1. NCCN guideline-concordant cancer care in sub-Saharan Africa: a population-based multicountry study of 5 cancers.
- Author
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Mezger NCS, Seraphin TP, Ballé R, Griesel M, Joko-Fru YW, Hämmerl L, Feuchtner J, Liu B, Zietsman A, Kamaté B, Gnangnon FHR, Gnahatin F, Mboungou DM, Assefa M, Amulen PM, Chesumbai G, Chingonzoh T, Lorenzoni CF, Korir A, Carvalho Santos PS, Mezger JM, Al-Ali HK, Mikolajczyk R, Parkin DM, Jemal A, and Kantelhardt EJ
- Subjects
- Adult, Aged, Female, Humans, Male, Middle Aged, Africa South of the Sahara epidemiology, Breast Neoplasms therapy, Breast Neoplasms epidemiology, Breast Neoplasms diagnosis, Breast Neoplasms pathology, Colorectal Neoplasms therapy, Colorectal Neoplasms epidemiology, Colorectal Neoplasms diagnosis, Colorectal Neoplasms pathology, Lymphoma, Non-Hodgkin therapy, Lymphoma, Non-Hodgkin epidemiology, Lymphoma, Non-Hodgkin diagnosis, Prostatic Neoplasms therapy, Prostatic Neoplasms epidemiology, Prostatic Neoplasms diagnosis, Prostatic Neoplasms pathology, Quality of Health Care standards, Registries, Uterine Cervical Neoplasms therapy, Uterine Cervical Neoplasms diagnosis, Uterine Cervical Neoplasms epidemiology, Uterine Cervical Neoplasms pathology, Guideline Adherence statistics & numerical data, Neoplasms therapy, Neoplasms epidemiology, Neoplasms diagnosis, Practice Guidelines as Topic
- Abstract
Background: To assess population-based quality of cancer care in sub-Saharan Africa and to identify specific gaps and joint opportunities, we assessed concordance of diagnostics and treatments with National Comprehensive Cancer Network Harmonized Guidelines for leading cancer types in 10 countries., Methods: Adult patients with female breast cancer, cervical cancer, colorectal cancer, non-Hodgkin lymphoma, and prostate cancer were randomly drawn from 11 population-based cancer registries. Guideline concordance of diagnostics and treatment was assessed using clinical records. In a subcohort of 906 patients with potentially curable cancer (stage I-III breast cancer, cervical cancer, colorectal cancer, prostate cancer, aggressive non-Hodgkin lymphoma [any stage]) and documentation for more than 1 month after diagnosis, we estimated factors associated with guideline-concordant treatment or minor deviations., Results: Diagnostic information based on guidelines was complete for 1030 (31.7%) of a total of 3246 patients included. In the subcohort with curable cancer, guideline-concordant treatment was documented in 374 (41.3%, corresponding to 11.7% of 3246 patients included in the population-based cohort): aggressive non-Hodgkin lymphoma (59.8%/9.1% population based), breast cancer (54.5%/19.0%), prostate cancer (39.0%/6.1%), colorectal cancer (33.9%/9.5%), and cervical cancer (27.8%/11.6%). Guideline-concordant treatment was most frequent in Namibia (73.1% of the curable cancer subcohort/32.8% population based) and lowest in Kampala, Uganda (13.5%/3.1%). Guideline-concordant treatment was negatively associated with poor ECOG-ACRIN performance status, locally advanced disease stage, origin from low Human Development Index countries, and a diagnosis of colorectal cancer or cervical cancer., Conclusions: The quality of diagnostic workup and treatment showed major deficits, with considerable disparities among countries and cancer types. Improved diagnostic services are necessary to increase the share of curable cancer in sub-Saharan Africa. Treatment components within National Comprehensive Cancer Network Guidelines for several cancers should be prioritized., (© The Author(s) 2024. Published by Oxford University Press.)
- Published
- 2025
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