Understanding the bricks to build better surgical oncology unit at Maputo Central Hospital: prevalent surgical cancers and residents knowledge.

Atílio Morais,Luís Antunes,Adriano Tivane,Carlos Selemane,Satish Tulsidás,Germano Pires,Lúcio Lara Santos,Moshin Sidat,Carla Carrilho,Matchecane Cossa,Jotamo Come,Manuel João Costa,Maria Do Rosário Martins

doi:10.11604/pamj.2019.32.83.18126

Abstract

IntroductionCancer is a growing concern in Mozambique. However, the country has limited facilities and few oncologists. Surgical oncologists are an unmet need. The aim of this study was to assess residents' knowledge in prevalent cancer domains and to identify and characterize prevalent cancers treated by surgery at Maputo Central Hospital, the largest hospital in Mozambique. The expectations were that the findings shall inform the development of a comprehensive curriculum in surgical oncology fellowship fit for the Hospital.MethodsTo identify and characterize prevalent cancers, we performed a retrospective analysis of individual cancer patient registries of Maputo Central Hospital (MCH), Mozambique. Information was recorded into data collection sheets and analyzed with SPSS® 21. To assess MCH residents oncologic knowledge, we invited Twenty-six junior residents (49% of all residents) of different specialties to take a 30 item multiple choice written test used elsewhere in previous studies. The test focused on the domains of Basis of oncology, Radiotherapy, Pathology, Chemotherapy, Pain management, Surgical oncology and Clinical Pathway. The test was administered anonymously and without prior notice. We analyzed the overall test and topic performance of residents.ResultsThe study covered a period of 3 years and 203 patients. The most prevalent malignant tumors treated by general and thoracic surgery in MCH cancer registry were esophageal (7%), female breast (6.5%) and colorectal cancer (2.8%). Globally these malignancies were diagnosed at an advanced stage of the disease and required a multimodal treatment. The mean percent correct score of residents was 37.3%. The dimension with the highest percent correct score were clinical management (46%) and surgical oncology (28%) showed the lowest correct score.ConclusionIn Maputo, Mozambique esophageal, breast and colorectal cancer were the most prevalent malignancies treated, with surgery, by thoracic or general surgery in MCH. The test scores suggest that, among residents, the knowledge in oncology needs to be improved, rendering support to the need of a surgical oncology training tailored to suit the local needs. Specific training should take into account local cancer prevalence, resources, their quality and the support of surgical oncology services with volume and experience.

Highlights

Cancer is a growing concern in Mozambique [1]
Morais A et al studied in depth the surgical resources available at the Maputo Central Hospital (MCH) to perform oncologic surgery, the difficulties manifested by the surgeons during the surgical treatment of cancer and designed a draft training program in cancer surgery [12]
More than a half of the 25 HCM patients with esophageal cancer were women, and the median age at diagnosis of 50 years (Min 27; max 74); colorectal cancer was most prevalent in men and over the 22 patients with median 47 years (Min 24; max 83)

Summary

Introduction

Cancer is a growing concern in Mozambique [1]. the provision of care to cancer patients is conditioned by the country limitations on facilities and specialized oncologists [2]. More than three-quarters of cancer patients in lowincome and middle-income countries (LMICs) do not receive timely, safe, and affordable cancer surgery [5, 8] To address this impending problem of lack of adequate surgical care for cancer patients on the global stage, the European Society for Surgical Oncology (ESSO) and the Society of Surgical Oncology (SSO) outlined a framework of a global curriculum in surgical oncology education and training [9]. The development of a fit for purpose, comprehensive and fast-track training program in surgical oncology at MCH, requires the characterization of the clinical and pathological profile of the most prevalent cancer surgery at Central Hospital de Maputo. In response to the shortage of information do develop an oncology training program, this study had two primary aims, namely: I. the characterization of the most prevalent malignant tumors treated at MCH; II. In response to the shortage of information do develop an oncology training program, this study had two primary aims, namely: I. the characterization of the most prevalent malignant tumors treated at MCH; II. surveying resident's knowledge of surgical oncology

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