Treatment outcomes of esophageal cancer in Eastern Africa: protocol of a multi-center, prospective, observational, open cohort study

Geoffrey C. Buckle, Alita Mrema, Michael Mwachiro, Yona Ringo, Msiba Selekwa, Gift Mulima, Fatma F. Some, Blandina T. Mmbaga, Gita N. Mody, Li Zhang, Alan Paciorek, Larry Akoko, Paul Ayuo, Stephen Burgert, Elizabeth Bukusi, Anthony Charles, Winnie Chepkemoi, Gladys Chesumbai, Bongani Kaimila, Aida Kenseko, Kitembo Salum Kibwana, David Koech, Caren Macharia, Ezekiel N. Moirana, Beatrice Paul Mushi, Alex Mremi, Julius Mwaiselage, Ally Mwanga, Jerry Ndumbalo, Gissela Nvakunga, Mamsau Ngoma, Margaret Oduor, Mark Oloo, Jesse Opakas, Robert Parker, Saruni Seno, Ande Salima, Furaha Servent, Andrew Wandera, Kate D. Westmoreland, Russell E. White, Brittney Williams, Elia J. Mmbaga, Katherine Van
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Esophageal squamous cell carcinoma (ESCC) is a major cause of cancer morbidity and mortality in Eastern Africa. The majority of patients with ESCC in Eastern Africa present with advanced disease at the time of diagnosis. Several palliative interventions for ESCC are currently in use within the region, including chemotherapy, radiation therapy with and without chemotherapy, and esophageal stenting with self-expandable metallic stents; however, the comparative effectiveness of these interventions in a low resource setting has yet to be examined.


This prospective, observational, multi-center, open cohort study aims to describe the therapeutic landscape of ESCC in Eastern Africa and investigate the outcomes of different treatment strategies within the region. The 4.5-year study will recruit at a total of six sites in Kenya, Malawi and Tanzania (Ocean Road Cancer Institute and Muhimbili National Hospital in Dar es Salaam, Tanzania; Kilimanjaro Christian Medical Center in Moshi, Tanzania; Tenwek Hospital in Bomet, Kenya; Moi Teaching and Referral Hospital in Eldoret, Kenya; and Kamuzu Central Hospital in Lilongwe, Malawi). Treatment outcomes that will be evaluated include overall survival, quality of life (QOL) and safety. All patients (≥18 years old) who present to participating sites with a histopathologically-confirmed or presumptive clinical diagnosis of ESCC based on endoscopy or barium swallow will be recruited to participate. Key clinical and treatment-related data including standardized QOL metrics will be collected at study enrollment, 1 month following treatment, 3 months following treatment, and thereafter at 3-month intervals until death. Vital status and QOL data will be collected through mobile phone outreach.


This study will be the first study to prospectively compare ESCC treatment strategies in Eastern Africa, and the first to investigate QOL benefits associated with different treatments in sub-Saharan Africa. Findings from this study will help define optimal management strategies for ESCC in Eastern Africa and other resource-limited settings and will serve as a benchmark for future research.