Epidemiology, Pathology, Management and Open Challenges of Breast Cancer in Central Sudan: A Prototypical Limited Resource African Setting

Little is known about breast cancer in Sudan. According to the recent data published by the Khartoum Cancer Registry, breast cancer was the most common cancer among Sudanese women. Generally, breast cancer in native African women is characterized by young age at onset, occurrence in multiparous premenopausal patients, advanced stage at diagnosis, large tumor size, high‐grade and triple‐negative phenotype, with correspondingly poor prognosis. In Sudan, it was reported that about 70% of the women diagnosed with breast cancer were younger than 50 years old. We present here data from local and international publications as well as primary information from the National Cancer Institute in Wad Medani (one of the only two cancer hospitals of the country, both located in Central Sudan in Khartoum and Wad Medani). We provide an up‐to‐date situation analysis of breast cancer in Central Sudan as an example for an African reality and the various open challenges of breast cancer in a limited resource setting. A better understanding of breast cancer in black African women is of global relevance, as there is an alarming increase in breast cancer among young black women worldwide, and these patients have the lowest survival rates

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Pediatric cancer research trends and performance in Africa: A bibliometric analysis from 1991 to 2022

Background: Childhood cancer rates in Africa are lower than in high-income countries but increasing, making pediatric cancers a significant public health concern. The purpose of this study was to provide an overview of the publication of pediatric cancer research in Africa, including publication types and citation trends over time. Methods: The Science Citation Index Expanded database within the Web of Science Core Collection was searched for articles published from 1991 to 2022 in the topic domain, using title, abstract, author keywords, and KeyWords Plus. Indicators used to assess publications performance of the countries included: total number of publications, single-country publications, collaborative publications with African countries, collaborative publications with non-African countries, first-author publications, corresponding-author publications, and single-author publications. Results: A total of 4461 relevant documents were retrieved, with 2770 original research articles. Annual number of articles rose from 13 articles in 1991 to 287 in 2022. Most articles were produced by Egypt (28 %) in North Africa, followed by South Africa (20 %) in sub-Saharan Africa. Collaboration between African countries remains low; however, international collaborations have enhanced the average number of citations per article. Most of the first authors (65 %) and corresponding authors (67 %) of these international collaborative articles were affiliated with non-African institutions. Conclusions: The number of publications sharply increased over the study period and diversely represents African countries. Collaborations with international partners increased citations; however, few of these publications had African first authors. Conversely, inter-institutional partnerships between African countries were relatively low, highlighting the need for better collaboration within Africa

Impact of the COVID-19 pandemic on patients with paediatric cancer in low-income, middle-income and high-income countries: a multicentre, international, observational cohort study

OBJECTIVES: Paediatric cancer is a leading cause of death for children. Children in low-income and middle-income countries (LMICs) were four times more likely to die than children in high-income countries (HICs). This study aimed to test the hypothesis that the COVID-19 pandemic had affected the delivery of healthcare services worldwide, and exacerbated the disparity in paediatric cancer outcomes between LMICs and HICs. DESIGN: A multicentre, international, collaborative cohort study. SETTING: 91 hospitals and cancer centres in 39 countries providing cancer treatment to paediatric patients between March and December 2020. PARTICIPANTS: Patients were included if they were under the age of 18 years, and newly diagnosed with or undergoing active cancer treatment for Acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, Wilms' tumour, sarcoma, retinoblastoma, gliomas, medulloblastomas or neuroblastomas, in keeping with the WHO Global Initiative for Childhood Cancer. MAIN OUTCOME MEASURE: All-cause mortality at 30 days and 90 days. RESULTS: 1660 patients were recruited. 219 children had changes to their treatment due to the pandemic. Patients in LMICs were primarily affected (n=182/219, 83.1%). Relative to patients with paediatric cancer in HICs, patients with paediatric cancer in LMICs had 12.1 (95% CI 2.93 to 50.3) and 7.9 (95% CI 3.2 to 19.7) times the odds of death at 30 days and 90 days, respectively, after presentation during the COVID-19 pandemic (p<0.001). After adjusting for confounders, patients with paediatric cancer in LMICs had 15.6 (95% CI 3.7 to 65.8) times the odds of death at 30 days (p<0.001). CONCLUSIONS: The COVID-19 pandemic has affected paediatric oncology service provision. It has disproportionately affected patients in LMICs, highlighting and compounding existing disparities in healthcare systems globally that need addressing urgently. However, many patients with paediatric cancer continued to receive their normal standard of care. This speaks to the adaptability and resilience of healthcare systems and healthcare workers globally