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Tobias Paul Seraphin MD Walburga Yvonne Joko-Fru MD Lucia Hämmerl MD Mirko Griesel MD Nikolaus Christian Simon Mezger MD Jana Cathrin Feuchtner MD Innocent Adoubi MD Marcel Dieu-Donné Egué BSc Nathan Okerosi Henry Wabinga MD Rolf Hansen BBA Samukeliso Vuma MD Cesaltina Lorenzoni PhD Bourama Coulibaly MD Sévérin W. Odzebe MD Nathan Gyabi Buziba MD Abreha Aynalem MD Biying Liu MPH Daniel Medenwald MD Rafael T. Mikolajczyk MD Jason Alexander Efstathiou MD Donald Maxwell Parkin MD Ahmedin Jemal PhD Eva Johanna Kantelhardt MD 《Cancer》2021,127(22):4221-4232
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Mirko Griesel Tobias P. Seraphin Nikolaus C.S. Mezger Lucia Hämmerl Jana Feuchtner Walburga Yvonne Joko-Fru Mazvita Sengayi-Muchengeti Biying Liu Samukeliso Vuma Anne Korir Gladys C. Chesumbai Sarah Nambooze Cesaltina F. Lorenzoni Marie-Thérèse Akele-Akpo Amalado Ayemou Cheick B. Traoré Tigeneh Wondemagegnehu Andreas Wienke Christoph Thomssen Donald M. Parkin Ahmedin Jemal Eva J. Kantelhardt 《The oncologist》2021,26(5):e807-e816
BackgroundCervical cancer (CC) is the most common female cancer in many countries of sub‐Saharan Africa (SSA). We assessed treatment guideline adherence and its association with overall survival (OS).MethodsOur observational study covered nine population‐based cancer registries in eight countries: Benin, Ethiopia, Ivory Coast, Kenya, Mali, Mozambique, Uganda, and Zimbabwe. Random samples of 44–125 patients diagnosed from 2010 to 2016 were selected in each. Cancer‐directed therapy (CDT) was evaluated for degree of adherence to National Comprehensive Cancer Network (U.S.) Guidelines.ResultsOf 632 patients, 15.8% received CDT with curative potential: 5.2% guideline‐adherent, 2.4% with minor deviations, and 8.2% with major deviations. CDT was not documented or was without curative potential in 22%; 15.7% were diagnosed with International Federation of Gynecology and Obstetrics (FIGO) stage IV disease. Adherence was not assessed in 46.9% (no stage or follow‐up documented, 11.9%, or records not traced, 35.1%). The largest share of guideline‐adherent CDT was observed in Nairobi (49%) and the smallest in Maputo (4%). In patients with FIGO stage I–III disease (n = 190), minor and major guideline deviations were associated with impaired OS (hazard rate ratio [HRR], 1.73; 95% confidence interval [CI], 0.36–8.37; HRR, 1.97; CI, 0.59–6.56, respectively). CDT without curative potential (HRR, 3.88; CI, 1.19–12.71) and no CDT (HRR, 9.43; CI, 3.03–29.33) showed substantially worse survival.ConclusionWe found that only one in six patients with cervical cancer in SSA received CDT with curative potential. At least one‐fifth and possibly up to two‐thirds of women never accessed CDT, despite curable disease, resulting in impaired OS. Investments into more radiotherapy, chemotherapy, and surgical training could change the fatal outcomes of many patients.Implications for PracticeDespite evidence‐based interventions including guideline‐adherent treatment for cervical cancer (CC), there is huge disparity in survival across the globe. This comprehensive multinational population‐based registry study aimed to assess the status quo of presentation, treatment guideline adherence, and survival in eight countries. Patients across sub‐Saharan Africa present in late stages, and treatment guideline adherence is remarkably low. Both factors were associated with unfavorable survival. This report warns about the inability of most women with cervical cancer in sub‐Saharan Africa to access timely and high‐quality diagnostic and treatment services, serving as guidance to institutions and policy makers. With regard to clinical practice, there might be cancer‐directed treatment options that, although not fully guideline adherent, have relevant survival benefit. Others should perhaps not be chosen even under resource‐constrained circumstances. 相似文献
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