title: Cancer survival in Malawi: a retrospective cohort study.
abstract: BACKGROUND
  Cancer is a leading cause of morbidity and mortality worldwide with the burden in sub-Saharan Africa projected to double by year 2030 from 715,000 new cases and 542,000 deaths in 2008. However, cancer survival data to inform interventions for early detection, diagnosis and treatment are lacking.
  
  
  METHODS
  Cancer survival analysis was conducted on 842 cancer patients registered and followed-up from 2006 to 2013 at NdiMoyo Palliative Care Centre in Salima District, central Malawi. Cancer survival was measured from the time of diagnosis.
  
  
  RESULTS
  In both sexes, the common types of cancer were; Kaposi's sarcoma (KS) (48.0%), cervical cancer (21.1%), cancer of oesophagus (14.8%), liver cancer (3.1%) and breast cancer (2.5%). In Males; KS, cancer of the oesophagus, cancer of the liver, bone cancer and non-Hodgkin's lymphoma were the commonest accounting for 67.4%, 19.4%, 3.9%, 1.0% and 1.0% respectively. In females; cancer of the cervix, KS, cancer of the oesophagus, cancer of the breast and cancer of the liver were the top five cancers accounting for 41.6%, 29.2%, 10.3%, 4.9% and 2.3% respectively. Of the 830 cancer patients with complete 5-year follow-up data, the overall median survival time was 9 months. Absolute survival rates at 1, 2, 3, 4 and 5 years or more were 31.8%, 18.0%, 12.5%, 7.8% and 6.0% respectively. The survival rates for top five cancers at 1, 2, 3, and 4 years or more were; KS (n= 397): 47.1%, 30.2%, 21.4% and 13.1%; cancer of the cervix (n = 174): 31.0%, 10.3%, 5.2% and 2.9%; cancer of the oesophagus (n = 124): 4.0%, 2.4%, 1.6% and 1.6%; liver cancer (n = 26): 19.2%, 3.8%, 3.8% and 3.8% and breast cancer (n = 21): 9.5%, 0%, 0%, 0% respectively. The risk of death was high in females than males, in those aged 50 years or more than in those aged less than 50 (p < 0.05).
  
  
  CONCLUSIONS
  This study demonstrated that cancer survival from the time of diagnosis in Malawi was poor with median survival time of about 9 months and only 6% of patients survived for 5 years or more. Improvement of early detection, diagnostic capability, access to treatment and palliative care services could improve cancer survival.
authors.affiliation: World Health Organisation, Malawi Country Office, Lilongwe, Malawi ; University of Malawi, College of Medicine, Community Health Department, Lilongwe, Malawi.
authors.forename: Kelias Phiri
authors.initials: KP
authors.lastname: Msyamboza
authors.affiliation: University of Malawi, College of Medicine, Community Health Department, Lilongwe, Malawi.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Manda
authors.affiliation: University of Malawi, College of Medicine, Community Health Department, Lilongwe, Malawi.
authors.forename: Bvumi
authors.initials: B
authors.lastname: Tembo
authors.affiliation: University of Malawi, College of Medicine, Community Health Department, Lilongwe, Malawi.
authors.forename: Chimwemwe
authors.initials: C
authors.lastname: Thambo
authors.affiliation: Ndimoyo Palliative Care Centre, Salima, Malawi.
authors.forename: Linly
authors.initials: L
authors.lastname: Chitete
authors.affiliation: Ndimoyo Palliative Care Centre, Salima, Malawi.
authors.forename: Christopher
authors.initials: C
authors.lastname: Mindiera
authors.affiliation: Ndimoyo Palliative Care Centre, Salima, Malawi.
authors.forename: Lucy Kishindo
authors.initials: LK
authors.lastname: Finch
authors.affiliation: Ndimoyo Palliative Care Centre, Salima, Malawi.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Hamling
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology*; D012189:Retrospective Studies; D012737:Sex Factors; D015996:Survival Rate; D013997:Time Factors; D055815:Young Adult
keywords: Cancer; Malawi; cancer survival; palliative care; sub-Saharan Africa
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