Cancer care and COVID-19: tailoring recommendations for the African radiation oncology context.

Lofti Kochbati,Rim Moujahed,Tajudeen Olasinde,Mouna Ben Rejeb,Zeineb Naimi,Verna Vanderpuye

doi:10.3332/ecancer.2020.1144

Abstract

Africa is the second most populous continent after Asia comprising 54 countries. Given the healthcare system deficiencies in Africa, the impact of the COVID-19 pandemic was expected to be disastrous. The first case of COVID-19 on the continent was reported in Egypt on 14 February 2020. By 13 May, cases had been reported in all 54 countries. Several practice guidelines specific to radiation oncology departments have been published, including prioritisation criteria for postponing radiotherapy, continuation of treatment, hypofractionation or even omitting radiotherapy. The oncology community in Africa has suddenly needed to protect both patients and caregivers and to ensure continuity of essential clinical services despite several challenges. Considering equipment unavailability, lack of human resources and poor infrastructure, tailoring COVID-19 pandemic management to the African context seems mandatory and a unified approach to guideline development in this context is encouraged. In this article, we discuss contextual issues coming into play, highlighting steps to be taken by radiotherapy centres in Africa to mitigate fallouts from the current pandemic to ensure the safety of our patients and staff as well as the impact on future care.

Highlights

Africa is the second most populous continent comprising 54 countries after Asia and a mixed bag of economies, the majority being in the low- to the middle-income groups
Available data indicate that more than one million new cancer cases are diagnosed in Africa annually [1]
We discuss radiotherapy guidelines in the context of the COVID-19 pandemic and highlight steps taken by radiotherapy centres in Africa to mitigate fallouts from the current pandemic to ensure the safety of our patients and staff even with restrained resources

Summary

Background

Africa is the second most populous continent comprising 54 countries after Asia and a mixed bag of economies, the majority being in the low- to the middle-income groups. The common goal of COVID-19 cancer treatment guidelines is to limit patient visits to clinical institutions by balancing the risk of infection and early mortality against the continuation of essential cancer treatments to improve outcomes [6] This implies adopting cost-effective, less invasive and immunosuppressive therapies. Long waiting times to be attended to due to the mandatory COVID-19 protocols, limited shift workers and social distancing rules result in disgruntled patients and family and overworked staff Cancer patients under these circumstances are reluctant to honour scheduled visits, partly compounded by the economic fallout especially in countries with high out of pocket payments and indirect medical expenditure. Cancer patients in Africa and many other resource-constrained regions have suboptimal outcomes for multifactorial reasons including poor screening uptake, late stage at diagnosis, low to access to timely and state-of-art care facilities. This, underscores the need for radiotherapy centres in Africa to consider the implementation of recommended strategies in the context of pragmatism

Conclusion

Findings

Funding declaration