Short term clinical outcome of treatment among patients with oesophageal cancer treated at Ocean Road Cancer Institute, Dar es salaam, Tanzania.

Abstract

There has been an increasing incidence of esophageal cancer in Tanzania. According to a report done at ORCI for the period between 2006 and 2009, the number of new cases per year increased from 181 per year in 2006 to 307 cases per year in 2009. Esophageal cancer is a disease in which malignant cells form in the tissues of the esophagus. The two most common forms of esophageal cancer are : 1. Squamous cell carcinoma: Which is the commonest type and it is also known as epidermoid carcinoma. 2. Adenocarcinoma: Cancer that begins in glandular cells. Adenocarcinomas usually form in the gastroesophageal junction. Radiation therapy in esophageal cancer has been used for many years with good results, either as the definitive treatment or as neoadjuvant treatment to improve locoregional control of disease; and attempt to preserve the larynx in cases of cancer of the cervical esophagus or the stomach in cases that involve the distal esophagus.It is successful in relieving dysphagia in approximately 50% of patients.Chemotherapy as a single modality has limited use. Type of Chemotherapy used will depends on the tumor type, but tends to be cisplatin-based every three weeks with fluorouracil (5-FU) either continuously or every three weeks.It may be given as adjuvant or neoadjuvant therapy. In general, the prognosis of esophageal cancer is quite poor, because most patients present with advanced disease. By the time the first symptoms such as dysphagia start manifesting themselves, the cancer has already well progressed. The overall five-year survival rate is approximately 15%, with most patients dying within the first year of diagnosis. There has been no study in Tanzania that has assessed the clinical outcome after treatment among patient with esophageal cancer. Based on the fact that acute side effects of radiotherapy normally take four weeks to disappear. The improvement of clinical symptoms and signs such as dysphagia and pain will be assessed at four weeks after completion of treatment.

Objectives To evaluatethe shorterm outcome of treatment among patients with cancer of oesophagus treated at Ocean Road Cancer Institute for the month of April to September 2012. Methodology This was Prospective cohort study covering four months (from April to September 2012). A total of 87 patients were recruited but only 75 patients were available for the final analysis.The patients recruited werenew oesophagial cancer patients received at ORCI who met the inclusion criteria during the study periodData collection for this study was based on a structured questionnaire.The short-term outcomes of treatment were assessed clinically by evaluation of symptoms and signs 4 weeks after the end oftreatment.Collected data was analyzed using SPSS programme version 15. Results Of the 75 patients assessed in the study, 61.3% were males and 38.7% were females. The mean (SD) of the studied patients was 55.8 (16.6) years. None of the patient was diagnosed with disease at stage I but most patients were diagnosed at stage II and III of the disease; 40% and 36% respectively. A significant improvement in dysphagia symptom score was found when comparing the mean pre-treatment and post-treatment dysphagia scores. Similarly,there was a significant improvement in pain score when comparing mean pre-treatment and post-treatment pain scores. When dysphagia was categorized as present or absent, none of the patient had no dysphagia at presentation. However after treatment, a significant number of patient (32%) experienced no dysphagia. Similarly, only 10.7% of the patients had no pain at presentation and this significantly raised to 20% after treatment. The results showed that an improvement in severity of dysphagia was significantly negatively related to stage of the disease, significantly negatively related to duration from arrival at ORCI to start treatment and significantly positively related to hemoglobin level