prevent harm in those patients unlikely to realize an effect of cancer-directed therapy. Disclosures: Casper: Janssen Research & Development: Research Funding.

10070 Background: Although many childhood cancers respond well to chemotherapy, survival among children with cancer in sub-Saharan Africa is poor. Little is known about children’s access to specialized cancer care in SSA or factors contributing to poor early outcomes. We aimed: 1) To estimate the proportion of childhood cancer patients without access to chemotherapy in Uganda; 2) To describe 30-day survival rates and predictors of mortality post diagnosis among children with lymphoma or Kaposi sarcoma (KS), the two most common pediatric cancers in Uganda. Methods: A retrospective study of incident childhood (age< 20 years) cancers diagnosed in Kyandondo County, Uganda from 2006-2009. We compared records of the population-based Kampala Cancer Registry (KCR) and patient records at the Uganda Cancer Institute (UCI), Uganda’s sole dedicated cancer treatment center. Patient characteristics were compared using Mann-Whitney and Pearson’s chi-square tests. Kaplan-Meier method and Cox regression models were used to describe mortality. Results: Of the 658 pediatric cases recorded in the KCR, only 238 (36%) presented to UCI. Patients identified in the KCR who did not present for care were more likely to be female, diagnosed in earlier years of the study, and to have a cancer other than KS or lymphoma. Of the 177 lymphoma and KS cases at UCI, 43.7% were Burkitt lymphoma (BL), 32.5% KS, and 23.8% other lymphomas. The post diagnosis 30-day overall survival rate was 77%. In multivariate analysis, age, gender, HIV status, platelets, and stage of cancer did not impact mortality. An increased risk of death at 30 days was predicted by presence of B-symptoms (HR=10.3, p=0.05), a diagnosis of BL compared to other lymphomas (HR=14.8, p=0.007), poor performance status (Karnofsky score <70, HR=14.7, p<0.001), and anemia (HR 1.5-fold per 1g/dL decrease in hemoglobin, p=0.002). Conclusions: Childhood cancer patients in Uganda have limited access to comprehensive care. Among those presenting to the UCI, a significant proportion die before they can benefit from chemotherapy. BL diagnosis, B-symptoms, performance status and hemoglobin level may be important predictors of early mortality among childhood cancer patients in sub-Saharan Africa.

The cultural aspects of a society incorporate customary beliefs, language, religion, cuisine, social habits and norms, music, arts, and spirituality. Spirituality relates to that which affects the human spirit or soul, as opposed to material or physical components or matters relating to religion or religious beliefs. All these dimensions can be intertwined and influenced by financial and other resources. Uganda is a religiously diverse nation with over 84% of the population Christian (Protestants, Roman Catholics, and others) and about 14% Muslim; the remainder follow traditional African religions or do not ascribe to any particular faith. The Uganda Cancer Institute, a public medical care facility that provides modern cancer treatment modalities, is one of the oldest specialist cancer care programs on the African continent. It was established in 1967 with most treatment modalities and is now opening regional centers within the country. Cancer care should include the following: understanding the religious and spiritual dimensions; level of education of the population; health literacy packages about specific cancers; addressing barriers to accessing services and beliefs about traditional medicines. In improving cancer care outcomes, patients’ diverse spiritual and cultural beliefs must be recognized, and available methods must be utilized in order to improve access and adherence to treatment modalities and regimens.

ABSTRACT Background: Cervical cancer ranked the fourth most cancer incidence in women. WHO announced that 311,000 women died from the disease in 2018. Cervical cancer screening uptake remains low, especially in low- and middle-income countries. This scoping review aimed to investigate the motivation for early detection of cervical cancer in women of reproductive age. Subjects and Method: A scoping review method was conducted in eight stages including (1) Identification of study problems; (2) Determining priority problem and study question; (3) Determining framework; (4) Literature searching; (5) Article selection; (6) Critical appraisal; (7) Data extraction; and (8) Mapping. The research question was identified using population, exposure, and outcome(s) (PEOS) framework. The search included PubMed, ResearchGate, and grey literature through the Google Scholar search engine databases. The inclusion criteria were English-language and full-text articles published between 2010 and 2020. A total of 275 articles were obtained by the searched database. After the review process, twelve articles were eligible for this review. The quality of searched articles was appraised by Joanna Briggs Institute Critical Appraisal tools. The data were reported by the PRISMA flow chart. Results: Seven articles from developing countries (Jamaica, Nepal, Africa, Nigeria, Libya, and Uganda) and five articles from developed countries (England, Canada, Sweden, and Japan) met the inclusion criteria with cross-sectional studies. The selected existing studies discussed 3 main themes related to motivation to early detection of cervical cancer, namely sexual and reproductive health problems, diseases, and influence factors. Conclusion: Motivation for cervical cancer screening uptake is strongly related to the early detection of cervical cancer among reproductive-aged women. Client-centered counseling and comprehensive sexual and reproductive health education play an important role in delivering information about the importance of cervical cancer screening. Keywords: motivation, cervical cancer, screening, early detection, reproductive-aged Correspondence: Siti Nurul Khotimah. Health Sciences Department of Master Program, Universitas Aisyiyah Yogyakarta. Jl. Siliwangi (Ringroad Barat) No. 63, Nogotirto, Gamping, Sleman, Yogyakarta, 55292. Email: Sitinurulkhotimah1988@gmail.com. Mobile: +6281227888442. DOI: https://doi.org/10.26911/the7thicph.03.65