Patient characteristics and outcomes of colorectal cancer (CRC) at Butaro Cancer Center of Excellence (BCCOE): Results from a retrospective cohort.

Abstract

e16081 Background: There are few studies on CRC in sub-Saharan Africa. BCCOE in Rwanda provides patients with CRC access to chemotherapy, surgery and radiotherapy referrals. Here, we describe patient characteristics, treatments delivered and outcomes. Methods: This retrospective observational study included 136 patients with CRC who presented between July 2012 and June 2018. We abstracted patient characteristics, diagnostic and treatment data, and outcomes from electronic and paper records. We compared baseline and treatment characteristics for colon cancer (CC) versus (vs.) rectal cancer (RC) patients. For patients treated with curative intent, we plotted Kaplan Meier estimation of disease free survival (DFS), defined as time from presentation to cancer recurrence, progression or death. Log-rank test was used to examine subgroup differences. Results: The mean age was 52.5, and 71 (52.2%) were female. 101 (74.2%) patients had RC. Compared to CC, patients with RC were older 54.5 vs. 46.9 (p = 0.0084), and more likely female 59.4 vs. 31.4 (p = 0.0043). All provinces in Rwanda were represented including 14 (10.3%) from outside Rwanda; 79 (58.1%) patients lived in rural areas. Median duration of symptoms prior to presentation was 12 months, and 57 (41.9%) had used traditional medicine prior to presentation. 72 (52.9%) patients were non-metastatic, 46 (33.8%) de novo metastatic, 4 (2.9%) recurrent, and 14 (10.2%) had indeterminate stage. Of the patients treated with curative intent, 54 (65.1%) had neoadjuvant and/or adjuvant chemotherapy, while only 34 (41.0%) had curative surgery. 40 (48.2%) patients received a permanent colostomy. 18 (27.7%) patients with RC received concurrent chemoradiation. Over the follow up period, 49 (36%) patients died or were referred for end of life care, 13 (9.3%) remain in surveillance, while 65 (47.8%) were lost to follow up. Median DFS for patients with non-metastatic disease was 22.2 months. On exploratory analyses, there were no statistically significant differences in DFS by cancer type, gender, or performance status, though these analyses were underpowered and follow-up short. Conclusions: CRC treatment requires multidisciplinary care, which is a challenge in low-resource settings. Our results highlight gaps in CRC care delivery and suboptimal patient outcomes; most striking gaps were the low rates of surgery and radiation, and high loss to follow up rates. Rigorous research is needed to understand the underlying causes, and to develop interventions to address these gaps.

Clinicopathological Characteristics and Mutational Landscape of APC, HOXB13, and KRAS among Rwandan Patients with Colorectal Cancer

“…In contrast to global data where CRC is reported to be more common in males than in females [9], in this study, we found that CRC was more common in females than in males (i.e., 63.0% versus 37.0%). Our findings also report a higher rate of female incidence than the 52.5% reported by Uwamariya et al [18] and the 52.2% reported by Fadelu et al [19].…”

“…CRC is underinvestigated in the Rwandan population. To our knowledge, only two papers [18,53] and one abstract [19] reporting on CRC in Rwanda have been published in international peer-reviewed journals within the last 10 years. In contrast to global data where CRC is reported to be more common in males than in females [9], in this study, we found that CRC was more common in females than in males (i.e., 63.0% versus 37.0%).…”

“…Despite the paucity of CRC research, the few published data show that, in contrast to other parts of the world where CRC is more frequent in males and/or in older patients [8,16,17], in Rwanda, females are more affected than males [18,19] and many Rwandan CRC patients are young [18,19]. Moreover, most patients are diagnosed with advanced disease, a high number of patients are lost to follow-up, and the overall survival of patients with CRC is poor [18,19]. These effects may be due to the low density of healthcare personnel, limited infrastructure and specialized care, lack of awareness of CRC among the Rwandan population, and the unavailability of screening programs [20].…”

Colorectal cancer disease profile and treatment patterns at an urban tertiary hospital in Rwanda

“…Among 74 patients, we found that the mean age at diagnosis was 54.6 years with a wide age range between 22 and 81. This finding is similar to previous findings at the BCCOE and Kigali University Teaching Hospital (KUTH) with reported mean age at presentation of 52.5 and 54.3 years, respectively [ 24 , 25 ]. The mean age of males at diagnosis was 56.6 years and the mean age of females at diagnosis was 51.4 years.…”

“…The finding of a smaller proportion of CRC cases in patients under 40 years old at KFH (13.5%) as compared to previous studies in SSA corresponds with the population served by KFH. KFH is a private hospital and therefore tends to serve a patient population of a higher socioeconomic status, in contrast to some other hospitals providing cancer care in Rwanda such as BCCOE, where 58.1% of CRC patients lived in rural areas [ 25 ]. KFH patients primarily live in Kigali, an urban setting, and may have more access to lifestyles and diets associated with westernisation and therefore more exposure to risk factors that lead to higher incidences of CRC in countries like the USA.…”