Descriptive epidemiological study of head and neck cancers at a single institution in Southern Africa

Naidoo, Komeela (2019-12)

Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Medical Imaging and Clinical Oncology. Radiation Oncology.

Thesis

ENGLISH SUMMARY : Head and Neck Cancers (HNCs) constitute a major public health concern worldwide. The incidence is approximately two times more in less-developed regions as compared to more developed regions. The estimated incidence in sub-Saharan Africa is 27593 per 100000 with a cumulative risk of 0.66. We evaluated patient demographics, risk factors, tumours characteristics, prognostic factors, disease stage, treatment intent and treatment modality in a cohort of patients with HNC in Cape Town, SA. Records of all HNC patients that presented to Tygerberg Hospital oncology department between 1 January 2015 and 31 December 2017 were reviewed. The following variables were described: patient demographics, which include age, sex, HIV status, and socio-economic status as well as tumour characteristics, risk factors, treatment intent and treatment modalities. Data was collected from 854 patients seen between 2015 and 2017. There were 603 (71%) male and 251 (29%) female. The male to female ratio was 2.4:1. The age range was 10-89 years (median age 58 years). Smoking was a risk factor in 737 (86.3%) and alcohol in 634 (74.2%) of patients. Of the 167 patients with oropharyngeal primaries, 16 (9.58%) patients had p16 positive, 78 (46.70%) were p16 negative and the p16 status was unknown in 73 (43.7%). The most common site was the oral cavity (n=320) and the most common sub-site was the anterior tongue (n=137). Eleven patients had two separate primaries at the time of diagnosis. In total, 466 patients (53.87%) presented with locally advanced, stage IVA disease. The median age of diagnosis, the most predominate primary site; histological subtype and stage at presentation were consistent with that reported in the literature. We have demonstrated that the majority of patients present at a late stage, with locally advanced disease. This together with the predominate risk factors of smoking and alcohol consumption is a potential target for health campaigns and awareness programmes. This cohort will be followed up for treatment outcomes and survival rates.

AFRIKAANSE OPSOMMING : Kop- en-nek kankers (KNK's) is 'n groot probleem vir die openbare gesondheid sektor. Die voorkoms van KNK’s is ongeveer twee keer meer in minder gegoede areas in vergelyking met meer ontwikkelde streke. Die geraamde voorkoms in sub-Sahara Afrika is 27 593 per 100 000 individue met 'n kummulatiewe risiko van 0,66. Ons het die pasiënt kenmerke , risiko faktore, gewas kenmerke, prognostiese faktore, siekte stadium,en behandelings doelwitte asook die behandelings modaliteit in 'n groep pasiënte wat met KNK’s gediagnostiseer was geëvalueer. Kliniese verslae van alle KNK’s-pasiënte wat vanaf 1 Januarie 2015 tot 31 Desember 2017 by Tygerberg-hospitaal se onkologie-afdeling gepresenteer het, is nagegaan. Die volgende veranderlikes is beskryf: pasiënt kenmerke, ouderdom, geslag, MIV- en sosio-ekonomiese status, sowel as die kanker gewas-karaktertrekke, risiko faktore, behandelings-doelwitte en modaliteit is geëvalueer. Kliniese inligting van 854 pasiënte, is nagegaan. Daar was 71% manlike en 29% vroulike pasiënte. Die verhouding tussen mans en vroue was 2.4:1. Die groep se ouderdom verspreiding was 10-89 jaar, met ‘n gemiddelde ouderdom van 58 jaar. Rook was 'n risiko faktor in 86,3% en alkohol in 74,2% van die pasiënte. In 167 pasiënte met primêre orofaryngeale kanker, was 9,58% pasiënte p16 positief, 46,70% was p16 negatief en in 43,7% van die pasiënte was die p16-status onbekend. Die oorwegende aangetasde area was die mondholte (n = 320) met die algemeenste sub-lokasie die anterior gedeelte van die tong (n = 137). Elf pasiënte het by hul aanvanklike presentasie, gepresenteer met twee afsonderlike primêre kankers. In totaal het 53,87% pasiënte gepresenteer met lokaal gevorderde stadium IVA-siekte. Die gemidelde ouderdom by diagnose, die oorheersende primêre area; histologiese subtipe en stadium tydens aanvanklike presentasie was in ooreenstemming met wat in die Internationale literatuur gemeld word. Ons het ook getoon dat die meerderheid van pasiënte presenteer met lokaal gevorderde siekte en met die risiko faktore van rook en alkohol misbruik is dit 'n potensiële teiken vir gesondheids veldtogte en bewusmakings programme. Hierdie groep word ook nog tans opgevolg vir behandelings uitkomste en oorlewing syfers.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/107099
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