VIH E Cancro Do Esófago Em Moçambique: O Que É Que Aprendemos?

Esophageal cancer (EC) is a common cancer in Mozambique, with esophageal squamous cell carcinomas (ESCC) being the most frequent subtype of this cancer. Little is known about the impact of the human immunodeficiency virus (HIV) on this pathology. The main goal of this study was to assess the association between EC and HIV infection. Methods: A case-control study was conducted, in 2018, at Maputo Central Hospital, Mozambique (MCH).  Consenting adults were eligible for inclusion. Patients with ESCC who underwent HIV testing constituted the case groups. Controls were selected from patients with surgical benign conditions, and they were matched by sex and age. Chi-square or Fisher’s exact tests were used to evaluate the association between two categorical variables. Comparisons between groups were performed, using independent samples t-tests or Mann–Whitney tests for continuous variables. Odds Ratio (OR), and the corresponding 95% confidence interval (CI) were computed using non-conditional logistic regression. A p-value < 0.05 was considered significant. Results: During the study period, 92 cases and 92 controls were enrolled into the study. 67.4% of the cases were female. The median age of cases and controls was 57 (35-83) and 52 (35-85) years, respectively. HIV-positive diagnosis significantly increased the odds of developing EC, mainly in females (OR=4.81; 95% CI: 2.24–10.32; p<0.001), but the same did not occur in males (OR=2.26; 95% CI: 0.80–6.36; p=0.123). Conclusion: Esophageal cancer and human immunodeficiency virus are common in Mozambique.  HIV infection is a potential risk factor for ESCC mainly in the female gender. Patients with HIV and other risk factors such as exposure to domestic or tobacco smoke should be educated and followed up for an early diagnosis of esophageal cancer. O cancro do esófago (CE) é um cancro comum em Moçambique, sendo os carcinomas de células escamosas do esófago (CCEE) o subtipo mais frequente deste cancro. Pouco se sabe sobre o impacto do vírus da imunodeficiência humana (VIH) nesta patologia. O principal objetivo deste estudo foi avaliar a associação entre CE e infeção pelo VIH. Métodos: Um estudo de caso-controlo foi conduzido, em 2018, no Hospital Central de Maputo, Moçambique (HCM). Adultos que consentiram em participar foram considerados elegíveis. Doentes com CCEE que realizaram teste de VIH constituíram o grupo de casos. Os controlos foram selecionados entre os doentes com condições benignas cirúrgicas que seriam operados no HCM, tendo sido emparelhados por sexo e idade. Os testes de qui-quadrado ou exato de Fisher foram utilizados para avaliar potenciais associações entre duas variáveis categóricas. Para realizar comparações entre grupos foi utilizado o teste t para amostras independentes ou o teste de Mann-Whitney para as variáveis contínuas. A razão de chances (OR) e o respetivo intervalo de confiança de 95% (IC) foram calculados usando regressão logística não-condicional. Um valor de p < 0,05 foi considerado significativo. Resultados: Durante o período de estudo, 92 casos e 92 controlos foram incluídos no estudo. 67,4% dos casos eram do sexo feminino. A idade mediana dos casos e dos controlos foi de 57 (35-83) e 52 (35-85) anos, respetivamente. O diagnóstico de VIH positivo aumentou significativamente as chances de desenvolver CE, principalmente nas mulheres (OR=4,81; IC 95%: 2,24–10,32; p<0,001), mas o mesmo não ocorreu nos homens (OR=2,26; IC 95%: 0,80–6,36; p=0,123). Conclusão: O cancro do esófago e o vírus da imunodeficiência humana são comuns em Moçambique. A infeção por VIH é um potencial fator de risco para CCEE, principalmente no sexo feminino. Pacientes com VIH e outros fatores de risco, como a exposição ao fumo doméstico ou do tabaco, devem ser educados e acompanhados para um diagnóstico precoce do cancro do esófago

Identifying barriers and finding solutions to implement best practices for cancer surgery at Maputo Central Hospital, Mozambique

Purpose: The aim of this study was to assess the surgical resources and surgical oncology team skills at the Surgical Department of Maputo Central Hospital (MCH) in Mozambique in order to define an educational program to support surgical oncology practice. Methods: From January 2017 to December 2017, a general evaluation of the resources of MCH was carried out, as well as its offerings in oncological care in different services. Data were obtained by reviewing documents, visiting surgical services and interviewing key informants and others informally. In addition, a group of seven surgeons of the Surgical Department of MCH answered a questionnaire about the quality of the cancer units (The Cancer Units Assessment Checklist for low- or middle-income African countries). Subsequently, surgical, anaesthesiology and intensive care facilities were evaluated according to the Portuguese-speaking African Countries Assessment of Surgical Oncology Capacity Survey (PSAC-Surgery). All the data were triangulated in order to identify gaps, develop an action plan and define an educational program. Results: Breast, oesophagus and colorectal cancers were the most commonly treated neoplasms in MCH. A range of technical and resource needs as well as the gaps in knowledge and skills were identified. All surgeons recognised the need to create a training program in oncology at the undergraduate level, specific training for residents and continuing oncological education for general surgeons to improve the practice of surgical oncology. It was evident that all these interventions needed to be formalised, appropriately certified and count for professional career progression. Based on the local epidemiological data and on these study findings, oncology education programs were developed for surgeons. Conclusions: The findings of this study contributed to the development of an educational program in surgical oncology, considered essential to the training of surgeons at MCH. The cancer educational programs and the mobilisation of adequate resources will ensure the provision of adequate surgical oncology treatments for MCH. The training requirements should be tailored to suit the local needs based on the most prevalent malignancies diagnosed in the region. In our view, this methodology may apply to other countries with similar realities in the formation of surgical oncologists.publishersversionpublishe

Understanding the bricks to build better surgical oncology unit at Maputo Central Hospital: prevalent surgical cancers and residents knowledge

Introduction: cancer is a growing concern in Mozambique. However, the country has limited facilities and few oncologists. Surgical oncologists are an unmet need. The aim of this study was to assess residents' knowledge in prevalent cancer domains and to identify and characterize prevalent cancers treated by surgery at Maputo Central Hospital, the largest hospital in Mozambique. The expectations were that the findings shall inform the development of a comprehensive curriculum in surgical oncology fellowship fit for the Hospital. Methods: to identify and characterize prevalent cancers, we performed a retrospective analysis of individual cancer patient registries of Maputo Central Hospital (MCH), Mozambique. Information was recorded into data collection sheets and analyzed with SPSS® 21. To assess MCH residents oncologic knowledge, we invited Twenty-six junior residents (49% of all residents) of different specialties to take a 30 item multiple choice written test used elsewhere in previous studies. The test focused on the domains of Basis of oncology, Radiotherapy, Pathology, Chemotherapy, Pain management, Surgical oncology and Clinical Pathway. The test was administered anonymously and without prior notice. We analyzed the overall test and topic performance of residents. Results: the study covered a period of 3 years and 203 patients. The most prevalent malignant tumors treated by general and thoracic surgery in MCH cancer registry were esophageal (7%), female breast (6.5%) and colorectal cancer (2.8%). Globally these malignancies were diagnosed at an advanced stage of the disease and required a multimodal treatment. The mean percent correct score of residents was 37.3%. The dimension with the highest percent correct score were clinical management (46%) and surgical oncology (28%) showed the lowest correct score. Conclusion: in Maputo, Mozambique esophageal, breast and colorectal cancer were the most prevalent malignancies treated, with surgery, by thoracic or general surgery in MCH. The test scores suggest that, among residents, the knowledge in oncology needs to be improved, rendering support to the need of a surgical oncology training tailored to suit the local needs. Specific training should take into account local cancer prevalence, resources, their quality and the support of surgical oncology services with volume and experience

Understanding the bricks to build better surgical oncology unit at Maputo Central Hospital: prevalent surgical cancers and residents knowledge

Cancer is a growing concern in Mozambique. However, the country has limited facilities and few oncologists. Surgical oncologists are an unmet need. The aim of this study was to assess residents' knowledge in prevalent cancer domains and to identify and characterize prevalent cancers treated by surgery at Maputo Central Hospital, the largest hospital in Mozambique. The expectations were that the findings shall inform the development of a comprehensive curriculum in surgical oncology fellowship fit for the Hospital