Palliative management of oesophageal cancer in South Africa

Abstract

Oesophageal cancer is common in South Africa (SA), and most patients are treated palliatively due to late presentation with advanced disease and poor performance status. Due to the unique challenges in SA, including resource constraints, palliative care may not be optimal. Most patients with oesophageal cancer in SA require individualised palliative care, ideally guided by a multidisciplinary team (MDT).

Dysphagia remains the most debilitating symptom, with self-expanding metal stents (SEMS) being the most effective and commonly used intervention. Other modalities include serial dilatation, endoluminal brachytherapy, external beam radiotherapy (EBRT), and endoscopic ablative techniques, though their availability is often limited. Systemic therapy may benefit selected patients with good performance status, while best supportive care (BSC) and psychosocial support are essential but inconsistently provided. Combined palliative modalities may improve outcomes, but further context-specific research is needed to guide optimal strategies in resource-limited settings.