Patient characteristics and outcomes of colorectal cancer at a cancer hospital in Rwanda: results from a retrospective cohort

Abstract

Colorectal cancer (CRC) is a significant contributor to cancer mortality in sub-Saharan Africa, yet it remains understudied. This study describes care gaps and survival outcomes of CRC in Rwanda. This was a retrospective observational cohort study. We included patients treated at Butaro Cancer Center of Excellence, a tertiary cancer center in Northern Rwanda. 163 patients with CRC who presented between July 2012 and June 2018 were included. Comprehensive data were collected on patient characteristics; diagnostic workup; treatment gaps; and survival outcomes up to August 2023. The main outcome measures were five-year overall survival (OS) for the entire cohort, and disease-free survival (DFS) for patients with localized disease; these were estimated using the Kaplan-Meier method. Exploratory multivariate survival analysis examined the associations between patient/disease characteristics and survival. The cohort median age was 53 years; 86 (53%) were females and 127 (78%) had rectal cancer. Most patients (98, 60%) had localized disease. Overall, 111 (68%) patients received chemotherapy, and 74 (45%) received primary surgical resection. Of those treated with curative intent, rate of primary surgical resection was higher in colon cancer (20, 91%) compared to rectal cancer (38, 40%). Only 24 (25.5%) patients with curable rectal cancer received radiotherapy. The median OS was 3.68 years, while the median DFS of patients with localized disease was 2.21 years. Gender and stage were associated with OS, but not disease location or age. For OS, compared to female patients, males had an adjusted hazard ratio (aHR) of 1.84 ( p = 0.007), while patients with metastatic disease had an aHR of 1.92 ( p = 0.004). Only disease location was associated with DFS, with an aHR of 2.35 ( p = 0.047) for rectal versus colon cancer. Multidisciplinary CRC treatment remains a challenge in Rwanda, similar to other low-resource settings. Our results highlight striking gaps in care, across all treatment modalities and particularly low rates of surgery and radiation. Not applicable.