HOSPITAL-BASED CANCER REGISTRY FRERE HOSPITAL, EAST LONDON CANCER INCIDENCE 1991-2009 TECHNICAL REPORT OCTOBER 2017 COMPILED BY: NOMFUNEKO SITHOLE | SENIOR RESEARCH TECHNOLOGIST South African Medical Research Council Burden of Disease Research Unit Cape Town NTUTHU SOMDYALA | SENIOR SCIENTIST South African Medical Research Council Burden of Disease Research Unit Cape Town EDITED BY: DR ELVIRA SINGH | PUBLIC HEALTH SPECIALIST HEAD: NATIONAL CANCER REGISTER National Health Laboratory service Johannesburg CONTACT DETAILS Nomfuneko Sithole South African Medical Research Council Burden of Disease Research Unit Physical address Francie Van Zijl Drive Parow Valley Tel: +27(0) 219380958 Fax: 0866769160 Email: [email protected] http://www.samrc.ac.za/intramural-research-units/BOD COPYRIGHT INFORMATION Copyright 2017, South African Medical Research Council. All materials in this report may be reproduced and copied for non- commercial purposes; citation as to source, however, is appreciated. SUGGESTION CITATION Sithole N and Somdyala NIM. Hospital-Based Cancer Registry Frere Hospital, East London, Cancer Incidence 1991-2009 Technical Report. Cape Town: South African Medical Research Council, 2017. ISBN: 978-1-928340-24-9. ACKNOWLEDGEMENTS The following individuals are acknowledged for their contribution and input in many ways including technical support: • Dr BP Pokharel who is the Head of Frere Hospital Oncology and Radiation Department • Miss Bulelani Nodliwa who is the secretary at Frere Hospital Oncology and Radiation Department • Mr Jermaine Carelse of SAMRC IT Department • Miss Akhona Ncinitwa, Mr Linda Mbuthini, Mrs Ria Laubscher, Mr William Msemburi and Mr Ian Neethling who are SAMRC colleagues • Prof Ehimario Igumbor who was the supervisor for Masters in Public Health thesis upon which this report is based PERMISSION AND FUNDING • Dr J Thomas who is the Director of Clinical Governance at Frere Hospital granted permission to use Frere Hospital Cancer Register • The Eastern Cape Health Research Committee granted permission for this study • The South African Medical Research Council funded the study HOSPITAL-BASEDHOSPITAL-BASED CANCER CANCER REGISTRY: REGISTRY: FRERE FRERE HOSPITAL HOSPITAL | | CANCER CANCER INCIDENCE INCIDENCE 1991 1991 - - 2009 2009 | | TECHNICAL TECHNICAL REPORT REPORT | | PAGE PAGE I 1 TABLE OF CONTENTS PREFACE 1 EXECUTIVE SUMMARY 2 BACKGROUND 4 POPULATION PROFILE 2011 5 METHODS 5 RESULTS 6 DISCUSSION 11 LIMITATIONS 12 CONCLUSION 12 REFERENCES 13 APPENDIX A 15 PAGE II | HOSPITAL-BASED CANCER REGISTRY: FRERE HOSPITAL | CANCER INCIDENCE 1991 - 2009 | TECHNICAL REPORT LIST OF TABLES Table 1: Distribution of the top 10 cancer sites by sex, 1991-2009 7 LIST OF FIGURES Figure 1: Eastern Cape Province population distribution by age and sex (Statistics South Africa, 2012) 5 Figure 2: Data exclusion steps 5 Figure 3: Annual number of malignant cases, 1991-2009 6 Figure 4: Percentage distribution of malignancy cases by race, 1991-2009 6 Figure 5: Percentage distribution of cases across municipalities, 1991-2009 6 Figure 6: Overall top 10 cancer sites (men and women combined), 1991-2009 6 Figure 7: Percentage distribution of boys cancers; 1991-2009 8 Figure 8: Percentage distribution of girls cancers; 1991-2009 8 Figure 9: Number of lung cancer cases by sex and year; 1991-2009 8 Figure 10: Number of lung cancer cases by age-group and sex; 1995-2000 8 Figure 11: Number of oesophageal cancer cases by year and sex; 1995-2009 8 Figure 12: Number of oesophageal cancer cases by age-group and sex; 1995-2009 9 Figure 13: Number of Kaposi sarcoma cases by sex; 1991-2009 9 Figure 14: Number of cases by selected cancer sites for three-time periods; 1995-1999, 2000-2004, 2005-2009 9 Figure 15: Lung cancer year and race interaction in men for three-time periods; 1995-1999, 2000-2004 & 2005-2009 9 Figure 16: Prostate cancer year and race interaction for three-time periods; 1995-1999, 2000-2004 & 2005-2009 9 Figure 17: Number of cases by selected cancer sites for three-time periods; 1995-1999, 2000-2004, 2005-2009 10 Figure 18: Cervical cancer year and race interaction for three-time periods; 1995-1999, 2000-2004 & 2005-2009 10 Figure 19: Breast cancer year and race interaction for three-time periods; 1995-1999, 2000-2004 & 2005-2009 10 Figure 20: Lung cancer year and race interaction for three-time periods; 1995-1999, 2000-2004 & 2005-2009 10 Figure 21: Comparison of ASRs per 100 000 population (World) of most common cancers in men; selected populations 11 Figure 22: Comparison of ASRs per 100 000 population (World) of most common cancers in women; selected populations 11 HOSPITAL-BASED CANCER REGISTRY: FRERE HOSPITAL | CANCER INCIDENCE 1991 - 2009 | TECHNICAL REPORT | PAGE III PREFACE For the past 15 years, our Eastern Cape Cancer Registry (ECCR) may reflect the realities of current inequities in the health system team has visited Frere Hospital annually to follow-up on cancer in South Africa, such disparities in health care pose a major patients who have been referred from the former Transkei challenge to the proposed National Health Insurance. regions that are under surveillance in the population-based cancer registry. We have been made to feel welcome as we have The third surprise by her study has been the low numbers of searched through registers, folders and data bases to ensure oesophageal cancer cases reported in the data. Given the that we capture any cancer related visits that have been made historical studies of cancers based in this hospital as well as by our study population and we extract the clinical details to the contemporary data from the ECCR, we were very surprised include in our register. as it has been a leading cancer. We have noted a decline in oesophageal cancer death rates from the national mortality When Nomfuneko Sithole was a public health student, we data but also think that it may be possible that patients with decided to give her the task of examining the routinely collected oesophageal cancer have been treated in other wards without Oncology and Radiation Department data at the hospital and radiotherapy, and are missing from this data source. When setting investigate what it could tell us about the trends in cancer up a hospital-based cancer registry, it would be particularly patients treated in the hospital. Her study has surprised us in important to incorporate information from the surgical ward so several ways. as to include cancer patients who are given surgical treatment only. Firstly, she found that the routine data are reasonably complete and she has clearly demonstrated that they can easily be used to This study begs the question what is the incidence of describe the profile of cancer cases treated in the hospital. From oesophageal cancer? Our team harbors an interest in this, we learn that with limited additional resource, it would be complementing the ECCR with a population-based cancer possible for Frere Hospital to establish a hospital-based cancer registry in Buffalo City Municipality to measure the incidence registry. We believe that an ongoing registry would assist the and monitor changing cancer patterns in an urban setting and hospital with resource planning and future caseload prediction. thereby contribute towards cancer control initiatives. We hope It could also serve as a tool for research. that this report will ignite an interest in establishing a hospital- based cancer registry – they are one of the major sources of Secondly, her analysis has highlighted the changing patient information for population-based cancer registries. profile treated by the hospital since 1991, with an apparent shift to private sector care by a section of the population. While this PROF DEBBIE BRADSHAW DIRECTOR: SAMRC Burden of Disease Research Unit September 2017 HOSPITAL-BASED CANCER REGISTRY: FRERE HOSPITAL | CANCER INCIDENCE 1991 - 2009 | TECHNICAL REPORT | PAGE 1 EXECUTIVE SUMMARY cancer patients increased from 74.3% in 1991 to 89.9% in 2009 while Whites decreased from 24.3% to 8.0%. Frere Hospital is a provincial government-funded referral hospital situated in East London in the Eastern Cape Province of South GEOGRAPHICAL DISTRIBUTION OF CASES Africa. It has an Oncology and Radiation Department that offers Cases originated from the Eastern Cape Province and beyond. A oncology services to patients coming from municipalities of large proportion was from Buffalo City Local Municipality (45.9%) Buffalo City, Amathole, OR Tambo, Chris Hani, uKhahlamba, while the remainder were from neighboring municipalities of Alfred Nzo and Cacadu. A few patients from Nelson Mandela Amathole (18%), OR Tambo (14%), Chris Hani (14%), UKhahlamba Municipality and even outside the Eastern Cape Province are also (4%), Alfred Nzo (2%), Cacadu (0.5%) and Nelson Mandela (0.4%). treated. Hospital-based cancer incidence has been investigated About 1.1% of the cases were from areas outside the Eastern periodically since the late 1950’s in this setting. This study sets out Cape Province. to examine trends in the radiotherapy administrative data system. MOST COMMON CANCERS DATA SOURCE Overall top 10 cancers recorded for both men and women Data clerks systematically record daily patient information include cervix (22.4%), female breast (14.0%), lung (9.4%), mouth using an administrative programme called the Radiotherapy (4.3%), colo-rectum (3.9%), larynx (3.7%), prostate (2.8%), tongue (RT) programme. The main objective of this registry is to keep (2.5%), oesophagus (2.2%) and Non-Hodgkin’s lymphoma (2.2%). patients’ information for planning for care and administration Unknown primary and ill-defined cancer sites featured among the of this hospital. Reasonably complete information has been most common cancers at 4.9% and 2.4%, respectively. collected in the RT programme from 01 January 1991. DISTRIBUTION OF COMMON CANCERS BY SEX This technical report includes cancer cases for the period 1991 TOP 5 CANCERS IN MEN: – 2009. Data were extracted from the RT programme into an • Lung (18.6%) excel spread sheet and checked for completeness and accuracy • Mouth (11.1%) of patients’ information details.