Ogbenna Ann Abiola, Oyedeji Olufemi Abiola, Famuyiwa Christiana Oluwakemi, Sopekan Babajide Ayodeji, Damulak Obadiah Dapus, Akpatason Esere Bernice, Olorunfemi Gbenga, Adekola Kehinde
Department of Haematology and Blood Transfusion, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Idi-Araba, Lagos, PMB 12003, Nigeria.
https://orcid.org/0000-0003-1441-2308.
Ecancermedicalscience. 2021 May 25;15:1239. doi: 10.3332/ecancer.2021.1239. eCollection 2021.
The outcome of acute myeloid leukaemia (AML) has remained a major concern even in developed countries. In resource poor countries, it is envisaged that the outcome will be far worse because of late presentations, lack of appropriate diagnostic facilities and supportive care. However, data to validate this is lacking and many of these countries lack an effective cancer registry. This study determined the clinician's perspective of the outcome of care of AML patients in Nigeria and their attitudes to the care of these patients. Structured self-administered questionnaire was used to assess the clinician's perception of outcomes of care, contributory factors and attitude to care of AML patients. Ninety-eight percent of clinicians reported that the outcome of care was suboptimal; 73.3% and 90.6% of the clinicians reported having less than 31% of AML patients surviving induction and post-induction therapies, respectively. Sixty-six-point one percent (66.1%), 50% and 62.7% of the clinicians have never used immunophenotyping, cytogenetic or molecular studies, respectively, in the management of AML patients under their care. Access to blood components other than Red cells was low; 23.3% had access to apheresis platelets and 55% to fresh frozen plasma. Forty-six percent of clinicians will either give half dose of chemotherapy or offer only supportive care. This reported early death rate is three times higher than that reported in developed countries with only 9% likely to survive the first year of induction compared to about 32.9% in Ontario. Approximately 28 units of pooled or apheresis derived platelet may be required in course of therapy but just 10% of clinicians have access to platelet apheresis. Lack of diagnostic facilities, blood components and clinicians' attitudes are contributing factors to the extremely poor outcomes of patients with AML in Nigeria.
即使在发达国家，急性髓系白血病（AML）的治疗结果仍是一个主要问题。在资源匮乏的国家，预计由于就诊延迟、缺乏适当的诊断设施和支持性护理，治疗结果会更糟。然而，缺乏证实这一点的数据，而且这些国家中的许多都没有有效的癌症登记系统。本研究确定了尼日利亚临床医生对AML患者护理结果的看法以及他们对这些患者护理的态度。采用结构化的自填式问卷来评估临床医生对护理结果、促成因素以及对AML患者护理态度的看法。98%的临床医生报告称护理结果不理想；分别有73.3%和90.6%的临床医生报告称接受诱导治疗和诱导后治疗的AML患者存活比例不到31%。在其负责治疗的AML患者管理中，分别有66.1%、50%和62.7%的临床医生从未使用过免疫表型分析、细胞遗传学或分子研究。除红细胞外的血液成分获取率较低；23.3%的人能够获取单采血小板，55%的人能够获取新鲜冰冻血浆。46%的临床医生要么给予半量化疗，要么仅提供支持性护理。报告的早期死亡率比发达国家高出三倍，诱导治疗第一年仅有9%的患者可能存活，而安大略省约为32.9%。治疗过程中大约可能需要28单位混合或单采来源的血小板，但只有10%的临床医生能够进行血小板单采。缺乏诊断设施、血液成分以及临床医生的态度是尼日利亚AML患者治疗结果极差的促成因素。
