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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 1  |  Issue : 2  |  Page : 67-71

Pattern and outcome of admission of cancer patients at radiation oncology ward university college hospital Ibadan Nigeria


1 Department of Radiation Oncology, University of Ibadan, Ibadan, Nigeria
2 Department of Radiation Oncology, University College Hospital, Ibadan, Nigeria

Date of Submission22-May-2020
Date of Decision09-Jun-2020
Date of Acceptance16-Aug-2020
Date of Web Publication30-Nov-2020

Correspondence Address:
Sharif Folorunso
Department of Radiation Oncology, University College Hospital, Ibadan
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JRMT.JRMT_7_20

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  Abstract 


Background: Cancer is the second leading cause of death globally. Approximately 70% of cancer mortalities occur in low- and middle-income countries like Nigeria largely due to late presentation. Majority of cancer deaths are largely preventable, accessible to screening and early detection. The care of cancer patients on admission is generally known to be time consuming and challenging. Reports on pattern and outcome of admission in cancer patients are scarce in Nigeria. The aim of this study is to provide data on the pattern and outcome of admission on a ward that is solely for the care of cancer patients. Methodology: This is a one-year retrospective study of cancer patients admitted between June 1st 2018 to May 31st 2019. The patients' information was extracted from the ward's admission book and duplicate of the death certificate. Data collected were analysed using the IBM Statistical Package for Social Sciences version 25. Results: A total of 318 admissions were recorded with female preponderance. More than half of the patients admitted were 40 to 59 years old. Majority of the patients 225 (70.8%) came from south western part of the country followed by the south south 55(17.3%). The commonest sites of primary disease were breast 81(25.5%), cervix 74 (23%), head and neck 43 (13.5%), gastrointestinal 49 (12.6%) and genitourinary cancers 23 (7.2%). Most of the patients admitted have stage 4 disease. 127 (39.9%) of the patients died on admission while 191 (60.1%) were discharged. There was statistically significant association between stage 4 disease and increased mortality (p=0.026). Breast cancers accounts for 40(31.5%) of mortality, cervix cancer 31(24.4%), head and neck cancer 16 (12.6%), genitourinary cancer 9 (7.1%), gastrointestinal cancer 6 (4.7%) and skin cancer 6(4.7%). Conclusion: Breast and cervical cancer were the commonest cases admitted. About 40% of the admitted died on the ward. The patients were mostly female in their productive ages.

Keywords: Admission, cancer, management outcome, patients


How to cite this article:
Folasire A, Folorunso S, Orekoya A, Ehiedu C, Olabumuyi A, Ntekim A. Pattern and outcome of admission of cancer patients at radiation oncology ward university college hospital Ibadan Nigeria. J Radiat Med Trop 2020;1:67-71

How to cite this URL:
Folasire A, Folorunso S, Orekoya A, Ehiedu C, Olabumuyi A, Ntekim A. Pattern and outcome of admission of cancer patients at radiation oncology ward university college hospital Ibadan Nigeria. J Radiat Med Trop [serial online] 2020 [cited 2021 Aug 4];1:67-71. Available from: http://www.jrmt.org/text.asp?2020/1/2/67/301901




  Introduction Top


Cancer is the second leading cause of death globally,[1] with an estimated 9.6 million deaths and global disease burden of 18.1 million in 2018.[2] Globally, 1 in 5 men and 1 in 6 women will develop cancer during their lifetime; of which, 1 in 8 men and 1 in 10 women will die from the disease.[1] These values reveal a rise in global cancer burden and mortality[2] Compared to 14.1 million new cases and 8.2 million cancer deaths in 2012.[3],[4] This increasing cancer burden can be ascribed to population growth and aging as well as changes in certain cancer etiologies occurring more in emerging economies where there is a shift from poverty and infection-related cancers to cancers associated with lifestyles peculiar to industrialized countries.

Approximately 70% of cancer mortalities occur in low- and middle-income countries.[4] This can be attributed to the higher frequency of certain cancer types with poor prognosis and higher mortality rates, late stage presentation and limited access to timely diagnosis and treatment.[1],[2]

In Ghana, the most common causes of cancer death in females were from breast (17.24%), hematopoietic cancers (14.69%), liver (10.97%), and cervix (8.47%). While in males, the highest cause of cancer deaths were from liver (21.15%), prostate (17.35%), hematopoietic cancers (15.57%), and stomach (7.26%).[5] In Nigeria, new cancer cases and deaths were estimated to be 115,950 and 70,327, respectively in 2018.[6] The most common cause of cancers in both sexes in Nigeria are cancers of the breast (22.7%), uterine cervix (12.9%), prostate (11.3%), colorectum (5.8%), and non-Hodgkin's lymphoma (NHL) 4.6%.[6]

The care of cancer patients on admission is generally known to be time consuming and challenging.[7] The fact that most cancer patients in this part of the world present with advanced disease coupled with poor facilities make the burden even more challenging. Reports on pattern and outcome of admission in cancer patients are scarce in Nigeria. There is need to have such data which would be helpful in planning for cancer treatment and assessing the quality of our in-patient cancer care. Our aim was to describe the pattern and outcome of admission in a ward that is solely for the care of cancer patients.


  Methodology Top


This is a 1-year retrospective study aimed at describing the pattern and outcome of admission at the Radiation Oncology Ward in our hospital, University College Hospital (UCH) Ibadan, South West, Nigeria. The patients captured in this study included all histologically confirmed cancer patients admitted from June 1, 2018, to May 31, 2019. The aim of this study was to evaluate the type of patients admitted to the ward and the outcome of their admission. The patients' information was extracted from the ward's admission register and duplicates of the death certificate register. The retrieved information included hospital number, sex, age, address, diagnosis, stage of the disease, and outcome of admission. Approval was obtained from the ethical committee of the UCH Ibadan.

Data analysis

IBM Statistical Package for Social Sciences, Version 25.0. IBM Corp. Released 2017. Armonk, NY: was used to analyze collated data. Descriptive statistics were used to present the data using tables. The Student's t-test was used for quantitative variables while Chi-square test was used for categorical variables. The results were presented in frequency distribution tables. The results obtained formed the basis of the discussion.


  Results Top


A total of 318 admissions were recorded at the radiation oncology ward over the study period. Out of these, 107 (33.6%) were male while 211 (66.4%) were female. More than half of the patients admitted are in the 40–59 years of age group. 83 (26.1%) were aged 60 years and above, while 64 (20.1%) were between 21 and 39 years. Majority of the patients (70.8%) came from the Southwestern part of the country, 55 (17.3%) from South-South, 16 (5%) from South East, 10 (3.1%) from the North Central and 3 (0.9%) from the North West [Table 1]..
Table 1: Sociodemographic characteristics of patients on admission

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The most common sites of primary disease were breast (25.5%), cervix (23%), head and neck (13.5%), gastrointestinal (12.6%), and genitourinary cancers (7.2%). When split by gender, breast, cervical, head and neck, and gastrointestinal cancer were the most common cancers in females while head and neck, gastrointestinal, genitourinary, and lung cancers were the most common in males [Table 2]. [Table 2] also shows the region of primary disease and mortality. Breast cancer accounted for 40 (31.5%), uterine cervix cancer 31 (24.4%), head and neck cancers 16 (12.6%), genitourinary cancers 9 (7.1%), gastrointestinal cancers 6 (4.7%), and skin cancers 6 (4.7%) deaths.
Table 2: Gender, primary tumor site, and outcome of the admitted patients

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Most of the patients admitted had Stage 4 disease [Table 3]. Out of the 318 patients admitted, 127 (39.9%) died on admission while 191 (60.1%) were discharged. Increased mortality was observed among patients who were admitted with Stage 4 disease (P = 0.017) [Table 3]. Apart from general deterioration in health due to widespread disease with multiple organ failure, some identified causes of death included chronic renal failure in nine patients with cervical cancer, pulmonary embolism in three patients with prostate cancer, widespread cerebral metastasis in 15 patients with breast cancer and chronic anemia with multiple pathological fractures in two patients with prostate cancer. All these events occurred in the context of already advanced diseases.
Table 3: The stage of disease and outcome of admission

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  Discussion Top


Sixty-five percent of the patients admitted were females giving the male:female ratio of 1:1.86. This is similar to the pattern reported by a previous study[8] but differs from the findings of similar studies in a medical oncology ward[9] and a pediatric ward.[10] The higher proportion of female may be because the most common cancers in Nigeria (breast and cervical cancers) predominantly affect the female.[2]

More than 70% of the patients were between 20 and 59 years of age. This is similar to the findings in previous reports in Nigeria and West Africa[11],[12],[13] The finding gives credence to the assertion that majority of cancer patients in Nigeria are within the young and active age group that constitute the work-force of the society.[14] Hence, a disease that affects this group could have grave economic consequence.[9] The mean age that was found to be higher in males compared to females may be due to the fact that age at diagnosis of the commonest cancers in female (breast and cervix) is far lower than the age at diagnosis in prostate and colorectal cancer which were the mostly seen cancers in male.[2] In previous studies, the mean age of patients with breast and cervical cancer were 48 years[15] and 44 years,[16] respectively while the mean age at diagnosis of prostate cancer was 67.5 years.[17]

This study showed that cancer patients admitted to the Radiation Oncology ward in UCH, Ibadan came from nearly all the geopolitical zones of the country. Most of the patients were from the southern part of the country with 71% coming from the South-West followed by the South-South region (17%). This is not unexpected because the hospital is in the southwestern part of the country. This pattern was also observed in similar studies in Lagos.[12] Apart from the proximity of these (southern) regions to Ibadan, the relatively higher number coming from the South-South compared to other regions (apart from south west) could be due to absence of a functioning radiotherapy facility in the region during the studied period.[18] This means that cancer patients from such regions would have to travel long distances to access care. The cost of travelling and accommodation issues may contribute to patients delay in accessing treatment until the disease progressed to advanced stages.[19]

Overall, breast and cervical cancer were the most common cancer seen followed by head and neck, gastrointestinal, and genitourinary malignancies. This is different from the findings of a study which reported liver, gastrointestinal, and hematological cancers as the most common malignancy in Enugu.[9] The Enugu report was from a general medical ward and the tumor types described are those that commonly present to physicians. Our ward admits patients with mostly solid tumors, while there are separate facilities for hematological and liver malignancies. When considered by gender, the most common cancer in females was breast followed by cervical, gastrointestinal, and then head and neck malignancies. In males head and neck cancers had the highest proportion, followed by gastrointestinal, genitourinary and lung cancers. However the proportion of different cancer types in men in Ibadan (from the Ibadan Cancer Registry 2018 data) were cancer of the prostate (21.7%), colorectal (7.6%), nonmelanoma skin cancer (6.4%), liver (6.1%), and NHL (4.8%). The difference in pattern could be explained by the fact that the Registry figure is population based while this study is an institutional departmental data. Besides, some cancer patients are usually admitted to other wards in the hospital such as surgical and hemato-oncology wards, gynecological and ear, nose, and throat wards. However the aim of this work was to describe the pattern and outcome of admission of cancer patients in an admission facility with optimal compliment of trained and experienced cancer care professionals-clinical oncologists, oncology nurses, therapy radiographers, psycho-oncologists, palliative care specialists, oncology pharmacists and with access to other specialists for consultation. This is the only cancer care ward in the hospital with this high caliber of staff. The outcome therefore reflects the results of best available care in the center.

Based on the available data, majority of patient had advanced disease. However, the lack data on disease stage of majority of patients weakens this data [Table 2]. Be that as it may, previous studies in the country support the high proportion of late presentation among cancer patients in Nigeria.[15],[20],[21] Some of the suggested reasons for the late presentation include low literacy levels, high rates of poverty, cultural and religious traditions, poor geographical access to cancer care, low level of awareness of breast and cervical cancers, lack of screening, and poor diagnostic procedure and treatment facilities.[20] The nonavailability of radiotherapy facilities in some regions of the country as mentioned earlier could delay treatment and contribute to late presentation with high mortality.

We observed a mortality rate of 39.9% from the total admission which could be due to the high proportion of late cases seen in this study. Published data on morality from cancer in Nigeria are scarce. Compared with other disease entities where data are available, the proportion in this report is similar to the findings of other studies in Nigeria that documented a mortality rate of 42.9% in hypertension related admission[22] and 31.9% in hospitalized HIV/AIDS patients.[23] A lower rate of 6.4% was however reported at surgical in-patient ward of a tertiary hospital in Nigeria.[24]

There was a significant association between stage 4 disease and mortality in this study (P = 0.017). Other authors have documented linkage between advanced cancer stage and poor prognosis.[15],[25] This could explain the high mortality in our study. Stage four diseases are universally considered terminal stages and active treatment are not always indicated. Best standard of care for such patients is palliative care which is well developed at our center and were offered to all those in need.

Finally, we also found that more than 55% of cancer patients that died at Radiation Oncology Ward have breast or cervical cancer (31.5% and 24.4%) [Table 2]. This is similar to the report from Ghana where hematological and hepatic malignancies are excluded.[5] Both cancers are accessible to screening procedures and have an improved prognosis if detected early.[26],[27] However, most patients present late in this environment. Lack of awareness as well as lack of access to screening facilities and treatment have however been associated with late presentations.[21]


  Conclusion Top


Most cancer patients on admission are females of productive age group. We observed a mortality rate of 39.9%. There was an association between advanced stage and mortality. Breast and cervical cancer are the most common cases on admission. Despite being accessible to screening procedure, both cases still account for the highest mortality due to late presentation.

Limitations

The retrospective nature of this study is a limitation as there were missing data which is common to this type of study. Low sample size was also associated with this study as well as the fact that not all cancer patients in the hospital were captured. Patients with hematological and hepatocellular malignancies are not reflected in this study as they are admitted in a different ward. Nevertheless, the outcome of this study is particularly useful in providing initial data with which further prospective studies could be designed and implemented. A baseline data with which future studies could be compared to follow improvements in outcome of cancer patients' treatment is provided.

Recommendation

Efforts should be made by all and sundry to ensure early diagnosis and prompt treatment of cancer patients. Health workers should create awareness of the scourge of cancer. Government and nongovernmental organizations and philanthropists should make screening for breast and cervical cancer available and affordable to the populace to aid early diagnosis. Governments, nongovernmental Organizations, and corporate organizations should assist in equipping existing radiotherapy centers and also establish newer centers across all the six geo-political zones of the country. These will reduce the plight of cancer patients travelling several miles to access oncology care and reduce the mortality rate from cancer in the country.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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