Cout réel de la prise en charge des cancers du col de l'utérus en radiothérapie au Cameroun / The real cost of the management of cervical cancers by radiotherapy in Cameroon

Introduction. Le cancer du col utérin est le deuxième cancer de la femme au Cameroun. La radiothérapie reste une des modalités thérapeutiques phares dans la prise en charge de cette pathologie et l'État participe en y apportant une subvention. Toutefois, plusieurs patientes n'accèdent pas au traitement en raison des difficultés financières. Notre objectif était d'évaluer le coût réel de la prise en charge afin de servir de support aux politiques d'aide aux patientes. Méthodologie. Uneétude descriptive, transversale portant sur les patientes traitées en radiothérapie à l'Hôpital Général de Douala pour cancer du col de l'utérus a été réalisée d'octobre 2020 à janvier 2021.Résultats. Au total 35 dossiers de patientes ont été inclus. Lespatientes avaient de faibles revenus (<108.810 XAF /mois, 51,3%), étaient sans assurance maladie (88,6%), provenant en majorité des villes hors de Douala (54,3%), avec des cancers localement évolués. Le coût global moyen du traitement était de 511 264 XAF+/-103479 XAF (779,42 +/-157,75 euros) pour chaque patiente. La durée moyenne de traitement était de 57,34 jours, avec un nombre médian de 27 séances. Les frais supplémentaires pendant le traitement provenaient de la chimiothérapie, de la gestion des effets secondaires, notamment des transfusions sanguines, et du bilan de suivi. Plus de la moitié des patientes ont eu besoin d'une prise en charge supplémentaire par chimiothérapie ou chirurgie. Conclusion. La prise en charge du cancer du col utérin par radiothérapie est coûteuse et peu accessible à la majorité des patientes Camerounaises.

Introduction.Cervix cancer is the second cancer among women in Cameroon. Radiotherapy is often warranted in its management. Many patients do not access treatment due to financial difficulties. Our objective was to assess the real cost of care in order to support patient assistance policies. Methodology. A descriptive cross over study of women treated by radiotherapy at the Douala General Hospital from October 2020 to January 2021 was conducted. Results. A total number of 35 patient files were included in the study. Patients generally had low income (<108.810 XAF /month), without medical insurance, lived out of Douala, and were diagnosed at locally advanced stages of their disease. Average cost of treatment for radiotherapy alone was 511,264 XAF +/-103,479 XAF. Average duration of treatment was 57.34 days, with a median number of 27 sessions. Extra cost came from chemotherapy, management of side effects especially from blood transfusions, and imaging. More than half of the patients required additional expense for adjunct chemotherapy or surgery. Conclusion. The total cost of treatment for cervix cancer by radiotherapy is quite expensive, and not accessible to the average Cameroonian

Brachial circumference as an alternative to body mass index for the detection of in-hospital undernutrition in a referal hospital, Cameroon.

The prevalence of undernutrition in hospitals in Africa is estimated at about 57 %. Simple anthropometric methods are available to detect it, including measurement of the brachial circumference (BC) and the body mass index (BMI). The aim of this study was to identify a threshold value that might make it possible to diagnose undernutrition in hospitals. It was a cross sectional study carried out at Douala General Hospital - Cameroon over a five months period. The measurements studied were: BMI, BC and percentage of weight loss. The Pearson test was used to compare the quantitative variables. The Receiving Operating Characteristic curve enabled us to determine a threshold value of the BC according to BMI. The study included 333 patients, with a mean age of 45 ± 16 years (range : 18-86). BMI and BC were strongly correlated; BC =11.69 + 0.68(BMI), with r2 = 0.65 (P < 0.01)). The threshold value of BC retained to detect undernutrition was 27 cm. The prevalence of undernutrition at the Douala General Hospital varies according to the anthropometric parameter used. At a BC threshold of 27 cm, the prevalence of undenutrition in our population was 24,3%.

Prise en charge des anémies chez les patients cancéreux dans un hôpital de référence de Douala, Cameroun

Introduction : L'anémie représente un facteur limitant dans la prise en charge des patients cancéreux. L'objectif général de ce travail était d'évaluer la prise en charge de l'anémie chez les patients cancéreux reçus à l'hôpital général de Douala, par rapport aux recommandations internationales. Patients et méthodes : Il s'agit d'une étude prospective menée du 1er septembre 2013 au 30 avril 2014. La sévérité de l'anémie après traitement spécifique a été évaluée à l'aide du classement OMS des grades de toxicité hématologique chimio-induite. La qualité de vie des patients a été évaluée grâce au score OMS du Performance status. La prise charge de l'anémie a été comparée aux standard options et recommandations françaises 2007. Résultats : Au total 301 patients ont été colligés. L'âge médian était de 42,5 ± 15,1. La prévalence de l'anémie à l'entrée était de 71,4% et passait à 80,7% après traitement. Tous les cancers ont été pourvoyeurs d'anémie sans différence statistiquement significative. Le taux d'abstention thérapeutique était de 16,9% avant l'initiation du traitement spécifique et de 13,6% après. Les anémies légères ≥ 10g/dl ont été traitées par fer oral. Les anémies modérées à sévères ont été traitées par transfusion sanguine. Les agents stimulants de l'érythropoïétine ont été utilisés dans 2,3% des cas. Le taux de respect des recommandations était de 17,5%. Conclusion : Cette prise en charge conformément aux recommandations internationales reste insuffisante. Elle se heurte à plusieurs obstacles dont le principal est financier, ainsi qu'à la rareté des médicaments. Un plaidoyer pour une subvention de médicaments sur cette problématique est à développer

[Clinical and immunological profile of HIV-infected patients at the initiation of antiretroviral therapy in Douala]. / Profil clinique et immunologique des patients infectés par le VIH à l'initiation du traitement antirétroviral à Douala.

The aim of this study was to describe the clinical and immunological profile of patients infected with HIV after initiation of antiretroviral therapy. Sociodemographic characteristics, clinical and immunological patients were recorded. Chi square test and Mann-Whitney were used to compare variables. The multivariate regression model identified risk factors. So that, 936 (56.2%) patients were in stages III and IV of the WHO and 65.2% at an advanced stage of the disease. Factors associated with initiation at an advanced stage, were male sex (p = 0.007) and time to diagnosis (p = 0.005). In 2/3 cases, treatment is started at an advanced stage of disease. It is therefore important to intensify awareness campaigns for early detection and encourage patients to ensure regular medical follow-up screening.

Devenir des patientes atteintes de carcinome mammaire invasif apres radiotherapie adjuvante au Cameroun

Le cancer du sein est le premier des cancers tant dans les pays industrialises que dans plusieurs pays africains. Au Cameroun; son incidence est de 29; 7 /100000 personnes-annees et sa mortalite de 16;6 / 100000. Parmi les moyens therapeutiques; la radiotherapie adjuvante a un role non negligeable pour ameliorer la survie. Aussi avons-nous eu le desir de decrire le devenir des patientes atteintes de carcinome mammaire invasif apres radio-therapie adjuvante. Nous avons alors mene une etude retrospective de janvier 2006 a decembre 2010 dans les Services de Radiotherapie des Hopitaux Generaux de Yaounde et de Douala. Afin de determiner le devenir des patientes en termes de survie sans rechute et de survie globale. Nous avons egalement etabli les courbes de survie selon la methode de Kaplan-Meier et analyse les donnees a l'aide du logiciel Epi Info 3.5.3 .Les patientes avaient un age moyen de 46 ans; extremes de 22 a 80 ans. La survie sans rechute etait de 82;5 a 5 ans; les taux de rechute loco-regionale et a distance respectivement de 9;1 et de 18;8. Pour la survie globale; la survenue d'une rechute loco-regionale associee au stade tardif etait un facteur de mauvais pronostic (p = 0;009 et 0;047) tandis que la chirurgie conservatrice l'etait pour la survie sans recidive (p = 0;042). La radiotherapie adjuvante pratiquee au Cameroun pour le traitement des carcinomes mammaires invasifs ameliore le pronostic locoregional et de ce fait la survie globale

Fractionated half-body irradiation (HBI) for the rapid palliation of widespread, symptomatic, metastatic bone disease: a randomized Phase III trial of the International Atomic Energy Agency (IAEA).

PURPOSE: To find the fastest and most effective/efficient method to economically deliver fractionated half-body irradiation (HBI) for widespread (WS), symptomatic, metastatic bone cancer. METHODS AND MATERIALS: A Phase III trial with 3 HBI arms: (Arm A) Control (15 Gy/5 fractions/5 days); (Arm B) Hyperfractionation (HF) (8 Gy/2 fractions/1 day); (Arm C) Accelerated HF (12 Gy/4 fractions/2 days). Six countries randomized 156 patients (all with WS bone metastases): 51, 56, and 49 patients to Arms A, B, and C, respectively. There were 72 (46%) breast, 50 (32%) prostate, 9 (6%) lung, and 25 (16%) miscellaneous primary tumors. Initial performance status (PS) was 1-2 in 101 (65%) and PS 3-4 in 55 (35%). The lower, upper, and middle halves of the body were treated 79, 68, and 9 times. RESULTS: Pain relief was seen in 91% of patients (45% complete [CR] and 46% partial [PR]) within 3-8 days. Overall (OS), median (MST), and pain-free (PFS) survival was 174, 150, and 122 days. Breast tumors had a higher OS (279 days) than that of other primary tumors, but when analyzed by treatment, was not significantly different than prostate tumors in Arm A. No survival differences were found in patients with PS 1-2 vs. 3-4, CR vs. PR, bone with/without visceral metastases, or by the number of metastases (< or > 15 bone lesions). Quality of life (QOL) assessed by the percent of the remaining life free of pain was 71%; furthermore significant improvements in PS, pain, and narcotic scores were seen after HBI. Toxicity was very acceptable (41% none, 50% mild/moderate, 12% severe but transitory); more was seen with upper HBI. CONCLUSION: In terms of response, time to response, OS, MST, PFS, QOL, and toxicity, schedules for Arms A and C were similar for all but prostate primaries. Schedule for Arm B, which delivered the lowest biologic dose in the shortest time, had significantly worse results in pain relief, OS, MST, PFS, and QOL. Results indicate that, for most primary tumor types (except prostate), delivering two HBI daily doses of 3 Gy in 2 consecutive days is as effective as delivering a daily dose of 3 Gy for 5 consecutive days. Thus, this is a faster and much more convenient HBI schedule for the palliation of pain in widespread cancer.

Les cancers ORL traités à l'hôpital général de Douala

De janvier 1990 a decembre 1996; nous avons recu en traitement 156 patients porteurs de cancers des voies aero-digestives superieures (Vads) histologiquement diagnostiques. Ils representaient 10;6de tous les cancereux recus durant cette periode. Les estimations tenant compte des facteurs socio-economiques et culturels locaux projettent une frequence relative de 4 pour 1000 000 habitants. Nous rapportons les manifestations clinico-pathologiques et les aspects histologiques retrouves. Les principales localisations sont representees par le rhino-pharynx (20;); l'amygdale (14); le sinus maxillaire (13); le larynx (12;2); les adenopathies cervicales primitives (8;3). Les survies globales a un an de chacune de ces localisations apres traitement sont respectivement de 56;25; 43;5 et 8

[Cancer localisation in men and women aged over 50 in Cameroon]. / Localisations des cancers chez les hommes et les femmes âgés de plus de 50 ans au Cameroun.

The aim of this study was to present the sites of cancers diagnosed in men and women aged 50 years and above in Cameroon. From the registries of the pathology laboratory of the Yaoundé Central Hospital which at the national level receives the majority of samples sent for histopathology analysis, we recorded all cases of cancers diagnosed in people aged 50 years and above, during the period from 1st January 1987 to 31st August 1996 (9 years 8 months). 1,925 cancers were recorded: -1,005 of these (52.2%) were issued from men aged fifty years and above. These 1,005 cancers came from seventeen sites, the most common being: liver (226 cases = 22.49%), prostate (222 cases = 22.09%), skin (195 cases = 19.40%) and ENT (100 cases = 9.95%); that made 73.93% (above 3/4) of cancers observed in men aged fifty years and above from this study. -920 of these (47.8%) were diagnosed from women aged fifty years and above. These 920 cancers came from twenty-two sites, the most common being: uterine cervix (292 cases = 31.74%), breast (170 cases = 18.48%), skin (111 cases = 12.07%) and liver (90 cases = 9.78%); that made 72.07% (about 3/4) of cancers observed in women aged fifty years and above, from this study.

A regional training programme for radiotherapists and allied professionals for the west African health community.

With 47% of the population under 15 years of age and the control of infectious and other communicable diseases, cancer will likely constitute a major health problem in West Africa in future. Radiotherapy facilities and trained manpower to run them are very limited within the subregion. This paper quantifies the severity of the situation and discusses a practical approach aimed at coping with the situation through the organisation of a training programme for radiotherapists, medical physicists and radiation technologists as part of the strategies for cancer control in West Africa. A curriculum is proposed for the training of radiotherapists.