Is the clinicopathological pattern of colorectal carcinoma similar in the state and private healthcare systems of South Africa? Analysis of a Durban colorectal cancer database

2017 ◽  
Vol 47 (4) ◽  
pp. 360-364 ◽  
Author(s):  
Xolani H Ntombela ◽  
Babongile MW Zulu ◽  
Molikane Masenya ◽  
Ben Sartorius ◽  
Thandinkosi E Madiba

Previous state hospital-based local studies suggest varying population-based clinicopathological patterns of colorectal cancer (CRC). Patients diagnosed with CRC in the state and private sector hospitals in Durban, South Africa over a 12-month period (January–December 2009) form the basis of our study. Of 491 patients (172 state and 319 private sector patients), 258 were men. State patients were younger than private patients. Anatomical site distribution was similar in both groups with minor variations. Stage IV disease was more common in state patients. State patients were younger, presented with advanced disease and had a lower resection rate. Black patients were the youngest, presented with advanced disease and had the lowest resection rate.

2021 ◽  
Author(s):  
M. McCabe ◽  
C. Penny ◽  
P. Magangane ◽  
S. Mirza ◽  
Y. Perner

Abstract Introduction: A large proportion of indigenous African (IA) colorectal cancer (CRC) patients in South Africa are young (<50years), with no unique histopathological or molecular characteristics. Anatomical site as well as microsatellite instability (MSI) status have shown to be associated with different clinicopathological and molecular features. This study aimed to ascertain key histopathological and miRNA expression patterns in microsatellite stable (MSS) and low-frequency MSI (MSI-L) patients, to provide insight into the mechanism of the disease. Methods: A retrospective cohort (2011-2015) of MSS/MSI-L CRC patient samples diagnosed at Charlotte Maxeke Johannesburg Academic Hospital was analyzed. Samples were categorized by site [Right colon cancer (RCC) versus left (LCC)], ethnicity [IA versus other ethnic groups (OEG)] and MSI status (MSI-L vs MSS). T-test, Fischer’s exact and Chi-square tests were conducted. Additional miRNA expression profiling was performed on IA patient samples. Results: IA patients with LCC demonstrated an increased prevalence in males, sigmoid colon, signet-ring-cell morphology, MSI-L with BAT25/26 marker instability and advanced disease association. MiRNA expression profiling revealed unique clustering, with dysregulation of let-7 and miRNA-125. Conclusion: This study revealed distinct histopathological features for LCC, and suggests BAT25/26, miRNAs let-7a-5p and miRNA-125a/b-5p as negative prognostic markers in African CRC patients. Larger confirmatory studies are recommended.


2014 ◽  
Vol 2014 ◽  
pp. 1-8
Author(s):  
Lydia M. Dreosti ◽  
Alicia McMaster ◽  
Rashem Mothilal

Oxaliplatin is a standard first-line treatment for metastatic colorectal cancer. The objectives were to document the therapeutic management of oxaliplatin in South Africa, determine the incidence and severity of sensory neuropathy, and record the 2-year survival rate. Meccelox was a prospective, noncontrolled, open label, multicentre, observational survey of adult patients with stage IV metastatic colorectal cancer treated with oxaliplatin-based chemotherapeutic regimens. The study was conducted from August 2007 to November 2011 in 29 sites in South Africa by 66 participating treating physicians. Among the 195 enrolled patients, 61% were treated with FOLFOX regimen (5-fluorouracil/folinic acid plus oxaliplatin) for an average of 12 cycles and 32% patients were treated with XELOX (capecitabine plus oxaliplatin) for an average of 6–8 cycles, with the main reason for discontinuation being completion of the preplanned prescribed regimen. In Meccelox survey, 80% of patients were treated with intent of palliation. Overall 64% of patients reported symptoms of sensory neuropathy. The 2-year survival rate was 30%. Conclusions. Patients received a specified preplanned number of chemotherapy cycles rather than being treated until disease progression or toxicity. Both the incidence of neuropathy and the 2-year survival rate were less than previous reports.


2019 ◽  
Vol 121 (11) ◽  
pp. 966-972 ◽  
Author(s):  
Tracey S. E. Genus ◽  
Catherine Bouvier ◽  
Kwok F. Wong ◽  
Rajaventhan Srirajaskanthan ◽  
Brian A. Rous ◽  
...  

Abstract Background The diagnosis of neuroendocrine neoplasms (NENs) is often delayed. This first UK population-based epidemiological study of NENs compares outcomes with non-NENs to identify any inequalities. Methods Age-standardised incidence rate (ASR), 1-year overall survival, hazard ratios and standardised mortality rates (SMRs) were calculated for all malignant NENs diagnosed 2013–2015 from UK national Public Health records. Comparison with non-NENs assessed 1-year overall survival (1YS) and association between diagnosis at stage IV and morphology. Results A total of 15,222 NENs were identified, with an ASR (2013–2015 combined) of 8.6 per 100,000 (95% CI 8.5–8.7); 4.6 per 100 000 (95% CI, 4.5–4.7) for gastro-entero-pancreatic (GEP) NENs. The 1YS was 75% (95% CI, 73.9–75.4) varying significantly by sex. Site and morphology were prognostic. NENs (predominantly small cell carcinomas) in the oesophagus, bladder, prostate, and female reproductive organs had a poorer outcome and were three times more likely to be diagnosed at stage IV than non-NENs. Conclusion Advanced stage at diagnosis with significantly poorer outcomes of some NENs compared with non-NENs at the same anatomical site, highlight the need for improved access to specialist services and targeted service improvement.


2017 ◽  
Vol 7 (4) ◽  
pp. 408-422 ◽  
Author(s):  
Khotso Tsotsotso ◽  
Elizabeth Montshiwa ◽  
Precious Tirivanhu ◽  
Tebogo Fish ◽  
Siyabonga Sibiya ◽  
...  

Purpose The purpose of this paper is to improve the understanding of the drivers and determinants of skills demand in South Africa, given the country’s history and its current design as a developmental state. Design/methodology/approach In this study, a mixed methods approach is used. The study draws information from in-depth interviews with transport sector stakeholders including employers, professional bodies, sector regulatory bodies and training providers. Complementary to the interviews, the study also analyses employer-reported workplace skills plans from 1,094 transport sector firms updated annually. A Heckman correction model is applied. Findings The study finds that changes in competition, technology, ageing employees, market conditions and government regulations are among the most frequently stated determinants reported through interviews. Using a Heckman regression model, the study identifies eight determining factors, which include location of firm, size of a firm, occupation type, racial and generational transformation, subsector of the firm, skills alignment to National Qualification Framework, reason for skills scarcity and level of skills scarcity reported. The South African transport sector skills demand is therefore mainly driven by the country’s history and consequently its current socio-economic policies as applied by the state itself. Research limitations/implications Wage rates are explored during stakeholder interviews and the study suggests that wage rates are an insignificant determinant of skills demand in the South African transport sector. However, due to poor reporting by firms, wage rates did not form a part of the quantitative analysis of the study. This serves as a limitation of the study. Practical implications Through this research, it is now clear that the state has more determining power (influence) in the transport sector than it was perceived. The state can use its power to be a more effective enabler towards increasing employer participation in skills development of the sector. Social implications With increased understanding and awareness of state’s influence in the sector, the country’s mission to redress the social ills of the former state on black South Africans stands a better chance of success. Private sector resources can be effectively mobilized to improve the social state of previously disadvantaged South Africans. However, given the economic dominance of the private sector and its former role in the apartheid era in South Africa; too much state influence in a supposedly free market can result in corporate resistance and consequently, market failure which can be seen as result of political interference. Originality/value South Africa has had an unprecedented social and economic trajectory to date. This said, its economic and social policies are unlike what we have observed before. Thus, identification of determinants and understanding of mechanisms of influence, on skills demand in the sector in which an African state plays such a close and active role, is in itself a unique contribution to knowledge and compels us to revisit our traditional assumptions about market behaviour. This study is one of the very few of its kind in the labour market research with a South African context.


2018 ◽  
Vol 2 (2) ◽  
Author(s):  
Michael J Hassett ◽  
Hajime Uno ◽  
Angel M Cronin ◽  
Nikki M Carroll ◽  
Mark C Hornbrook ◽  
...  

Abstract The treatments provided to and survival of patients with recurrent vs de novo stage IV advanced breast, lung, and colorectal cancer may differ but have not been well studied. Using population-based data from the Cancer Research Network for 4510 patients with advanced breast, lung, or colorectal cancer, we matched recurrent/de novo patients on demographic factors. We found longer survival for recurrent vs de novo lung cancer (182 matched pairs); no significant difference for colorectal cancer (332 matched pairs); and shorter survival for recurrent vs de novo breast cancer (219 matched pairs). Compared with recurrent cases, chemotherapy use and radiation therapy use were more common among de novo cases. Differences in treatment and survival between recurrent and de novo advanced cancer patients could inform prognostic estimates and clinical trial design.


2010 ◽  
Vol 53 (3) ◽  
pp. 35-59 ◽  
Author(s):  
Sabine Marschall

Abstract:This article investigates issues of identity construction and public memorialization in postapartheid South Africa. It focuses on the Sunday Times Heritage Project, a unique private-sector initiative that involved the installation of thirty memorials throughout the country between 2006 and 2008. The article discusses the conceptualization and implementation of the project, pointing out important differences between this private initiative and the state-directed heritage effort. By interrogating the nexus between race, space, and memory in the construction of memorials, the article highlights the significance of placement and location in the formation of new identity discourses.


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