Treatment outcomes of esophageal cancer in Eastern Africa: protocol of a multi-center, prospective, observational, open cohort study

Abstract

Background Esophageal squamous cell carcinoma (ESCC) is a major cause of cancer morbidity and mortality in Eastern Africa. The majority of patients with ESCC in Eastern Africa present with advanced disease at the time of diagnosis. Several palliative interventions for ESCC are currently in use within the region, including chemotherapy, radiation therapy with and without chemotherapy, and esophageal stenting with self-expandable metallic stents; however, the comparative effectiveness of these interventions in a low resource setting has yet to be examined. Methods This prospective, observational, multi-center, open cohort study aims to describe the therapeutic landscape of ESCC in Eastern Africa and investigate the outcomes of different treatment strategies within the region. The 4.5-year study will recruit at a total of six sites in Kenya, Malawi and Tanzania (Ocean Road Cancer Institute and Muhimbili National Hospital in Dar es Salaam, Tanzania; Kilimanjaro Christian Medical Center in Moshi, Tanzania; Tenwek Hospital in Bomet, Kenya; Moi Teaching and Referral Hospital in Eldoret, Kenya; and Kamuzu Central Hospital in Lilongwe, Malawi). Treatment outcomes that will be evaluated include overall survival, quality of life (QOL) and safety. All patients (≥18 years old) who present to participating sites with a histopathologically-confirmed or presumptive clinical diagnosis of ESCC based on endoscopy or barium swallow will be recruited to participate. Key clinical and treatment-related data including standardized QOL metrics will be collected at study enrollment, 1 month following treatment, 3 months following treatment, and thereafter at 3-month intervals until death. Vital status and QOL data will be collected through mobile phone outreach. Discussion This study will be the first study to prospectively compare ESCC treatment strategies in Eastern Africa, and the first to investigate QOL benefits associated with different treatments in sub-Saharan Africa. Findings from this study will help define optimal management strategies for ESCC in Eastern Africa and other resource-limited settings and will serve as a benchmark for future research. Trial registration This study was retrospectively registered with the ClinicalTrials.gov database on December 15, 2021, NCT05177393.

Update on pathology laboratory development and research in advancing regional cancer care in Malawi

“…The majority ( n = 30, 55%) of this latter group includes publications related to the study of LPDs. However, the KCH laboratory has also been involved in the research of esophageal cancer ( 4 – 6 ), breast cancer ( 7 , 8 ), cervical cancer ( 9 – 11 ), melanoma ( 12 ), head and neck squamous cell carcinoma ( 13 ), and KS ( 14 – 19 ).…”

Landscape of esophageal cancer in Northern Kenya: experience from Garissa Regional Cancer Center

“…In terms of diagnosis of EC, triple modalities such as endoscopic biopsy, histology confirmation and staging scans are the standard of care [11]. Emerging novel approaches to screening that may be cost-effective in EC endemic regions have been explored such as the use of Lugol's iodine staining using endoscopy to detect precancerous lesions in the esophageal mucosa by Mwachiro et al [12] and the use of swallowable Cytosponge [13], a form of minimally invasive esophageal cytology sampling technique to improve early detection for this debilitating disease that presents at locally advanced stage in many EC hotspots in Africa [14][15][16][17][18].…”

“…However, the prognosis remains poor, and the overall 5-year survival rate of less than 20% [17]. Ongoing prospective studies will shape guidelines-based management strategies for EC in the Eastern Africa region which could potentially be a benchmark for other low-and-middle-income countries plagued with the high incidence of ESCC [18]. Due to late-stage presentation, early initiation of nutrition intervention such as placement of a feeding tube and palliative care services including optimal pain control is vital in improving the overall survival and quality of life in EC patients [19][20][21].…”