Clinico-Pathological Characteristics, Treatment Modality and Survival of Patients with Lung Cancer at Ocean Road Cancer Institute, Tanzania

Abstract

Background: Lung cancer is the most common cancer worldwide, accounting for 13% of all incident cancers and it is more common in males than females. Lung cancer is the leading cause of cancer deaths worldwide with rate of 18.4% of total deaths. High incidences of lung cancer are reported in developed countries than developing countries. The risk factors associated with lung cancer include smoking tobacco -most common, occupational exposure, environmental dust, Gender, Age, and Genetics. Lung cancer is classified into two main categories; Small cell lung cancer (SCLC) 10-15% or non- small cell lung cancer (NSCLC) 80-85%.There is a scarcity of data on the burden of lung cancer in East Africa due to misdiagnosis. Most patients who present with cough, chest pain are more often diagnosed with pulmonary tuberculosis and pneumonia. In view of this, lung cancer data is limited. The objective of the study was to determine the clinico- pathological characteristics, treatment modalities and survival rate of patients with lung cancer treated at ORCI from January 2014 to December2018. Methodology: Retrospective analytical study was used in which data was extracted from medical charts of patients treated at ORCI between January 2014 and December 2018.Exracted information included social demographics, risk factors, clinical presentation, pathological features, treatment modalities and survival. The analysis was done using SPSS IBM version 23. Frequency and percentage were used to summarize categorical variables and means and standard deviation were used to summarize continuous variable. T-test was used to compare means and chi square test/fisher’s exact test was used to compare proportions. Survival curves were drawn using Kaplan Meier and log-rank test was used to test the difference in survival times. Cox regression was used in multivariate analysis to assess for possible confounders. p<0.05 was considered statistically significant. Results. The study recruited 79 patients. The mean age of the study population was 56.85 years. Male to female ratio was 1.4:1. 36.7% of patients were peasant farmers.41.8% of the patients were smokers while 46.8% were non- smokers. Family history of lung cancer was present in only 17.7%. The most common symptoms were cough (84.8%) and chest pain (73.4%) while the least common symptom was chest tightness (16.5%). 39.2% of the patients were misdiagnosed with pulmonary tuberculosis. More than two third of patients had ECOG less than 2. 92.4% of patients had NSCLC while SCLC accounted for 7.6%. About two thirds of the patients had stage 4 disease and the commonest site of metastasis was contralateral lung with pleural effusion (35.6%). Surgery (lobectomy) was done in only 5.4%. All most all patients (96.2%) received chemotherapy. About one third of the total patients received radiotherapy. Out of all patients who received radiotherapy only 9 (33.3%) of 27 were treated with curative intent. Only 8.9% of patients received targeted therapy and all were NSCLC. The agents used were Bevacizumab, Erlotinib, and Dabrafenib. The two year overall survival was about 37%. The mean overall survival rate was 10.14 months and the median overall survival was 8 months. Surgery, radiotherapy use, Chemotherapy use and ECOG status of less than 2 were positive predictors of survival while weight loss, hemoptysis, metastasis to bone and ECOG status more than 2 were negative predictors of survival. Conclusion Patients treated at Ocean Road Cancer Institute had characteristics and survival rates that are similar to data from international literature. A high proportion of patients were diagnosed at advanced stages and the outcomes remained poor because many of them were not able to complete treatment prescribed