Epidemiological profile and factors associated with mortality among patients with gastrointestinal cancers in a Haitian cancer program
Authors: J. Bernard, V. DeGennaro
Journal: Annals of Oncology (2018)

Introduction: Gastrointestinal (GI) cancers are among the neoplasms with high burden in the low and middle-income countries. According to GLOBOCAN 2012, GI cancers are among the most common and the most lethal cancers in Haiti. A ten-year epidemiologic study on cancers in Haiti showed that GI cancers were the second most common cancer type (FD Jacques et al, 2017). Despite these data the epidemiology of GI cancers in Haiti remains poorly studied. The aim of this study was to describe the epidemiology and outcome of GI cancers in Haiti and to determine risk factors associated with mortality. Methods: A two-year cross-sectional, retrospective study was conducted in the cancer program of Innovating Health International (IHI), in Port-au-Prince, Haiti. The charts of the patients with the clinical and/or pathological diagnosis of all GI cancers from January 1st, 2016 to December 31st, 2017 were reviewed to collect data on key variables such as age, gender, cancer type, TNM clinical stage, alcohol and tobacco use, family history of cancer, baseline performance status and outcome. These variables were then evaluated to determine their association with mortality. Results: Seventy-six (76) cases of gastrointestinal cancers were managed during the study period. GI cancers all types combined were the third most common cancer type in our cohort after breast cancer and gynecological cancers. The median age of the study population was 60 years [21-89] for 52.6% males and 47.4% females. 13.2% of the patients were regular alcohol users and 25% admitted tobacco use. 10.5% of the patients had a known family history of cancer. Colorectal cancer was the most common GI cancer type with 28.9% of the cases, followed by gastric cancer (23.7%), pancreatic cancer (10.5%), liver cancer (10.5%), biliary cancer (7.9%), esophageal cancer (5.3%) and anal cancer (2.6%). The remaining 10.5% were cases of carcinoma of unknown primary (CUP) identified as possible GI cancers. 96.4% of patients with TNM staging were diagnosed at stages III or IV. The overall mortality rate was 60.5%. The cancer types with the highest mortality rate were biliary cancer with 83.3%, gastric cancer with 77.8%, pancreatic cancer and esophageal cancer with 75%. Colorectal cancer had a mortality rate of 40.9%. Patients were more likely to die if they were female (Odds Ratio (OR)=2.1, p = 0.16), aged 70 years old or more (OR = 4.4, p = 0.06), had non-colorectal GI cancer (OR = 4.4, p = 0.009) or a baseline ECOG of 1 or more (OR = 7.5, p = 0.0005). 6.5% of the patients were lost to follow-up. Conclusion: Gastrointestinal cancers are diagnosed at an advanced stage, which mainly explains the high mortality rate. Having non-colorectal GI cancer or a baseline ECOG ≥ 1 was significantly associated with mortality. Prevention and screening programs need to be implemented and cancer awareness reinforced in Haiti for earlier diagnosis. A prospective and multicenter study is needed to better evaluate the burden and risk factors of GI cancers in Haiti.