The Current Landscape of Staging and Treatment of Colorectal Cancer in a Region of Ukraine: a Mixed Methods Study
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SURGERY IN LOW AND MIDDLE INCOME COUNTRIES
The Current Landscape of Staging and Treatment of Colorectal Cancer in a Region of Ukraine: a Mixed Methods Study Pamela W. Lu1,2 • Galyna Shabat1,3 • Solomiia Semeniv4 • Maryana Fedorkiv3 • Adam C. Fields1 Heather G. Lyu1 • Andriy Beznosenko5 • Jennifer S. Davids6 • Nelya Melnitchouk1,2
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Accepted: 8 September 2020 Socie´te´ Internationale de Chirurgie 2020
Abstract Background In Ukraine, the 1-year mortality for colorectal cancer is much higher than that seen in high-income countries. We investigated practice patterns of colorectal cancer treatment in a region of Ukraine to account for high mortality rates. Methods An explanatory sequential mixed methods design was used. Data from patients who underwent surgery for colorectal cancer in Ivano-Frankivsk from 2011 to 2015 were collected via retrospective chart review, and descriptive statistics were calculated. Semi-structured interviews were performed with local practicing surgeons and oncologists until thematic saturation was reached. Results A total of 960 patients who underwent surgery were identified in the Ivano-Frankivsk region with colon (689) or rectal (271) cancer. 11.7% of patients underwent preoperative CT of the abdomen and pelvis, and only 1.7% underwent CT of the chest. 4.1% of patients underwent a complete preoperative colonoscopy, while 31.0% had incomplete colonoscopies. Postoperatively, 31.1% of patients with stage II colon cancer and 43.9% of patients with stage III colon cancer underwent adjuvant chemotherapy. For patients with stage II and III rectal cancers, 20.9% and 33.3% underwent chemotherapy, while 68.4% and 66.7% underwent radiation therapy, respectively. Fifteen physicians completed interviews. Two major themes emerged regarding physician perceptions on providing colorectal cancer care: lack of resources and systems level issues negatively impacting patient care. Conclusion In this region in Ukraine, staging practices for colorectal malignancies are inconsistent and inadequate, and adjuvant treatments are varied. This is likely attributable to the lack of resources facing providers and the prohibitively high cost of care to patients.
& Nelya Melnitchouk [email protected] 1
Department of Surgery, Division of Colorectal Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
2
Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
3
Department of Surgery, Ivano-Frankivsk National Medical University, Ivano-Frankivsk, Ukraine
4
National Children’s Specialized Hospital ‘‘Ohmatdyt’’, Kyiv, Ukraine
5
Department of Oncocoloproctology, National Cancer Institute, Kyiv, Ukraine
6
Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA
123
World J Surg
Introduction Colorectal cancer is the fourth most common cause of cancer death worldwide, and the burden of disease is expected to increase [1]. While colorectal cancers have become a relatively treatable malignancy when
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