Whom to treat? Factors associated with chemotherapy recommendations and outcomes among patients with NHL at the Uganda Cancer Institute

• Published in: PloS one 2018-02, Vol.13 (2), p.e0191967-e0191967
• Main Authors: Menon, Manoj, Coghill, Anna, Mutyaba, Innocent, Okuku, Fred, Phipps, Warren, Harlan, John, Orem, Jackson, Casper, Corey
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Antineoplastic Agents - therapeutic use; Biology and Life Sciences; Blood; Cancer; Cancer patients; Cancer therapies; Care and treatment; Chemotherapy; Clinical medicine; Diagnosis; Expenditures; Female; Granulocytes; Growth factors; Health aspects; Health care; Hemoglobin; HIV; Hospitals; Human immunodeficiency virus; Humans; Infectious diseases; Laboratories; Leukemia; Lymphoma; Lymphoma, Non-Hodgkin - drug therapy; Male; Medical diagnosis; Medical prognosis; Medical records; Medical research; Medicine; Medicine and Health Sciences; Middle Aged; Mortality; Multivariate analysis; Neutropenia; Non-Hodgkin's lymphomas; Oncology; Patients; Pediatrics; People and Places; Retrospective Studies; Systematic review; Treatment Outcome; Uganda; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0191967

Cancer treatment options in sub-Saharan Africa are scarce despite an increasing burden of disease. Identification of those cancer patients who would benefit most from the limited resources available would allow broader and more effective therapy. We conducted a retrospective analysis of patients over the age of 18 at the time of a pathologic diagnosis of NHL between 2003 and 2010 who were residents of Kyandondo County (Uganda) and presented to the Uganda Cancer Institute for care. A total of 128 patients were included in this analysis. Chemotherapy was recommended to 117 (91.4%) of the patients; the odds of recommending chemotherapy decreased for each additional month of reported symptoms prior to diagnosis. Of the 117 patients to whom chemotherapy was recommended, 111 (86.7%) patients received at least 1 cycle of chemotherapy; HIV infected patients, as well as those with a lower hemoglobin and advanced disease at the time of diagnosis were significantly less likely to complete therapy. Among the patients who initiated chemotherapy, twenty patients died prior to treatment completion (including nine who died within 30 days). Hemoglobin level at the time of presentation was the only variable associated with early mortality in the adjusted model. In resource-poor areas, it is essential to align health care expenditures with interventions likely to provide benefit to affected populations. Targeting cancer therapy to those with a favorable chance of responding will not only save limited resources, but will also prevent harm in those patients unlikely to realize an effect of cancer-directed therapy.