Browsing by Subject "Cancer"
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- ItemOpen AccessAn investigation of the impact of the B cell lymphoma factor Activation Induced Cytidine Deaminase (AICDA/AID) on epigenetic plasticity(2025) Makofane, Lincon Kgasha; Shaheen, Mowla; Beatrice, RamorolaCancer is a major cause of both mortality and morbidity globally, with 10 million deaths reported in 2020 by the Global Cancer Observatory (GLOBOCAN). To address this burden, it is crucial to deepen our understanding of the biology of the disease to create opportunities for addressing therapeutic challenges. Epigenetic regulation has recently emerged as a prominent factor in cancer progression, and aberrant epigenetic alterations have been reported in many key cancer-driving genes. The overexpression of the DNA modifying enzyme Activation-induced cytidine deaminase (AICDA) is a factor linked to cancer progression, particularly B-cell derived non-Hodgkin lymphomas, but has also been associated with other inflammation-associated cancers, including colorectal cancer (CRC). The widely recognised normal role of AICDA is in antibody-producing B cells, where its cytosine deaminating ability within DNA is essential for the production of a diverse array of antibodies. In high grade B cell lymphomas, such as diffuse large B cell lymphoma (DLBCL) and Burkitt lymphoma (BL), overexpression of AICDA is particularly associated with oncogenic genomic translocations, thought to be driven by aberrant DNA repair, following the deamination events. More recently, the oncogenic function of AICDA has been expanded to include modulation of the epigenetic landscape, through the enzyme's ability to alter CpG sites/islands, because of its deamination function. Additionally, a few studies have shown that AICDA can partner with other regulatory proteins to modulate gene methylation. However, such a direct involvement of AICDA in the alteration of gene expression by disrupting DNA methylation remains uncertain due to a lack of scientific evidence. The current study therefore sought to investigate the impact of AICDA on the transcription of key oncogenes, with the view to focus on the role of AICDA in their methylation status in future studies. The human AICDA open reading frame (ORF) was cloned into a lentiviral backbone vector, and AICDA overexpression was verified in HEK293 cells using western blotting. A third-generation Lentiviral transduction system was used to produce lentiviral particles (AICDA expressing and empty-vector control) to transduce a non-cancerous lymphoblastoid cell line (PB-B95-8H) and a DLBCL cell line (HBL 1). Flow cytometry was used to sort successfully transduced cells. However, the AICDA-overexpressing cells did not survive in culture for longer than 72 hours post-sorting. This is likely due to oncogene induced death, as these cells already express AICDA at relatively high levels. An alternate CRC model was chosen and was justified by the published literature as well as in silico analyses using the Cancer Genome Atlas (TCGA) CRC dataset which indicated that AICDA expression in CRC correlated with poor survival. Two CRC cell lines stably expressing AICDA were developed and were found to tolerate high levels of AICDA. Thereafter, proliferation was assessed using growth curve analysis, and WST-1 assay. Growth curves showed that expressing AICDA significantly enhanced cell proliferation. In addition, the WST-1 cell proliferation assay also showed similar results, indicating that AICDA expression promotes cell proliferation. A wound healing assay was performed to investigate the impact of AICDA expression on the migration, and the results indicated that AICDA expression in CRC cells enhances the migratory ability if the cells, relative to the control. CRC cells expressing AICDA had higher IC50 values compared to control cells, when treated with increasing doses of the chemotherapeutic drug 5-Fluorouracil (5-FU), indicating a resistance to cell death. However, this was not reflected in western blot analyses where the expressions of apoptotic markers PARP-1 and Caspase-3 were assessed. The cell cycle profiling showed that AICDA provides mild protection from cell death induced by 5-FU, and delays S-phase, in CRC cells. Quantitative PCR (qPCR) was performed to investigate the impact of AICDA expression on the transcriptional regulation of seven key oncogenes, namely PIM1, FANCA, DNMT1, DNMT3A, ZEB1, CD274, and MYC. The results showed that AICDA expression in CRC significantly impacted the expression level of the selected oncogenes. Variations could be observed between the two CRC cell models, which imply that the cellular context is important in mediating the impact of AICDA on changes in gene transcription. Additionally, both upregulation and downregulation of genes were observed, indicating diversity in the mechanism via which AICDA modulates gene expression. The findings of this study therefore demonstrate that AICDA functions as an oncogene in CRC and provides the cells with a significant proliferative advantage. Crucially, it shows that AICDA expression impacts the transcription of key oncogenes. Future work will focus on investigating the role of methylation in the transcriptional changes observed, and how AICDA is involved in this process.
- ItemOpen AccessAn investigation of the rehabilitation needs, development, and preliminary outcomes of an education and exercise self-management intervention for breast cancer survivors(2025) Beutel, Anita; Shamley, Delva; Naidoo, Nirmala; Naidoo, Nirmala NiriAn investigation of the rehabilitation needs, development, and preliminary outcomes of an education and exercise self-management intervention for breast cancer survivors. The central premise of this thesis was that breast cancer (BC) survivors face debilitating long-term side effects (LTSEs) after completing their medical cancer treatment (MCT), such as chronic pain and upper limb dysfunction, cancer-related fatigue, a reduction in health-related quality of life (HRQoL), reduced physical function, weight gain, and lymphoedema. It was hypothesised that BC survivors may not receive education and support to manage these and other LTSEs. It was also hypothesised that LTSEs of BC treatment can be improved by an education and exercise self-management intervention (SMI). Firstly, a qualitative study using focus group discussions was conducted to investigate the lived experience of LTSEs of BC treatment and the rehabilitation needs of survivors, in a semi-urban region of South Africa (SA)(n = 23). The findings of the qualitative study revealed that survivors were affected by LTSEs of MCT. These impacted their daily lives, and in some cases, the ability to provide for their families. Participants were unable to self-manage their symptoms as they had not been provided with information or rehabilitation for these sequelae of their cancer. Furthermore, many participants lacked support from cancer support organisations, and felt isolated. Transportation and financial challenges were identified, and survivors lived in geographically diverse areas. Attitudes towards and perspectives of participating in a rehabilitation intervention including an exercise component, were positive. However, specific exercise and rehabilitation preferences varied between participants. For example, some participants preferred to exercise in a group, while others preferred to exercise alone, or with a family member. Some participants preferred to receive survivorship information via email or through printed material, while others preferred to receive talks. Second, a systematic review and meta-analysis was conducted to determine the effectiveness of SMIs including an exercise component, to improve LTSEs and physical activity, in BC survivors following the completion of MCT. The systematic review and meta-analysis presented in this thesis (n = 10 studies) found that, as an alternative to supervised on-site interventions, SMIs including an exercise component are effective to improve LTSEs and increase physical activity, in early-stage BC survivors following MCT. Third, the results of the qualitative study and the systematic review were used to inform the content and structure; and the Medical Research Council (MRC) guidelines for intervention development were used to inform the process of developing an education and exercise SMI. As patient-centred SMIs based on cognitive behavioural and self-management principles have shown promise in previous chronic disease management programmes, the new intervention ‘Survive and Thrive' was informed by the abovementioned principles. Content validation was established by obtaining feedback from a multidisciplinary team of five South African clinical BC experts and refining the intervention accordingly. An acceptability evaluation was conducted through a small qualitative study including three BC survivors. Alterations were made to the intervention according to the results of this study. The final phase was a single-group, pre-test-post-test study (n = 33) to determine the feasibility, safety, and preliminary outcomes of the newly developed intervention, in early-stage BC survivors who had completed their MCT. The baseline findings of the intervention study suggest that prevalence and levels of pain and cancer-related fatigue were high, and HRQoL index scores and physical activity levels were low at baseline, compared to previous studies of BC survivors conducted in high-income countries. The intervention was feasible and safe to implement in this study. Furthermore, significant improvements were demonstrated post-intervention in terms of pain and fatigue prevalence, severity, and interference, HRQoL, self-efficacy, and exercise participation. The findings of this thesis revealed that physical LTSEs were a significant problem for South African BC survivors, and that they were largely unaddressed by the standard of care. Further, the findings demonstrated that a resource-efficient SMI was feasible, safe, and potentially effective to improve patient-reported outcomes in South African BC survivors.
- ItemOpen AccessAnti-cancer effects of aqueous extracts of Dodonaea Viscosa on Burkitt lymphoma(2023) Saferdien, Aaliyah; Mowla, ShaheenAnti-cancer effects of aqueous extracts of Dodonaea Viscosa on Burkitt lymphoma Cancer is a leading public health problem worldwide, and although modern treatments have undeniably improved patient outcomes, many cancers remain refractory or untreatable. New and more effective treatments are needed, and natural phytochemical compounds are a valuable source for the development of such treatments. In South Africa, the high HIV prevalence is a compounding factor in cancer incidence, with some cancers being disproportionately high among HIV-positive individuals. One such cancer is Burkitt lymphoma (BL), a highly aggressive B-cell-derived malignancy, which develops predominantly in HIV-infected individuals. Many cancer patients, especially those from rural communities, use traditional medicine (TM) as an alternative to chemotherapy. While conventional treatments have been thoroughly researched and tested before clinical approval, alternative treatments have not. Therefore, TM may not necessarily be beneficial to patients, could interfere with conventional treatment if used concurrently, and in some instances, be harmful to users. One TM commonly used by communities in the Western Cape regions of South Africa is derived from the plant Dodonaea viscosa. Extracts from this plant have not been widely investigated scientifically, however, preliminary work indicates that it holds potential anti-cancer properties. In the current research, the inhibitory potential of D. viscosa extracts (DVE) on BL was comprehensively assessed, using in vitro assays, as well as using an in vivo mouse model. Using cell viability assays, the IC50 of DVE on two BL cell lines, namely Ramos and BL41, was determined. The Ramos IC50 was 0.06 mg/ml while that of BL41 was 0.18 mg/ml. Notably, the noncancerous lymphoblastoid control cell line (LCL) was significantly less sensitive to DVE compared to both BL cell lines with selectivity indices of 2.8 (using IC50) and 1.7 (using IC30) for Ramos and BL41 respectively. Cell Trace proliferation and colony formation assays showed retardation in the proliferation of extract-treated BL cells (3.2-fold and 10.9-fold reduction in progress to daughter cell generation relative to untreated for Ramos and BL41 respectively). Additionally, DVE induced significant apoptosis, as shown by cellular morphological analyses, Annexin V and caspase 3/7 activity assays, cell cycle profiling and western blotting, showing enhanced expression of effector apoptotic markers (cleaved caspase 3 and cleaved PARP). The PI3K/Akt pathway, which is often altered in BL and known to drive lymphomagenesis, was found to mediate, at least partially, the cytotoxicity of DVE - the PI3K inhibitor p-PTEN was upregulated, leading to upregulation of its target p-PDK1. Additionally, the effector molecule p-AKT (ser 473) and p-GSK3 were altered. Lastly, using a BL xenograft mouse model, DVE was found to be significantly less toxic than the approved drug Doxorubicin, and to slow down tumour growth over time. This study revealed that aqueous extracts from the Dodonaea viscosa plant, used by traditional healers, is a valuable source of lead compounds for the development of novel therapeutics in the treatment of Burkitt lymphoma
- ItemOpen AccessEstimating the treatment cost of colon cancer at Groote Schuur Hospital(2025) Nnene, Kelechi; Cunnama, Lucy; Moodley, Jennifer; Ataguba, JohnBackground: Due to the high mortality-to-incidence ratio of colon cancer in South Africa, urgent public health measures are needed to improve treatment outcomes. Costing studies can be leveraged to understand the treatment cost burden for colon cancer, providing crucial insights for allocating resources to finance such measures. This study aims to assess treatment options and costs for colon cancer treatment from the perspective of healthcare providers at a public healthcare facility in South Africa. Method: The study used an ingredient-based approach to assess colon cancer treatment costs by stage at the colorectal clinic and combined colorectal oncology unit at Groote Schuur Hospital. The costing process involved two steps: first, treatment options were defined according to facility guidelines and verified through expert interviews; then, these options were linked to relevant cost items for each cancer stage based on expert input. Second, a bottom-up costing method was used to estimate and aggregate per-patient costs across treatment components for each stage. One-way sensitivity analysis addressed uncertainties in post-surgical inpatient admissions and staff categories. All costs are presented in 2024 South African Rands (ZAR) and United States Dollars (USD). Results: Colon cancer treatment components include staging and risk assessment investigations, clinical consultations, surgery and chemotherapy. The estimated guideline-based per-patient costs for treatment are R60,156 ($3,216) for stages I and II (low-risk); R75,132 ($4,017) for high-risk stage II and stage III; and R171,935 ($9,193) for stage IV. Surgical treatment represents a major cost driver, with additional expenses from inpatient admissions following surgery. Sensitivity analysis indicates that reducing postoperative inpatient stay by 25% lowers the treatment cost by approximately 5% across all stages. Conclusion: Colon cancer treatment costs are significant, increasing with each colon cancer stage. To manage these escalating costs and reduce the overall healthcare burden, policies should prioritise early detection and invest in accessible, stage-appropriate interventions to improve patient outcomes.
- ItemOpen AccessEvaluating the outcomes of cancer patients receiving palliative care in Botswana(2025) Radikara, Naledi; Krause, Stephanie; Masupe, TinyBotswana is an upper middle-income country in Sub-Saharan Africa that is experiencing a growing incidence of cancer and other Non-Communicable Diseases and is at the early stages of implementing Palliative Care (PC). PC has been shown to enhance the quality of life (QoL) of patients and their families, consequently improving their health outcomes. This research will emphasise the importance of PC in the Botswana health care system and aims to determine the outcomes of patients under palliative care at Princess Marina Hospital (PMH). Methods: We prospectively enrolled 53 consecutive patients with a diagnosis of metastatic and/or progressive cancer who were referred to the PC team for the first time from March 2023 to November 2023. The primary end-point was a change in symptoms and QoL from baseline to four (4) weeks as per the APCA African POS questionnaire and the ECOG PS tool. Participants were assessed initially at entry to PC services and again after 4 weeks while under PC. Results: A total of 53 participants were included in the initial assessment while 42 were included in both the initial and subsequent assessments, indicating an attrition rate of 21%. The top 5 cancers were: breast (20.8%), cervical(15.1%), prostate(9.4%), anorectal(9.4%) and oesophageal(9.4%). Symptoms occurring in at least 50% of the participants were: pain (94.3%), weakness (75.5%), nausea (58.5%), loss of appetite (64.1%), constipation (50.9%), dry mouth (69.8%), drowsiness (56.6%), poor mobility (54.7%) and worry (90.6%). The results showed that the difference was statistically significant between the two -time points for pain (z=2.707, p = 0.0068), shortness of breath (z=2.261, p=0.0238), nausea (z=3.275, p=0.0011), loss of appetite (z=2.480, p=0.0131), constipation (z=2.832, p=0.0046), drowsiness( z=3.091, p=0.0020), ability to share feelings with family and friends(z=0.701, p=0.0069) and advice to plan for the future(z=2.586, p=0.0097).Vomiting(z=0.982, p=0.326), dry mouth(z=1.466, p=0.1426) , poor mobility(z=1.922, p=1.922), feelings of worry( z= 1.127, p=0.2596), feeling that life is worthwhile(z=1.330, p=0.1835) and feeling at peace(z=1.651, p=0.0987) did not show a statistically significant difference between the before and after measurements, however, in all these domains, the difference was such that the average score was less at the subsequent assessment. Total mean scores (composite scores) for the physical and psychological symptoms were analysed between the two time periods and the difference was statistically significant (z=3.828, p=0.0001). The difference between the before and after measurements for functional status was not statistically significant (z=-0.611, p=0.542). Conclusion: Patients with advanced cancer have a high symptom burden which affects their QoL. A PC approach appears to be effective in improving symptoms and QoL of patients with advanced cancer.
- ItemOpen AccessA microRNA-based liquid biopsy signature for the early detection of esophageal squamous cell carcinoma: a retrospective, prospective and multicenter study(2022-02-11) Miyoshi, Jinsei; Zhu, Zhongxu; Luo, Aiping; Toden, Shusuke; Zhou, Xuantong; Izumi, Daisuke; Kanda, Mitsuro; Takayama, Tetsuji; Parker, Iqbal M; Wang, Minjie; Gao, Feng; Zaidi, Ali H; Baba, Hideo; Kodera, Yasuhiro; Cui, Yongping; Wang, Xin; Liu, Zhihua; Goel, AjayBackground Currently, there is no clinically relevant non-invasive biomarker for early detection of esophageal squamous cell carcinoma (ESCC). Herein, we established and evaluated a circulating microRNA (miRNA)-based signature for the early detection of ESCC using a systematic genome-wide miRNA expression profiling analysis. Methods We performed miRNA candidate discovery using three ESCC tissue miRNA datasets (n = 108, 238, and 216) and the candidate miRNAs were confirmed in tissue specimens (n = 64) by qRT-PCR. Using a serum training cohort (n = 408), we conducted multivariate logistic regression analysis to develop an ESCC circulating miRNA signature and the signature was subsequently validated in two independent retrospective and two prospective cohorts. Results We identified eighteen initial miRNA candidates from three miRNA expression datasets (n = 108, 238, and 216) and subsequently validated their expression in ESCC tissues. We thereafter confirmed the overexpression of 8 miRNAs (miR-103, miR-106b, miR-151, miR-17, miR-181a, miR-21, miR-25, and miR-93) in serum specimens. Using a serum training cohort, we developed a circulating miRNA signature (AUC:0.83 [95%CI:0.79–0.87]) and the diagnostic performance of the miRNA signature was confirmed in two independent validation cohorts (n = 126, AUC:0.80 [95%CI:0.69–0.91]; and n = 165, AUC:0.89 [95%CI:0.83–0.94]). Finally, we demonstrated the diagnostic performance of the 8-miRNA signature in two prospective cohorts (n = 185, AUC:0.92, [95%CI:0.87–0.96]); and (n = 188, AUC:0.93, [95%CI:0.88–0.97]). Importantly, the 8-miRNA signature was superior to current clinical serological markers in discriminating early stage ESCC patients from healthy controls (p < 0.001). Conclusions We have developed a novel and robust circulating miRNA-based signature for early detection of ESCC, which was successfully validated in multiple retrospective and prospective multinational, multicenter cohorts.
- ItemOpen AccessPhytodentistry in Africa: prospects for head and neck cancers(2021-02-05) Adeola, Henry A; Sabiu, Saheed; Aruleba, Raphael T; Adekiya, Tayo A; Adefuye, Anthonio O; Adefuye, Ogheneochuko J; Oyinloye, Babatunji EBackground Orthodox dentistry has undergone significant changes in recent times with the introduction of various omics and molecular targeted therapies both at the experimental/trial and clinical implementation level. Although, significant milestones have been achieved in the molecular dentistry field in the past decade, there remains a dearth of application of phytopharmacological innovation in personalized and targeted therapies for dental diseases. Main body From time immemorial, plant products have long been an integral aspect of dental practice ranging from chewing sticks/herbal kinds of toothpaste to dental/impression materials. The current era of precision medicine seeks to apply a multipronged molecular and bio-computational approaches to solve fundamental medical problems that have hitherto remained difficult. Remarkable changes in the molecular/omics era, have transformed empirical therapies into personalized/individualized ones. Furthermore, the combinatorial application and the widespread introduction of high-throughput molecular tools such as pharmacogenomics, phytopharmacology, metabolomics, mathematical modelling, and genetic engineering inter alia, has tremendously improved the diagnostic and therapeutic landscape of medicine. Additionally, the variable molecular epidemiology of diseases among different population and emerging molecular evidence warrants the use of customized novel theranostic techniques. Unfortunately, the footprint of such emerging application is sparse in dental diseases such as maxillofacial cancers. Conclusion Hence, this review seeks to evaluate the potential application of phytopharmacological approaches to head and neck cancers in a resource-limited environment, such as Africa.
- ItemOpen AccessThe T-box transcription factor TBX3 drives proliferation by direct repression of the p21WAF1 cyclin-dependent kinase inhibitor(BioMed Central, 2016-04-22) Willmer, Tarryn; Hare, Shannagh; Peres, Jade; Prince, SharonBackground: TBX3, a member of the T-box family of transcription factors, is essential in development and has emerged as an important player in the oncogenic process. TBX3 is overexpressed in several cancers and has been shown to contribute directly to tumour formation, migration and invasion. However, little is known about the molecular basis for its role in development and oncogenesis because there is a paucity of information regarding its target genes. The cyclin-dependent kinase inhibitor p21WAF1 plays a pivotal role in a myriad of processes including cell cycle arrest, senescence and apoptosis and here we provide a detailed mechanism to show that it is a direct and biologically relevant target of TBX3. Results: Using a combination of luciferase reporter gene assays and in vitro and in vivo binding assays we show that TBX3 directly represses the p21WAF1 promoter by binding a T-element close to its initiator. Furthermore, we show that the TBX3 DNA binding domain is required for the transcriptional repression of p21WAF1 and that pseudo-phosphorylation of a serine proline motif (S190) located within this domain may play an important role in regulating this ability. Importantly, we demonstrate using knockdown and overexpression experiments that p21WAF1 repression by TBX3 is biologically significant and required for TBX3-induced cell proliferation of chondrosarcoma cells. Conclusions: Results from this study provide a detailed mechanism of how TBX3 transcriptionally represses p21WAF1 which adds to our understanding of how it may contribute to oncogenesis.
- ItemOpen AccessTwenty years of home-based palliative care in Malappuram, Kerala, India: a descriptive study of patients and their care-givers(BioMed Central, 2018-02-14) Philip, Rekha Rache; Philip, Sairu; Tripathy, Jaya Prasad; Manima, Abdulla; Venables, EmilieBackground: The well lauded community-based palliative care programme of Kerala, India provides medical and social support, through home-based care, for patients with terminal illness and diseases requiring long-term support. There is, however, limited information on patient characteristics, caregivers and programme performance. This study was carried out to describe: i) the patients enrolled in the programme from 1996 to 2016 and their diagnosis, and ii) the care-giver characteristics and palliative care support from nurses and doctors in a cohort of patients registered during 2013–2015. Methods: A descriptive study was conducted in the oldest community-based palliative clinic in Kerala. Data were collected from annual patient registers from 1996 to 2016 and patient case records during the period 2013–2015. Results: While 91% of the patients registered in the clinic in 1996 had cancer, its relative proportion came down to 32% in 2016 with the inclusion of dementia-related illness (19%) cardiovascular accidents (17%) and severe mental illness (5%).Among patients registered during 2013–15, the median number of home visits from nurses and doctors in 12 months were five and one respectively. In the same cohort, twelve months’ post-enrolment, 56% of patients died, 30% were in continuing in active care and 7% opted out. Those who opted out of care were likely to be aged < 60 years, received one or less visit annually from a doctor or have a serious mental illness. 96% of patients had a care-giver at home, 85% of these care-givers being female. Conclusions: The changing dynamics over a 20-year period of this palliative care programme in Kerala, India, highlights the need for similar programmes to remain flexible and adapt their services in response to a growing global burden of Non Communicable Diseases. While a high death rate is expected in this population, the high proportion of patients choosing to stay in the programme suggests that home-based care is valued within this particular group. A diverse range of clinical and psycho-social support skills are required to assist families and their caregivers when caring for a cohort such as this one.
- ItemOpen AccessUnderstanding the burden of HIV-related cancers in South Africa's Eastern Cape Province: A 2002-2017 retrospective study(2025) Ncinitwa, Akhona; Myer, London; Mabunda, SikhumbuzoBackground: The Human Immunodeficiency Virus (HIV)-related cancers in South Africa are a critical public health issue that echoes trends seen across other low-middle income countries (LMICs). These cancers include Kaposi sarcoma, non-Hodgkin's lymphoma, and cervical cancer. Understanding the HIV-related cancer trends and incidence is crucial for achieving improved health outcomes. Therefore, this study aims to understand the HIV- related cancers in the Eastern Cape province of South Africa Methods: This retrospective study used secondary analysis of data generated by the Eastern Cape Cancer Registry linked to the HIV database from the National Health Laboratory Services through probabilistic record linkage to identify and characterise cancer among people living with HIV. Included were cancer cases reported between 1st January 2002 and 31st December 2017 of adult men and women diagnosed with HIV-related cancers. Statistical analysis was done using STATA18.0. A join-point regression model was used to characterise the cancer trends. The Kaplan-Meier curve was used for survival analysis. Results: The sample comprised 1183 eligible cancer patient records, with 1044 (88.3%) females. The HIV prevalence among cancer patients was 74.5%. Specifically, 75.5% of males and 74.3% of females were living with HIV. The trends of Kaposi sarcoma showed an increase between 2002 and 2015 with an annual percentage change (APC) of 17.4%, and between 2015 and 2017, trends decreased with an APC of 22.6%. Cervical cancer trends decreased between 2002 and 2004 with an APC of 14.4%; from 2004 to 2017, there was a sharp increase of 33.2% APC. Kaposi sarcoma had the highest survival median of 3.1 years (p=0.06) for people living with HIV, followed by non-Hodgkin's lymphoma with 2.9 years (p=0.96), and lastly cervical cancer with 2.5 years (p=0.73). Conclusion: The growing burden of cervical cancer and Kaposi sarcoma among people living with HIV remains a problem in the Eastern Cape. Therefore, targeted interventions such as regular screening, early diagnosis, access to appropriate treatment, a system to track treatment adherence and survival rates, appropriate resource allocation, and targeted educational programmes are needed to address the burden.
- ItemOpen AccessWellbeing among sub-Saharan African patients with advanced HIV and/or cancer: an international multicentred comparison study of two outcome measures(BioMed Central Ltd, 2014) Harding, Richard; Selman, Lucy; Ali, Zippy; Powell, Richard; Namisango, Eve; Mwangi-Powell, Faith; Gwyther, Liz; Gikaara, Nancy; Higginson, Irene; Siegert, RichardBACKGROUND: Despite the high mortality rates of HIV and cancer in sub-Saharan Africa, there are few outcome tools and no comparative data across conditions. This study aimed to measure multidimensional wellbeing among advanced HIV and/or cancer patients in three African countries, and determine the relationship between two validated outcome measures. METHODS: Cross-sectional self-reported data from palliative care populations in Kenya, Uganda and South Africa using FACIT-G+Pal and POS measures. RESULTS: Among 461 participants across all countries, subscale "social and family wellbeing" had highest (best) score. Significant country effect showed lower (worse) scores for Uganda on 3 FACIT G subscales: Physical, Social + family, and functional. In multiple regression, country and functional status accounted for 21% variance in FACIT-Pal. Worsening functional status was associated with poorer POS score. Kenyans had worse POS score, followed by Uganda and South Africa. Matrix of correlational coefficients revealed moderate correlation between the POS and FACIT-Pal core scale (0.60), the FACIT-G and POS (0.64), and FACIT-G+Pal with POS (0.66). CONCLUSIONS: The data reveal best status for family and social wellbeing, which may reflect the sample being from less individualistic societies. The tools appear to measure different constructs of wellbeing in palliative care, and reveal different levels of wellbeing between countries. Those with poorest physical function require greatest palliative and supportive care, and this does not appear to differ according to diagnosis.