Posted: Friday, September 30, 2022
A pair of collaborative studies published in The Lancet Gastroenterology & Hepatology explored the challenges of treating patients with hepatocellular carcinoma in sub-Saharan Africa and offered some possible solutions. “The current status of hepatocellular carcinoma prevention and management in sub-Saharan Africa is no longer tolerable. Guidelines adopting a one-size-fits-all approach are neither realistic nor practical,” stated C. Wendy Spearman, PhD, of the University of Cape Town, South Africa, and colleagues. According to Eduard Jonas, PhD, of the University of Cape Town, South Africa, and colleagues, “the necessary management guidelines will be best achieved by incorporation of resource-sensitive algorithms catering for the diversity in sub-Saharan Africa.”
Both articles addressed the disparity in diagnosis, treatment, and outcomes. For instance, in high-income countries, approximately 40% of patients are diagnosed at an early stage, allowing for better outcomes. However, in sub-Saharan Africa, 95% of patients are diagnosed with advanced or terminal disease and have a median survival of 2.5 months after diagnosis. In addition, 30% to 40% of patients are treated with curative intent in high-income countries, leading to an expected 5-year survival of 70%. In contrast, fewer than 1% of patients in sub-Saharan Africa are being treated with curative intent.
The studies cited that improved screening programs in European countries have allowed more patients to qualify for surgery and transplantation, improving prospective outcomes. The groups explain that currently, an effective implementation in sub-Saharan Africa would likely vary by region, and meeting a 40% target for curative-intended treatment could take up to 27 years.
To address poor access to screening and treatment capacity, the groups conclude that new treatment centers must be established. Furthermore, regionally based surgical/transplantation centers could be established to serve multiple countries, reducing costs. These regional centers could also serve as hubs for expansion of treatment resources and multidisciplinary medical teams.
To increase the number of patients eligible for curative treatment, the authors suggested screening and surveillance could be combined in patients with chronic hepatitis B virus infection and no cirrhosis, since Barcelona Clinic Liver Cancer–based management guidelines do not apply to these patients. Although expensive treatments exist, their implementation in sub-Saharan Africa may not be available or attainable. Thus, local ablation, for instance, may be conducted at low cost via ethanol injection for some tumors.
The authors recommended several measures to improve the outlook for patients in sub-Saharan Africa. The group proposed a multipronged diverse effort, including education, vaccination, and treatment against diseases that increase risk; screenings; increased treatment centers and standards; and improved national reporting.
Disclosure: For full disclosures of the study authors, visit www.thelancet.com.