Addis Ababa population-based pattern of cancer therapy, Ethiopia

Autoři: Jana Feuchtner aff001;  Assefa Mathewos aff002;  Asmare Solomon aff002;  Genebo Timotewos aff002;  Abreha Aynalem aff002;  Tigeneh Wondemagegnehu aff002;  Amha Gebremedhin aff003;  Fekadu Adugna aff002;  Mirko Griesel aff001;  Andreas Wienke aff001;  Adamu Addissie aff004;  Ahmedin Jemal aff005;  Eva Johanna Kantelhardt aff001
Působiště autorů: Institute of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany aff001;  Radiotherapy Center, Addis Ababa University, Addis Ababa, Ethiopia aff002;  Division of Hematology, Department of Internal Medicine, Addis Ababa University, Addis Ababa, Ethiopia aff003;  School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia aff004;  Surveillance and Health Service Reseach, American Cancer Society, Atlanta, Georgia, United States of America aff005;  Department of Gynaecology, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle, Germany aff006
Vyšlo v časopise: PLoS ONE 14(9)
Kategorie: Research Article
doi: 10.1371/journal.pone.0219519


Cancer in Sub-Saharan Africa is becoming an important challenge for health services due to rising numbers of patients. In Addis Ababa with around 3.5 million inhabitants, more than 2000 cases are diagnosed annually. In this retrospective population-based cohort study we assessed completeness of and waiting time for cancer-therapy among patients registered in the Addis Ababa City Cancer Registry (AACCR), Ethiopia. Patient hospital files were retrieved to complete the data from AACCR. A total of 588 files were found (51% of those diagnosed from January to March 2012 and 2014). We analyzed completeness and waiting time of chemotherapy and radiotherapy; with completeness defined as ≥85% therapy received according to local guidelines. Analysis was done for the five most common cancer-types commonly treated with chemotherapy (breast, colorectal, non-Hodgkin`s lymphoma, lung and ovarian) and the four most common cancer-types commonly treated with radiotherapy (breast, cervical, head and neck and rectal). In our study, half of the patients (54.1%) received adequately dosed chemotherapy and 24.5% of patients received adequately dosed radiotherapy. The median waiting time was 2.1 months (Range: 0 to 20.72) for chemotherapy and 7 months (Range: 0.17 to 21.8) for radiotherapy. This study underscores the need for health system measures to improve cancer-directed therapy in Ethiopia, especially concerning radiotherapy.

Klíčová slova:

Medicine and health sciences – Oncology – Cancer treatment – Cancer chemotherapy – Radiation therapy – Clinical oncology – Cancers and neoplasms – Breast tumors – Breast cancer – Pharmaceutics – Drug therapy – Chemotherapy – Clinical medicine – Diagnostic medicine – Cancer detection and diagnosis – People and places – Geographical locations – Africa – Ethiopia


1. Harford JB. Barriers to overcome for effective cancer control in Africa. The Lancet Oncology. 2015; 16: e385–e393. doi: 10.1016/S1470-2045(15)00160-6 26248846

2. GLOBOCAN. Available: Accessed 24.07.18.

3. Demographic Components of Change—United Nations Population Division | Department of Economic and Social Affairs. Available: Accessed 24.07.18.


5. Cazap E, Magrath I, Kingham TP, Elzawawy A. Structural Barriers to Diagnosis and Treatment of Cancer in Low- and Middle-Income Countries. The Urgent Need for Scaling Up. J Clin Oncol. 2016; 34: 14–19. doi: 10.1200/JCO.2015.61.9189 26578618

6. Allemani C, Weir HK, Carreira H, Harewood R, Spika D, Wang X-S, et al. Global surveillance of cancer survival 1995–2009: analysis of individual data for 25 676 887 patients from 279 population-based registries in 67 countries (CONCORD-2). The Lancet; 385: 977–1010. doi: 10.1016/S0140-6736(14)62038-9 25467588

7. Jedy-Agba E, McCormack V, Adebamowo C, dos-Santos-Silva I. Stage at diagnosis of breast cancer in sub-Saharan Africa: a systematic review and meta-analysis. The Lancet Global Health. 2016; 4: e923–e935. doi: 10.1016/S2214-109X(16)30259-5 27855871

8. Sullivan R, Alatise OI, Anderson BO, Audisio R, Autier P, Aggarwal A, et al. Global cancer surgery. Delivering safe, affordable, and timely cancer surgery. The Lancet Oncology. 2015; 16: 1193–1224. doi: 10.1016/S1470-2045(15)00223-5 26427363

9. Gyorki DE, Muyco A, Kushner AL, Brennan MF, Kingham TP. Cancer surgery in low-income countries: an unmet need. Arch Surg. 2012; 147: 1135–1140. doi: 10.1001/archsurg.2012.1265 23248017

10. Kingham TP, Alatise OI, Vanderpuye V, Casper C, Abantanga FA, Kamara TB, et al. Treatment of cancer in sub-Saharan Africa. The Lancet Oncology. 2013; 14: e158–e167. doi: 10.1016/S1470-2045(12)70472-2 23561747

11. Abdel-Wahab M, Bourque J-M, Pynda Y, Iżewska J, van der Merwe D, Zubizarreta E, et al. Status of radiotherapy resources in Africa. An International Atomic Energy Agency analysis. The Lancet Oncology. 2013; 14: e168–e175. doi: 10.1016/S1470-2045(12)70532-6 23561748

12. Ethiopia Population (2018)—Worldometers. Available: Accessed 24.07.18.

13. Ethiopia: Regions, Major Cities & Towns—Population Statistics in Maps and Charts; 31.10.17. Available: Accessed 24.07.18.

14. Collections—Quandl. Available: Accessed 26.08.16.

15. Woldeamanuel YW, Girma B, Teklu AM. Cancer in Ethiopia. The Lancet Oncology. 2013; 14: 289–290. doi: 10.1016/S1470-2045(12)70399-6 23561741

16. Barton MB, Frommer M, Shafiq J. Role of radiotherapy in cancer control in low-income and middle-income countries. The Lancet Oncology. 2006; 7: 584–595. doi: 10.1016/S1470-2045(06)70759-8 16814210

17. Timotewos G, Solomon A, Mathewos A, Addissie A, Bogale S, Wondemagegnehu T, et al. First data from a population based cancer registry in Ethiopia. Cancer Epidemiol. 2018; 53: 93–98. doi: 10.1016/j.canep.2018.01.008 29414637

18. CI5—Home. Available: Accessed 03.11.18.

19. TNM | UICC. Available: Accessed 28.07.18.

20. Cervical Cancer Stages; 27.07.18. Available: Accessed 28.07.18.

21. Bonadonna G, Valagussa P, Moliterni A, Zambetti M, Brambilla C. Adjuvant Cyclophosphamide, Methotrexate, and Fluorouracil in Node-Positive Breast Cancer—The Results of 20 Years of Follow-up. N Engl J Med. 1995;332:901–6. doi: 10.1056/NEJM199504063321401 7877646

22. Ethiopia—Life expectancy at birth 2016. Available: Accessed 28.07.18.

23. Kantelhardt EJ, Moelle U, Begoihn M, Addissie A, Trocchi P, Yonas B, et al. Cervical cancer in Ethiopia: survival of 1,059 patients who received oncologic therapy. Oncologist. 2014; 19: 727–734. doi: 10.1634/theoncologist.2013-0326 24951611

24. Kantelhardt EJ, Zerche P, Mathewos A, Trocchi P, Addissie A, Aynalem A, et al. Breast cancer survival in Ethiopia: a cohort study of 1,070 women. Int J Cancer. 2014; 135: 702–709. doi: 10.1002/ijc.28691 24375396

25. Eber-Schulz P, Tariku W, Reibold C, Addissie A, Wickenhauser C, Fathke C, et al. Survival of breast cancer patients in rural Ethiopia. Breast Cancer Res Treat. 2018. doi: 10.1007/s10549-018-4724-z 29479644

26. Shiferaw S, Addissie A, Gizaw M, Hirpa S, Ayele W, Getachew S, et al. Knowledge about cervical cancer and barriers toward cervical cancer screening among HIV-positive women attending public health centers in Addis Ababa city, Ethiopia. Cancer Med. 2018; 7: 903–912. doi: 10.1002/cam4.1334 29441700

27. Dye TD, Bogale S, Hobden C, Tilahun Y, Hechter V, Deressa T, et al. Complex care systems in developing countries: breast cancer patient navigation in Ethiopia. Cancer. 2010; 116: 577–585. doi: 10.1002/cncr.24776 20029968

28. Birhan W, Giday M, Teklehaymanot T. The contribution of traditional healers' clinics to public health care system in Addis Ababa, Ethiopia. A cross-sectional study. J Ethnobiol Ethnomed. 2011; 7: 39. doi: 10.1186/1746-4269-7-39 22132758

29. Grosse Frie K, Samoura H, Diop S, Kamate B, Traore CB, Malle B, et al. Why Do Women with Breast Cancer Get Diagnosed and Treated Late in Sub-Saharan Africa? Perspectives from Women and Patients in Bamako, Mali. Breast Care (Basel). 2018; 13: 39–43. doi: 10.1159/000481087 29950966

30. Harding R, Selman L, Agupio G, Dinat N, Downing J, Gwyther L, et al. The prevalence and burden of symptoms amongst cancer patients attending palliative care in two African countries. European Journal of Cancer. 2011; 47: 51–56. doi: 10.1016/j.ejca.2010.08.003 20822896

31. World Health Organization. WHO | WHO's cancer pain ladder for adults. Available: Accessed 28.07.18.

32. Dedey F, Wu L, Ayettey H, Sanuade OA, Akingbola TS, Hewlett SA, et al. Factors Associated With Waiting Time for Breast Cancer Treatment in a Teaching Hospital in Ghana. Health Educ Behav. 2016; 43: 420–427. doi: 10.1177/1090198115620417 27091222

33. Otieno ES, Micheni JN, Kimende SK, Mutai KK. Delayed presentation of breast cancer patients. East Afr Med J. 2010; 87: 147–150. 23057289

34. Grosse Frie K, Kamaté B, Traoré CB, Ly M, Mallé B, Coulibaly B, et al. Factors associated with time to first healthcare visit, diagnosis and treatment, and their impact on survival among breast cancer patients in Mali. PLoS One. 2018; 13: e0207928. doi: 10.1371/journal.pone.0207928 30496219

35. Bhatia RK, Rayne S, Rate W, Bakwenabatsile L, Monare B, Anakwenze C, et al. Patient Factors Associated With Delays in Obtaining Cancer Care in Botswana. J Glob Oncol. 2018; 4: 1–13. doi: 10.1200/JGO.18.00088 30199305

36. Arndt V, Sturmer T, Stegmaier C, Ziegler H, Becker A, Brenner H. Provider delay among patients with breast cancer in Germany: a population-based study. J Clin Oncol. 2003; 21: 1440–1446. doi: 10.1200/JCO.2003.08.071 12697864

37. Birhanu Z, Abdissa A, Belachew T, Deribew A, Segni H, Tsu V, et al. Health seeking behavior for cervical cancer in Ethiopia. A qualitative study. Int J Equity Health. 2012; 11: 83. doi: 10.1186/1475-9276-11-83 23273140

38. Mostert S, Arora RS, Arreola M, Bagai P, Friedrich P, Gupta S, et al. Abandonment of treatment for childhood cancer. Position statement of a SIOP PODC Working Group. The Lancet Oncology. 2011; 12: 719–720. doi: 10.1016/S1470-2045(11)70128-0 21719348

39. Delaney G, Jacob S, Featherstone C, Barton M. The role of radiotherapy in cancer treatment: estimating optimal utilization from a review of evidence-based clinical guidelines. Cancer. 2005; 104: 1129–1137. doi: 10.1002/cncr.21324 16080176

40. Rosenblatt E, Fidarova E, Zubizarreta EH, Barton MB, Jones GW, Mackillop WJ, et al. Radiotherapy utilization in developing countries: An IAEA study. Radiother Oncol. 2018; 128: 400–405. doi: 10.1016/j.radonc.2018.05.014 29859755

41. Denny L, Sanjose S de, Mutebi M, Anderson BO, Kim J, Jeronimo J, et al. Interventions to close the divide for women with breast and cervical cancer between low-income and middle-income countries and high-income countries. The Lancet. February///25; 389: 861–870. doi: 10.1016/S0140-6736(16)31795-0

Článek vyšel v časopise


2019 Číslo 9

Nejčtenější v tomto čísle

Tomuto tématu se dále věnují…


Zvyšte si kvalifikaci online z pohodlí domova

Ulcerative colitis_muž_břicho_střeva
Ulcerózní kolitida
nový kurz

Blokátory angiotenzinových receptorů (sartany)
Autoři: MUDr. Jiří Krupička, Ph.D.

Antiseptika a prevence ve stomatologii
Autoři: MUDr. Ladislav Korábek, CSc., MBA

Citikolin v neuroprotekci a neuroregeneraci: od výzkumu do klinické praxe nejen očních lékařů
Autoři: MUDr. Petr Výborný, CSc., FEBO

Zánětlivá bolest zad a axiální spondylartritida – Diagnostika a referenční strategie
Autoři: MUDr. Monika Gregová, Ph.D., MUDr. Kristýna Bubová

Všechny kurzy