Predictors of Radiation Therapy Incompletion Among Patients With Esophageal Cancer in Tanzania

Abstract

Abstract 96 Purpose The incidence of esophageal cancer in East Africa is disproportionately high. In Tanzania, radiation therapy (RT) is routinely offered for definitive and palliative therapy; however, many patients do not complete RT or die shortly thereafter. The current study aimed to characterize RT treatment patterns in Tanzania and identify predictive factors for RT incompletion. Methods We performed a retrospective chart abstraction for patients with esophageal cancer who were treated with RT at a national referral cancer center in Tanzania from 2011 to 2013. Definitive intent was defined as RT prescriptions with at least 20 fractions with concurrent chemotherapy. Other fractionation regimens were considered palliative. Wilcoxon rank-sum tests, χ2 tests, and logistic regression models were used to identify factors that are associated with palliative or definitive RT incompletion. Results A total of 300 patients—202 male and 98 female patients—were identified with a median age of 60 years (interquartile range [IQR], 48 to 70 years). Nearly 100% (299 of 300) of patients reported dysphagia to solids, and 54% (155 of 288) reported dysphagia to liquids. Median duration of symptoms before presentation was 4 months (IQR, 2 to 6 months), and median time from diagnosis to RT was 1.2 months (IQR, 0.8 to 1.9 months). Overall, 23% were unable to complete RT as a result of death or clinical decompensation. Palliative treatment was administered to 149 patients, and 26% did not complete RT. Definitive treatment was administered to 151 patients, and 20% did not complete RT ( P = .24). Patients younger than age 60 years were less likely to complete palliative RT (odds ratio [OR], 2.4; P = .02). Tobacco use (OR, 2.7; P = .04) and RT initiation within 30 days of diagnosis (OR, 3.5; P = .004) were associated with incomplete definitive RT. Conclusion In Tanzania, approximately 23% of patients die or decompensate before completing esophageal RT. Patients younger than age 60 years were less likely to complete palliative RT. Tobacco use and RT initiation within 30 days of diagnosis was associated with definitive treatment incompletion, perhaps reflecting differences in cancer biology or pace of disease. Additional understanding of how these factors contribute to RT incompletion may inform supportive care resource allocation and patient selection for esophageal RT in Tanzania and similar resource-limited settings. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs were provided by the authors.