96036-03-2 br Based on initial results we formed a working g
Based on initial results, we formed a working group of cli-nicians from RPCI and clinicians, cancer registrars, and administrative staffs from LLC who discussed and determined what additional parameters were relevant in the context of the 96036-03-2 we were assessing. Once the parameters to be
collected were finalized, we sought out software programs to help establish the registry. This program had to possess certain features to meet our goal of having a system that could be utilized in resource limited settings. Thus, the program had to be low cost, easily accessible, function without internet connectivity, provide a modifiable template of parameters, and be compliant with international cancer registry standards.
CanReg 5 is a free open source application created by IARC that contained all the elements we needed to establish a registry. Via webinar series provided through the GICR, we proceeded to learn how to use CanReg and modify the pro-vided registry template to fit the parameters we wanted to collect. With these findings, CanReg 5 was downloaded to begin the creation of our initial cancer registry. Modifications were made to CanReg’s existing system definition to allow for the grouping and collection of the following parameters. Under patient information, we collected the following: ethnicity, phone number, occupation, educational level, and referral information. Under follow-up: vital status, disease status, cause of death, and performance status (based on ECOG score13). Under social and medical history: smoking status, pack years, tobacco source, alcohol consumption sta-tus, drinks per week, and comorbidities. Under tumor infor-mation: laterality, receptor status, TNM stage. Under treatment: dates of treatment, treatment status, surgery, ra-diation therapy, chemotherapy, hormonal therapy, and immunotherapy.
A total of 226 cancer incident cases presented at LCC between July 2014 and June 2016. Diagnostic, staging, therapeutic, and palliative interventions were provided. Patient information such as demographics, diagnosis, stage, treatment, and complications were collected. As the center is still in its early phase of growth (fourth year of existence), survival data have not been collected yet. From the collected information, the following parameters were analyzed: number of patient en-counters during 6-mo intervals, disease site distribution, and stage distribution.
Since July 2014, Lakeshore has seen an increase in the number of new cancer incident cases when evaluated at 6-mo intervals (Fig. 1). Evaluation of these patients by disease site revealed that the most common subtype was breast cancer (38%). This was followed by prostate (12%), colorectal (8%), and cervical (6%) cancer. A combination of gynecological, upper
Fig. 1 e Number of new cancer cases seen in 6-mo intervals. (Color version of figure is available online.)
gastrointestinal, CNS, hematological, and renal cancer constituted 25% of the disease sites (Fig. 2). The majority (85%) of cases were presented at stages III and IV. Twenty-four percent of patients were presented at stage III and 61% were presented at stage IV (Fig. 3).
In developing nations, there has been an ongoing epidemio-logical transition from communicable to noncommunicable diseases (NCDs).14 The most common NCDs include diabetes, chronic obstructive pulmonary disease (COPD), cardiovascu-lar disease (CVD), and cancer.
According to the African Health Observatory, in Nigeria, noncommunicable diseases accounted for 16% of years of life lost by a major cause in 2012.15 In the same year, the most common conditions were cardiovascular diseases, chronic respiratory diseases, diabetes mellitus, and malignant neo-plasms. In 2012, there were 14.1 million new cancer cases and 8.2 million cancer deaths worldwide.3 Fifty-five percent of the mortality occurred in less developed countries. In Africa, there were 645,000 cases reported with approximately 52% of those cases resulting in cancer death. In Nigeria, approximately 100,000 new cases occur each year with a high annual mor-tality rate. The rise in cases has been attributed to increasing life expectancy, changes in lifestyles, and decreased risk of death from infectious diseases.
LCC is the first private center dedicated solely to cancer care in Nigeria. It is located in Lagos and is affiliated with Roswell Park Cancer Institute (RPCI) in Buffalo, NY. Since its establish-ment in 2014, the services it has provided include screening, diagnostic interventions, surgery, chemotherapy, and palliative care. Public health care financing is limited in Nigeria. A sig-nificant proportion of patients rely on a combination of out-of-pocket payments, employer benefits, and donor funding to finance the cost of health care.16,17 LCC caters to all segments of the population. However, the fact that it is a private facility reduces the proportion of indigent patients treated there.