Disparity in oesophageal cancer management in South Africa: a comparison between two tertiary centres with special focus on the palliation of dysphagia

  • Daniel Nel University of Cape Town
  • Musa Omar University of Cape Town
  • Galya Chinnery University of Cape Town
  • Eduard Jonas University of Cape Town
Keywords: oesophageal cancer management, disparity, South Africa, tertiary centres

Abstract

Background: For most patients with oesophageal cancer worldwide, palliation of dysphagia is the goal which is most commonly achieved with self-expanding metal stents (SEMS). The aim of this study was to assess the profile and management of oesophageal cancer patients at Frere Hospital in the Eastern Cape, and compare this to a similar cohort from Groote Schuur Hospital (GSH) in the Western Cape Province.

Methods: This study is a retrospective comparative cohort which reviewed all patients diagnosed with oesophageal cancer by the Frere Hospital and GSH endoscopy units from January to December 2015. Independent prospective electronic databases for the two hospitals were merged for comparative analysis. 

Results: During the study period, 346 and 108 patients were diagnosed with oesophageal cancer at Frere Hospital and GSH respectively. The rate of curative intended intervention was similarly low, with 3% of cases at Frere Hospital undergoing oesophagectomy or definitive radiotherapy as compared to 5% at GSH (p = 0.48). In terms of palliation, significantly more patients received palliative oncological therapy at GSH as compared to Frere Hospital (21% vs 8%, p < 0.001). At Frere Hospital, 281 patients (81%) were treated primarily with serial dilatations. At GSH, 9 patients received a single dilatation, all as a bridge to radiotherapy or stenting. At Frere Hospital, 28 patients (8%) were stented, as compared to GHS where 69 patients (64%) were managed with a stent (p < 0.001).

Conclusion: This study shows significant differences in the oncological and endoscopic palliation of patients between the two institutions, highlighting a gross disparity in healthcare provision between them. The reasons for these disparities should be investigated and equipoise addressed by national health policy makers.

Author Biographies

Daniel Nel, University of Cape Town

Division of General Surgery, Groote Schuur Hospital, Cape Town, South Africa

Musa Omar, University of Cape Town

University of Cape Town, South Africa

Galya Chinnery, University of Cape Town

Upper GI surgery, Surgical Gastroenterology Unit, Division of General Surgery, Groote Schuur Hospital, Cape Town, South Africa

Eduard Jonas, University of Cape Town

Surgical Gastroenterology Unit, Division of General Surgery, Groote Schuur Hospital, Cape Town, South Africa

Published
2019-04-24
How to Cite
Nel, D., Omar, M., Chinnery, G., & Jonas, E. (2019). Disparity in oesophageal cancer management in South Africa: a comparison between two tertiary centres with special focus on the palliation of dysphagia. South African Journal of Surgery, 57(2), 10-15. Retrieved from http://sajs.redbricklibrary.com/index.php/sajs/article/view/2842
Section
General Surgery