{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T21:25:06Z","timestamp":1783545906599,"version":"3.55.0"},"reference-count":48,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2023,6,27]],"date-time":"2023-06-27T00:00:00Z","timestamp":1687824000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000048","name":"American Cancer Society","doi-asserted-by":"publisher","award":["43359"],"award-info":[{"award-number":["43359"]}],"id":[{"id":"10.13039\/100000048","id-type":"DOI","asserted-by":"publisher"}]},{"name":"German Ministry for Economic and Development Cooperation"},{"name":"German International Cooperation","award":["13.2238.7-004.41"],"award-info":[{"award-number":["13.2238.7-004.41"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Although non-Hodgkin lymphoma (NHL) is the 6th most common malignancy in Sub-Saharan Africa (SSA), little is known about its management and outcome. Herein, we examined treatment patterns and survival among NHL patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We obtained a random sample of adult patients diagnosed between 2011 and 2015 from 11 population-based cancer registries in 10 SSA countries. Descriptive statistics for lymphoma-directed therapy (LDT) and degree of concordance with National Comprehensive Cancer Network (NCCN) guidelines were calculated, and survival rates were estimated.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Findings<\/jats:title>\n                  <jats:p>Of 516 patients included in the study, sub-classification was available for 42.1% (121 high-grade and 64 low-grade B-cell lymphoma, 15 T-cell lymphoma and 17 otherwise sub-classified NHL), whilst the remaining 57.9% were unclassified. Any LDT was identified for 195 of all patients (37.8%). NCCN guideline-recommended treatment was initiated in 21 patients. This corresponds to 4.1% of all 516 patients, and to 11.7% of 180 patients with sub-classified B-cell lymphoma and NCCN guidelines available. Deviations from guideline-recommended treatment were initiated in another 49 (9.5% of 516, 27.2% of 180). By registry, the proportion of all patients receiving guideline-concordant LDT ranged from 30.8% in Namibia to 0% in Maputo and Bamako. Concordance with treatment recommendations was not assessable in 75.1% of patients (records not traced (43.2%), traced but no sub-classification identified (27.8%), traced but no guidelines available (4.1%)). By registry, diagnostic work-up was in part importantly limited, thus impeding guideline evaluation significantly. Overall 1-year survival was 61.2% (95%CI 55.3%-67.1%). Poor ECOG performance status, advanced stage, less than 5 cycles and absence of chemo (immuno-) therapy were associated with unfavorable survival, while HIV status, age, and gender did not impact survival. In diffuse large B-cell lymphoma, initiation of guideline-concordant treatment was associated with favorable survival.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Interpretation<\/jats:title>\n                  <jats:p>This study shows that a majority of NHL patients in SSA are untreated or undertreated, resulting in unfavorable survival. Investments in enhanced diagnostic services, provision of chemo(immuno-)therapy and supportive care will likely improve outcomes in the region.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/oncolo\/oyad157","type":"journal-article","created":{"date-parts":[[2023,6,27]],"date-time":"2023-06-27T15:41:58Z","timestamp":1687880518000},"page":"e1017-e1030","source":"Crossref","is-referenced-by-count":6,"title":["Guideline Concordance of Treatment and Outcomes Among Adult Non-Hodgkin Lymphoma Patients in Sub-Saharan Africa: A Multinational, Population-Based Cohort"],"prefix":"10.1093","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5090-1080","authenticated-orcid":false,"given":"Nikolaus Christian Simon","family":"Mezger","sequence":"first","affiliation":[{"name":"Global Health Working Group, Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg , Halle , 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Walburga","family":"Joko-Fru","sequence":"additional","affiliation":[{"name":"African Cancer Registry Network , Oxford , UK"},{"name":"Nuffield Department of Population Health, University of Oxford , Oxford , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jana","family":"Feuchtner","sequence":"additional","affiliation":[{"name":"Global Health Working Group, Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg , Halle , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annelle","family":"Zietsman","sequence":"additional","affiliation":[{"name":"African Cancer Registry Network , Oxford , UK"},{"name":"Dr AB May Cancer Care Centre , Windhoek , Namibia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-F\u00e9lix","family":"P\u00e9ko","sequence":"additional","affiliation":[{"name":"African Cancer Registry Network , Oxford , UK"},{"name":"Registre des cancers de Brazzaville , 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Mali"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guy","family":"N\u2019da","sequence":"additional","affiliation":[{"name":"African Cancer Registry Network , Oxford , UK"},{"name":"Registre des cancers d\u2019Abidjan , Abidjan, C\u00f4te d\u2019Ivoire"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cesaltina Ferreira","family":"Lorenzoni","sequence":"additional","affiliation":[{"name":"African Cancer Registry Network , Oxford , UK"},{"name":"Departamento de Patologia, Faculdade de Medicina, Universidade Eduardo Mondlane, Hospital Central de Maputo , Mozambique"},{"name":"Registo de Cancro, Minist\u00e9rio da Sa\u00fade , Maputo , Mozambique"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-Th\u00e9r\u00e8se","family":"Akele-Akpo","sequence":"additional","affiliation":[{"name":"African Cancer Registry Network , Oxford , UK"},{"name":"D\u00e9partement d\u2019anatomo-pathologie, Facult\u00e9 des Sciences de la Sant\u00e9 , Cotonou , Benin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rg Michael","family":"Mezger","sequence":"additional","affiliation":[{"name":"Albert-Ludwig University of Freiburg , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mascha","family":"Binder","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine IV, Oncology\/Hematology, Martin-Luther-University Halle-Wittenberg , Halle , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Biying","family":"Liu","sequence":"additional","affiliation":[{"name":"African Cancer Registry Network , Oxford , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Bauer","sequence":"additional","affiliation":[{"name":"Institute of Pathology, Martin-Luther-University Halle-Wittenberg , Halle , 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