An audit of Cancer in the Surgical Wards of a tertiary healthcare facility in a resource-limited setting

  • B A Ayoade
  • B A Salami
  • A O Adekoya
  • A O Tade
  • H O Ebili
  • A A Olatunji
Keywords: Cancer, Curative care, Late presentation, , Palliative care, Survival rate


Background: In Africa, cancer is an emerging public health concern. In Sub-Saharan Africa, data on cancer epidemiology and survival which are necessary for the planning of treatment and control of cancers are scarce.

Methods: A retrospective study of all patients who were admitted to the surgical wards in a Nigerian tertiary facility between January 2012 and December 2016 was done.  The retrieved data included demographic features, presenting symptoms, mode of presentation, duration of illness, diagnosis, stage of disease, treatment modalities, treatment intention, compliance with treatment, survival, and current status.

Result: The 279 patients studied comprised 81 (29.0%) males and 198 (71.0%) females. Cancer of the female breast was the leading malignancy occurring in 59% (165/279) patients; this was followed by colon cancer in19% (54/279) and prostate cancer in 10% (29/279). The commonest cancer among the females was breast cancer while prostate cancer was the commonest among the males. The stage of the disease was classified as early in 14.7% (41/279), locally advanced in 61.6% (172/279) and metastatic in 23.7% (66/279). Treatment goal was palliative for 57% (159/279) of the patients, curative in 26%while 13.6% (38/279) of the patients received no anti-cancer treatment. Ninety-six patients (34.5%) refused treatment or defaulted from treatment after the commencement of therapy. Although 53 (19%) patients died within the first month of admission, the overall mean duration of survival was 12.71 ± 13.0 months (range of 1- 84 months).

Conclusion: Late presentation of patients, high treatment default rate, inappropriate management plan and overall poor survival were identified as daunting issues in cancer management in a resource-limited setting.


Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC Cancer-Base No. 11[Internet]. Lyon, France: International Agency for Research on Cancer: 2013 Available from [Accessed on the 16th May 2017].

Human Development Report (2013). United Nations Development Programme (UNDP).

Ferlay J, Shin HR, Bray F, Forman D, Mathers CD, Parklin D. GLOBOCAN 2008, Cancer Incidence and Mortality Worldwide: IARC Cancer-Base No. 10 [Internet]. Lyon, France: International Agency for Research on Cancer: 2010. Available from [Accessed on the 16th May 2017].

Stefan DC. Cancer Care in Africa: An Overview of Resources. J Global Oncol 2015;1(1):30-5. DOI:10.1200/JGO.2015.000406

World Health Organization. National Cancer Control programmes. Geneva: World Health Organization; 2002.

Barton MB, Frommer M, Shafiq J. Role of radiotherapy in cancer control in low-income and middle income countries. Lancet Oncol 2006; 7(7): 584-95.

Parkin DM. The evolution of the population based cancer registry. Nat Rev Cancer. 2006; 6(8): 603-12.

Shukla D, Patel VK, Chhari AS, Dubey CS, Garg RK, Singh AP, et al. Epidemiological profile of a tertiary teaching hospital in Vindhya region with special reference to high proportion of carcinoma of gall bladder. Int Surg J 2016; 3: 2025-33.

Kanavos P. The rising burden of cancer in the developing world. Ann Oncol 2006; 17 (Supplement 8): viii15-viii23. doi:10.1093/annonc/mdl983.

Oladeji A, Atalabi O, Jimoh M, Ntekim I, Elumelu T. Delay in presentation of cancer patients for diagnosis and management: An institutional report. The Internet Journal of Oncology 2016; 13(1). DOI: 10.5580/IJO.44745.

Reville B, Foxwell AM. The global state of palliative- progress and challenges in cancer care. Ann Palliat Med 2014; 3(3): 129-38. DOI: 10.3978/j.issn.2224-5820.2014.07.03.

Egwuonwu OA, Anyanwu SNC, Nwofor AME. Default from neoadjuvant chemotherapy in premenopausal female breast cancer patients: What is to blame? Niger J Clin Pract 2012; 15(3): 265-69.

Obrist M, Osei-Bonsu E, Soliman A S. Factors related to incomplete treatment of breast cancer in Kumasi, Ghana. Breast 2014; 23(6): 821-28.

Earle GC, Landrum MB, Souza JM, Neville BA, Weeks JC, Ayanian JZ. Aggressiveness of Cancer Care near the end of life: Is it a Quality of care issue? J Clin Oncol 2008; 26: 3860-66. DOI:10.1200/JCO.2007.15.8253

Miner TJ. Palliative surgery for advanced cancer: lessons learned in patient selection and outcome assessment. Am J Oncol 2005; 28(4): 411-14.

Ott JJ, Ullrich A, Miller AB. The importance of early symptom recognition in the context of early detection and cancer survival. Eur J Cancer 2009; 45(16): 2743-48. DOI:10.1016/j.ejca 2009.08.009.

Allemani C, Weir HK, Carreira H, Harewood R, Spika D, Wang X ,et al. Global surveillance of cancer survival 1995-2009: analysis of individual data for 25676887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet 2015; 385 (9972): 977-1010. DOI: 10.1016/S0140-6736(14)62038-9.