Colorectal cancer care in Tanzania: an evaluation of clinical characteristics, treatment patterns and quality metrics at a national cancer referral hospital.

Background: Colorectal cancer (CRC) is a leading cause of cancer morbidity and mortality in Tanzania. Non-metastatic CRC is a potentially curable disease that requires multidisciplinary management. This study aimed to evaluate clinicopathologic characteristics for CRC, treatment patterns and select quality metrics at Ocean Road Cancer Institute from 2014 to 2019, the time period immediately preceding the release of Tanzania's first National Cancer Treatment Guidelines in 2020. Methods: Quality metrics were selected a priori based upon existing international quality measures, the newly released Tanzania National Cancer Treatment Guidelines and key stakeholder input. Demographic, clinicopathologic and treatment data were abstracted from medical charts for all adult patients with newly diagnosed non-metastatic CRC presenting to Ocean Road Cancer Institute from 2014 to 2019. A clinician reviewed all case report forms for quality assurance. Patient characteristics, treatment patterns and quality metrics were examined using descriptive analyses. Results: Of 678 patients with CRC, 421 (62%) had non-metastatic disease. Of those with non-metastatic disease, 92 (22%) had colon cancer, 175 (42%) had rectal cancer and 154 (36%) were classified as CRC primary site not otherwise specified. Most patients with colon cancer (n = 86, 93%) underwent surgical resection. Quality of adjuvant chemotherapy was high for colon cancer, with most patients receiving timely treatment (73% within 8 weeks of surgery) and most (81%) with stage III disease receiving appropriate treatment. Documentation in surgical pathology reports was poor, with only 5 of 78 (6%) documenting examination of >12 lymph nodes. Among rectal cancer patients, use of preoperative chemoradiation (7%) and perioperative chemotherapy (27%) was low for locally advanced disease. Overall, only 42 (24%) of patients with rectal cancer underwent surgery and 42 (24%) received no treatment. Conclusion: The majority of patients with non-metastatic colon cancer received high-quality care, whereas care delivery was less consistent among patients with rectal cancer. This suggests possible challenges in delivering complex, multidisciplinary care in low-resource settings. These findings will serve as a contemporary benchmark for future evaluations of the Tanzanian National Cancer Treatment Guidelines and their impact on CRC care and outcomes.