Collapse of Cancer Care Under the Current Conflict in Sudan.

Sudan has been under an armed conflict between the Sudanese Armed Forces and the Rapid Support Forces (RSF) militia since April 15, 2023. The conflict has turned the country into the largest internal displacement humanitarian crisis with 9.05 million internally displaced persons including 2.2 million children younger than 5 years and caused 1.47 million Sudanese to flee the country as refugees. The conflict has had a major destructive impact on the health system, which has incurred targeting with air raids, ground invasion, vandalization, looting of assets and supplies, and killing of doctors, nurses, and other health personnel. Khartoum Oncology Hospital, Sudan's main cancer hub for treatment, diagnostics, and research has become nonfunctional as a result of the conflict. The National Cancer Institute in Wad Medani, the second largest hub, faced a similar fate as the conflict spread to Al-Gezira State. Patients with cancer have been displaced multiple times in Sudan with grave consequences on the continuity of care, worsening of their disease outcomes and palpable negative impacts on children. The oncology workforce in Sudan have themselves been displaced yet are working hard to provide services and care for patients under impossible circumstances. Sudan's doctors in diaspora have rallied to provide support but they face multiple obstacles. As the conflict continues to spread, we call upon the WHO, the United Nations Children's Fund, St Jude Hospital, and all relevant partners to implement an immediate evacuation operation with urgent air lifts of the affected children to continue their cancer care in neighboring countries as was done in Ukraine and Gaza.

Pancreatic cancer in Saudi Arabia (2005-2020): increasing trend.

Pancreatic cancer, a highly fatal malignancy, has shown a global rise in the incidence and mortality rates. However, these rates vary significantly across different regions worldwide. This study aims to assess the incidence and mortality of pancreatic cancer in Saudi Arabia. We collected the data from 16 annual cancer incidence reports in Saudi Arabia for the study period (2005-2020) and from the WHO's IARC Global Cancer Observatory website. Although the burden of pancreatic cancer in Saudi Arabia is relatively lower compared to global rates, the disease incidence has shown a steady increase over the study period, in addition to regional variations within the country. The disease predominantly affects the elderly population, aged 50 years and above in both genders, with males exhibiting higher rates than females. Further studies are required to identify the potential risk factors for pancreatic cancer in the Saudi population.

Colorectal Cancer in Saudi Arabia: The Way Forward.

Colorectal cancer is the most common cancer in Saudi males and the second most common cancer in Saudi females with increasing incidence throughout the last four decades. Although the disease incidence is on the rise, still there is no systemic screening for colorectal cancer in the Saudi population. Early onset colorectal cancer is common in the Saudi population and up to 50% in Saudi patients diagnosed at late stages with regional and distal metastasis. Therefore, more efforts are required to control the disease in the Kingdom of Saudi Arabia. In this regard,  systematic work at national level is highly required to make  colorectal cancer screening for population at risk part of the routine primary health care activities. This paper highlights the current situation of colorectal cancer in the Kingdom of Saudi Arabia with relation to incidence, mortality and morbidity in addition to the disease control efforts going on. Finally, some recommendations are provided to strengthen the control program of colorectal cancer.

Evaluating utility and feasibility of mismatch repair testing of colorectal cancer patients in a low-middle-income country.

Molecular pathology services for colorectal cancer (CRC) in Sudan represent a significant unmet clinical need. In a retrospective cohort study involving 50 patients diagnosed with CRC at three major medical settings in Sudan, we aimed to outline the introduction of a molecular genetic service for CRC in Sudan, and to explore the CRC molecular features and their relationship to patient survival and clinicopathological characteristics. Mismatch repair (MMR) and BRAF (V600E) mutation status were determined by immunohistochemistry. A mismatch repair deficient (dMMR) subtype was demonstrated in 16% of cases, and a presumptive Lynch Syndrome (LS) diagnosis was made in up to 14% of patients. dMMR CRC in Sudan is characterized by younger age at diagnosis and a higher incidence of right-sided tumours. We report a high mortality in Sudanese CRC patients, which correlates with advanced disease stage, and MMR status. Routine MMR immunohistochemistry (with sequential BRAF mutation analysis) is a feasible CRC prognostic and predictive molecular biomarker, as well as a screening tool for LS in low-middle-income countries (LMICs).

Survival Outcomes of Breast Cancer in Sudanese Women: A Hospital-Based Study.

PURPOSE: Breast cancer (BC) is the leading malignancy among Sudanese women. Yet, data on survival are limited. This study aimed to determine 5-year overall survival (OS) of BC in Sudanese women, and identify prognostic demographic and clinicopathologic factors. PATIENTS AND METHODS: A hospital-based retrospective study was conducted by reviewing data of women with BC diagnosed and treated at the National Cancer Institute-University of Gezira during 2012, and followed up to end of August 2018. Data were retrieved from medical records and analyzed, OS was determined, and the prognostic factors were explored. RESULTS: A total of 225 cases were recruited. The median age at presentation was 45 years (range, 22-85 years). Clinical stage I, II, III, and IV represented 3.1%, 31.6%, 48%, and 17.3%, respectively. Most women (81.3%) were treated with curative intent. Of those, 25.1% received neoadjuvant chemotherapy. Mastectomy was the commonest (61.7%) type of surgery. The median follow-up period was 59.8 months with mean OS time of 55.7 months. The 5-year cumulative survival rate was 58%. The 5-year OS rates for stages I, II, III, and IV were 71.5%, 82.4%, 56.5%, and 8.4%, respectively. For lymph node (LN)-positive cases, 5-year OS rate was 63% and for LN-negative was 83.5%. Presenting with advanced-stage disease and positive LN status associated with short OS times (P < .005). CONCLUSION: OS of women with BC in Central Sudan is worse than in the developed world, but similar to African countries. Our findings indicate that advanced stage at diagnosis and lymph nodal involvement are strong predictors of short survival times. Raising awareness and introducing early detection programs are critical for better survival of these patients.

Axillary Lymph Node Dissection for Breast Cancer: Efficacy and Complication in Developing Countries.

PURPOSE: Axillary lymph node dissection (ALND) frequently is performed as part of the surgical management of breast cancer as a therapeutic and prognostic index, but increasingly has been perceived as associated with significant complications. Data on efficacy and complications of ALND in Sudan are lacking. The aim of this study was to assess the efficacy and complications of ALND in patients with breast cancer treated with mastectomy and breast-conserving surgery. METHODS: We performed a prospective, hospital-based study in women with invasive breast cancer who underwent modified radical mastectomy or breast-conserving surgery with ALND between September 2014 and August 2015. The efficacy of ALND was defined as retrieval of ≥ 10 lymph nodes. Complications of ALND were assessed objectively and subjectively and defined as either present or absent. RESULTS: Of 96 patients with breast cancer included in the study, 40 (42%) developed postaxillary clearance complications. The median follow-up time was 18 months (range, 12 to 24 months). Numbness was reported by 21.9% of patients. Seroma was noted in 15.6% and lymphedema in 9.4%. Approximately 9% reported episodes of infection or inflammation at the surgical site. None of the studied factors were found to affect the incidence of complications significantly. Ten or more lymph nodes were retrieved in 81.3% of patients, and nodal metastasis was found in 62.5%. CONCLUSION: This study shows that the prevalence of undesirable adverse effects after ALND is 42%, with paresthesia and seroma being the most prevalent. The lymphedema prevalence was low in relation to other evaluated symptoms.

Olanzapine for the Prevention of Chemotherapy-Induced Nausea and Vomiting: A Comparative Study From Sudan.

PURPOSE: Chemotherapy-induced nausea and vomiting (CINV) is a distressing adverse effect. Neurokinin-1 receptor antagonist (NK1RA)-containing regimens are the standard regimens for CINV prophylaxis in patients with cancer receiving highly or moderately emetogenic chemotherapy (HEC or MEC). NK1RA agents are expensive and were not registered in Sudan. Recently, regimens containing olanzapine, the available and affordable medication in Sudan, were introduced as another option. This study aimed to compare the efficacy of an olanzapine-containing regimen with the antiemetic regimen that was currently used in our institute for CINV prophylaxis in HEC/MEC settings. PATIENTS AND METHODS: The study prospectively compared an olanzapine-containing regimen (acute phase: olanzapine, ondansetron, dexamethasone; delayed phase: olanzapine, ondansetron) with an ondansetron/dexamethasone regimen (acute phase: ondansetron, dexamethasone; delayed phase: ondansetron) in adult patients with cancer receiving HEC or MEC. The study outcomes were complete response (CR; no emesis and no rescue medications) and nausea control (no nausea), which were assessed in the acute (0 to 24 hours), delayed (24 to 120 hours), and overall (0 to 120 hours) phases. RESULTS: The study included 131 patients (olanzapine-containing: 50 patients; ondansetron/dexamethasone: 81 patients). CR and nausea control were higher in the olanzapine-containing than in the ondansetron/dexamethasone regimen (CR: acute phase, 86% v 71.6%; P = .086; delayed phase, 72% v 30.9%; P < .001; overall phase, 66% v 25.9%; P < .001; nausea control: acute phase, 86% v 74.1%; P = .127; delayed phase, 76% v 34.6%; P < .001; overall phase, 72% v 29.6%; P < .001). The major toxicity of olanzapine was grade 1 and 2 sedation or drowsiness (25 patients). CONCLUSION: An olanzapine-containing regimen has better efficacy for prevention of CINV in the HEC/MEC setting. Oncologists working in a limited-resource setting should be familiar with olanzapine-containing regimens, because NK1RA agents are not affordable and not easily available.