Oesophageal cancer in Area 2 of Kwazulu-Natal: predictors of late presentation

Abstract

Background: There are limited prospective data sets on clinical characteristics, stage of presentation and treatment of patients with Oesophageal  Squamous Cell Carcinoma (OSCC) in South Africa. This study aimed to assess the frequency and severity of clinical characteristics associated with late  presentation of patients with OSCC presenting to a cancer referral centre in KwaZulu-Natal, South Africa.

Methods: A prospective consecutive series of patients presenting with confirmed OSCC treated at Greys Hospital in 2016/2017 were enrolled. Data  collected included: age, gender, home language, referral centre, clinical and laboratory characteristics: dysphagia score, Eastern Cooperative Oncology  Group (ECOG) performance status, body mass index (BMI), serum albumin, tumour pathology and treatment administered.

Results: One hundred  patients were analysed. Ninety four percent spoke isiZulu. The mean age was 61 with a male to female ratio of 1.5:1 Ninety percent had palliative  treatment as their overall assessment precluded curative treatment. Five patients underwent curative treatment. The age standardised incidence (ASR)  was 25.2 per 100 000. The factors associated with late presentation and their frequency were: advanced dysphagia grade ( >/=2 in 68%), malnutrition  (BMI <18.5kg/m² in 49%), hypoalbuminaemia (serum albumin < 35 g/l in 70%), poor performance status (ECOG>/=2 in 50% ) and moderate to poor  tumour differentiation in 95% of patients.

Conclusions: OSCC in Kwazulu-Natal has double the ASR of South Africa and places a significant burden on the  region’s health care system. Factors associated with late presentation occur in the majority and alone or in combination preclude curative therapies. The  frequency of these factors serve as a benchmark for comparison, and reduction in their frequency may indicate effectiveness of interventions designed  to improve awareness and access to proper care.