Cancer Control In Africa Research Articles

Designing a Collaborative Breast Radiology Training Program to Tackle Tanzania’s Breast Cancer Crisis

Breast cancer incidence and mortality continue to increase in Africa. In Tanzania, breast cancer is the second leading cause of cancer death for women, and breast cancer incidence and mortality are projected to increase by 80% by 2030. Education gaps among health care workers, delayed presentation, limited screening, and low health literacy all pose significant challenges to providing optimal breast cancer care. Considering these factors, it is imperative to train expert breast radiologists. We present a collaborative breast radiology training program in Tanzania aimed at building local capacity to address national breast cancer challenges. Although cancer control in Africa faces many challenges, developing customized training programs for breast radiology, in conjunction with national cancer programs, may represent a key strategy for addressing breast cancer.

Building a sustainable future: Closing the gap in radiotherapy and brachytherapy resources to achieve the sustainable development agenda 2030 goals for cervical cancer control in Africa

AbstractThough radiation therapy services have been launched or expanded in several countries, there have also existed brief or seemingly ongoing infrastructure gaps. The purpose of this health policy study is to provide an overview of the radiation therapy resources available in Africa and to assess how well they align with the agenda 2030 goals, with a specific focus on the role of radiation therapy (both radiotherapy and brachytherapy) in reducing the incidence of cervical cancer. The study consulted publicly accessible datasets to gather information on each nation's radiation therapy equipment, cervical cancer mortality and incidence, gross domestic product (GDP), gross national income (GNI) and population size. This information was used to generate a final dataset for analysis across various African nations, identifying any gaps or areas where improvement is needed. We compared the external beam units (or brachytherapy afterloaders) and unmet needs across nations that had access to either external beam radiation therapy or brachytherapy using a straightforward linear regression. R studio was used for the statistical analysis. Africa's overall unmet need for radiotherapy service was 71.5%. Megavoltage units per cancer incidence and megavoltage units per million population had a strong significant association with economic status (GDP [r2 = 0.83; p < .001]: and GNP [r = 0.83; p < .001]). Additionally, the unmet cervical cancer needs based on the available brachytherapy capacity is about 60%. Interestingly, there was a strong correlation between cervical cancer incidence and brachytherapy capacity. Overall, the study provides valuable insights that can inform policy and decision‐making related to the provision of radiation therapy services in Africa. We expect that international organisations, African Union entities and governments will utilise the Directory of Radiotherapy Centres (DIRAC) initiative as a blueprint for establishing benchmarks and invest in radiotherapy and brachytherapy services in Africa.

COVID-19 exposed pre-existing roadblocks for cancer control in Africa: strategies, lessons and recommendations from the 2019–2020 Africa Cancer Research and Control ECHO

COVID-19 exposed pre-existing roadblocks for cancer control in Africa: strategies, lessons and recommendations from the 2019–2020 Africa Cancer Research and Control ECHO

How COVID-19 exposed pre-existing roadblocks for cancer control in Africa: strategies, lessons and recommendations from the 2019-2020 Africa Cancer Research and Control ECHO.

The COVID-19 related mitigation measures adversely affected various cancer control activities in Africa, with cancer prevention and screening activities amongst the most significantly impacted. When the COVID-19 pandemic struck, the Africa Cancer Research and Control ECHO utilised their virtual platform to share experiences and knowledge of how to continue cancer service delivery during the pandemic. This analysis describes the evolved strategies, dilemmas, and recommendations to strengthen the health systems for cancer control in Africa. Eleven 1-hour-long sessions about the then newly emerging coronavirus infection and its impact on cancer control in Africa were held from April 2020 to August 2020, using Zoom®. An average of 39 participants attended the sessions including scientists, clinicians, policymakers and global partners. Sessions were analysed thematically. Most strategies to maintain cancer services during the COVID-19 pandemic centred around cancer treatment, with few strategies on maintaining cancer prevention services, early detection, palliative care and research services. The most mentioned challenge during the pandemic was fear of exposure to COVID-19 infection at the health facility during diagnosis, treatment or follow-up for cancer care. Other challenges were disruptions to service delivery, inaccessibility of cancer treatment, disruption of research activities and a lack of psychosocial support for COVID-19 related fear/anxiety. Significantly, this analysis shows that the COVID-19 related mitigation measures exacerbated existing predicaments in Africa, such as inadequate attention to cancer prevention strategies, psychosocial and palliative services and cancer research. The Africa Cancer ECHO recommends African countries to leverage the infrastructure developed in response to COVID-19 pandemic to strengthen the health system along the entire cancer control continuum. This calls for urgent action to develop and implement evidence-based frameworks and comprehensive National Cancer Control Plans that will withstand any future disruptions.

Strategies to Increase Participation of African Populations in Clinical Trials

Conducting clinical research in low- and middle-income countries is essential to address the global impact of cancer. In 2017, ASCO convened an Academic Global Oncology Task Force that recommended an increase in global oncology research to enhance the field of oncology through research and education. The emerging crisis of cancer in Africa demands a similar global commitment to workforce development, infrastructure building, and access to care that will provide a platform for impactful and relevant research efforts. In the words of the African Organisation for Research and Training in Cancer, it is time to "transform cancer control in Africa through collaboration in education, research, (and) delivery of equitable and timely interventions to minimize the impact of cancer." Although there are some initiatives aimed at developing research capacity to host trials in Africa, there is now a need to establish strategic partnerships with the aim of achieving harmonized, accredited clinical trial units capable of running trials according to Good Clinical Practice standards.

Abstract 11: Neglected Elements of Cancer Control During The COVID-19 Pandemic in Africa: Call for Action from 2019-2020 African Cancer Research and Control ECHO Programme

Abstract Purpose: As the world is learning to live with the coronavirus (COVID-19) pandemic, there is a shift in cancer control priorities and focus, with innovations to ensure continuity of cancer treatment and patient support during the COVID-19 pandemic. However, cancer control requires a comprehensive approach to minimize cancer incidence, mortality and improve the quality of life of those living with cancer. Hence, this analysis aimed to identify areas of cancer control affected by the COVID-19 pandemic that would equally affect cancer incidence, morbidity and mortality in Africa. Methods: The Africa Cancer Research and Control ECHO® Programme (Africa Cancer ECHO) is a community of practice that meets in an online platform to discuss cancer control challenges and solutions in the Africa region. The Africa Cancer ECHO conducted eleven sessions from April to August 2020 about the emerging COVID-19 pandemic, its impact on cancer control in Africa, and country-level practices as presented through case and didactic presentations. Sessions were analysed thematically to identify elements of cancer control that are adversely affected as a result of the COVID-19 pandemic and how they have been addressed. Results: HPV vaccination, cancer screening and early detection services, palliative care (PC) services, and cancer registration were particularly adversely affected, and in many cases have not yet resumed in some African countries. Recommendations included: use of affordable point of care HPV tests with immediate results; introducing COVID-19 testing along with HPV-testing; transitioning PC services from hospice to home care; and embracing Information Technology to enhance cancer registration. Conclusion: Cancer prevention, screening, supportive care, and surveillance services need to be urgently revitalised in Africa. The Africa Cancer ECHO platform highlights the need for generation of locally-relevant, evidence-based strategies that will safeguard past gains and continue to maximize the reduction of cancer incidence, morbidity and mortality during the COVID-19 pandemic. Citation Format: Annet Nakaganda, Nwamaka Lasebikan, Elise M. Garton, Benda Kithaka, Mishka K. Cira. Neglected Elements of Cancer Control During The COVID-19 Pandemic in Africa: Call for Action from 2019-2020 African Cancer Research and Control ECHO Programme [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 11.

Strengthening of oncology nursing education and training in Africa in the year of the nurse and midwife: addressing the challenges to improve cancer control in Africa.

The Cancer burden in Africa is increasing. Nurses play a pivotal role in health care systems and find themselves in a key position to engage with patients, communities and other health professionals to address disparities in cancer care and work towards achieving cancer control in Africa. The rapidly evolving nature of cancer care requires a highly skilled and specialised oncology nurse to either provide clinical care and/or conduct research to improve evidence-based practice. Although Africa has been slow to respond to the need for trained oncology nurses, much has been done over the past few years. This article aims to provide an update of Oncology nursing education and training in Africa with specific focus on South Africa, Ghana, Nigeria, Kenya, Zambia and Egypt. Mapping oncology nursing education and training in Africa in 2020, the International Year of the Nurse and the Midwife, provides an opportunity to leverage on the essential roles of the oncology nurse and commit to an agenda that will drive and sustain progress to 2030 and beyond.

Cancer control in Africa: is cancer research a luxury or necessity?

Decision makers dealing with resource allocation in Africa have the impression that cancer research is a luxury. As a result of this, very few or no resources are allocated for cancer research in Africa. Since in healthcare, clinical and epidemiological research provides an evidence base for formulation of health policies and facilitates decision making by policy makers, the lack of evidence base makes decision making intuitive. A situation like this is not cost-effective and is unacceptable. It is, therefore, important that for Africa to make effective decisions to improve the health of its population, cancer research informing policy and decision makers is a necessity and not a luxury.

Cancer control in Africa: surgery.

Surgery is the mainstay of cancer treatment and lack of surgical treatment is a major driver in holding back optimal cancer care. Surgery is essential for global cancer care in all resource settings. Of the estimated 18.1 million new cases of cancer in 2018, over 80% of cases will need surgery, some several times. Many patients throughout the world do not have access to cancer surgery. Many of the key adjunct treatment modalities for cancer surgery—e.g., anaesthesia, pathology and imaging—are also inadequate. Solutions are necessary and should include better-regulated public systems, international partnerships, super-centralisation of surgical services, novel surgical clinical trials and new approaches to improve quality and scale up cancer surgical systems through education and training. Delivery of safe, affordable and timely cancer surgery to all must be at the heart of global and national cancer-control planning.

Challenges and opportunities in the creation and implementation of cancer-control plans in Africa.

Cancer on the African continent is quickly becoming an overt public health crisis due to an aging population and changes in lifestyle. The World Health Organization (WHO) states that a national cancer-control programme should aim to reduce cancer incidence and mortality and improve quality of life of cancer patients, through a national cancer-control plan (NCCP) that is systematic, equitable and evidence-based. Despite this, only 11 countries in Africa have a current NCCP. Participants in a US National Cancer Institute-supported, multi-year, technical assistance programme for cancer-control planning noted three main opportunities to improve how plans are created and implemented: 1) mobilisation of resources and partners for plan implementation; 2) accurate surveillance data to promote better resourcing of NCCPs; and, 3) sustainable and innovative partnership models to strengthen capacity to implement NCCPs. Most countries in the region face similar challenges in the development and implementation of an NCCP, including inadequate human, technical, and financial resources. Collaborative partnerships increase access to evidence-based cancer-control planning tools, mentoring and technical assistance, and have the potential to bridge the capacity gap and catalyse better implementation of NCCPs. Challenges can be overcome by better leveraging these opportunities to address the gaps that inhibit cancer control in Africa.

Promoting Cancer Control in Africa With “Ubuntu”: A Report of the African Organization for Research and Training in Africa (AORTIC) 10th Conference, 2015 in Marrakech, Morocco

The objectives of the African Organization for Research and Training in Cancer (AORTIC), includes bringing products of decades of advances in cancer research to African populations through local and international collaboration. The consistent and huge growth in participation in the conferences and the diversity of the nations is a witness to the success of the organization thus far. The theme for the Tenth AORTIC International Conference on Cancer in Africa in Morocco in 2015 was "Road map to Cancer Control in Africa" and topics of discussion of paramount importance for low- and middle-income African countries included childhood cancers such as BL, cancers of the cervix, breast, and prostate; cancers associated with HIV-infection such as cervical, vulvar, and anal; as well as cancer care challenges associated with palliative care. The role of environmental factors that underlie some epigenetic changes in some of the cancers was emphasized. Oral and poster presentations from various parts of the continent indicate the growth of basic and translational science of cancer in the region, with studies revealing regional diversity in the frequencies of the triple-negative breast cancer, cervical cancer, prostate cancer, HCC, and Burkitt's lymphoma. There was a sign that Africa is trying to keep pace with the paradigm shift and focusing on translational medicine. This was shown by suggestions for application of genome-wide association studies, new generation sequencing, as well as the evaluation of single nucleotide polymorphisms that may be responsible for variable susceptibility in some of the prevalent cancers in people of African descent. J. Cell. Physiol. 232: 2287-2295, 2017. © 2016 Wiley Periodicals, Inc.

A vision for improved cancer screening in Nigeria.

A vision for improved cancer screening in Nigeria.

Cancer in Africa 2012

Noncommunicable diseases, and especially cancers, are recognized as an increasing problem for low and middle income countries. Effective control programs require adequate information on the size, nature, and evolution of the health problem that they pose. We present estimates of the incidence and mortality of cancer in Africa in 2012, derived from "GLOBOCAN 2012," published by the International Agency for Research on Cancer. There were 847,000 new cancer cases (6% of the world total) and 591,000 deaths (7.2% of the world total) in the 54 countries of Africa in 2012, with about three quarters in the 47 countries of Sub-Saharan Africa. While the cancer profiles often differ markedly between regions, the most common cancers in men were prostate (16.4% of new cancers), liver (10.7%), and Kaposi sarcoma (6.7%); in women, by far the most important are cancers of the breast (27.6% of all cancers) and cervix uteri (20.4%). There are still deficiencies in surveillance systems, particularly in Sub-Saharan Africa and, specifically, of their most vital component, population-based cancer registries. With the number of annual cancer cases and deaths likely to increase by at least 70% by 2030, there is a pressing need for a coordinated approach to improving the extent and quality of services for cancer control in Africa, and better surveillance systems with which they can be planned and monitored. The results are the best data currently available and provide a reasonable appraisal of the cancer situation in Africa.

Collaborative activities of United Nations agencies and partners in support of cancer control in Africa

Introduction In most low and middle income countries (LMICs), including the majority of African countries, cancer burden is increasing rapidly and poses enormous challenges to the health systems. This foresees the need for urgent action and the establishment of strategic partnerships, as well as mobilizing resources and coordinating efforts among counterparts for the development and strengthening of cancer control interventions.

Challenges and opportunities in cancer control in Africa: a perspective from the African Organisation for Research and Training in Cancer

Sub-Saharan Africa has a disproportionate burden of disease and faces a major public-health challenge from non-communicable diseases. Although infectious diseases continue to afflict Africa, the proportion of the overall disease burden in sub-Saharan Africa attributable to cancer is rising. The region is predicted to have a greater than 85% increase in cancer burden by 2030. Approaches to minimise the burden of cancer in sub-Saharan Africa in the past few years have had little success because of low awareness of the cancer burden and a poor understanding of the potential for cancer prevention. Success will not be easy, and will need partnerships and bridges to be built across countries, economies, and professions. A strategic approach to cancer control in sub-Saharan Africa is needed to build on what works there and what is unique to the region. It should ideally be situated within strong, robust, and sustainable health-care systems that offer quality health care to all people, irrespective of their social or economic standing. However, to achieve this will need new leadership, critical thinking, investment, and understanding. We discuss the present situation in sub-Saharan Africa and propose ideas to advance cancer control in the region, including the areas of cancer awareness, advocacy, research, workforce, care, training, and funding.

Improvement of pathology in sub-Saharan Africa

In the coming decades, cancer will be a major clinical and public health issue in sub-Saharan Africa. However, clinical and public health infrastructure and services in many countries are not positioned to deal with the growing cancer burden. Pathology is a core service required to serve many needs related to cancer in sub-Saharan Africa. Cancer diagnosis, treatment, and research all depend on adequate pathology. Pathology is also necessary for cancer registration, which is needed to accurately estimate cancer incidence and mortality. Cancer registry data directly guide policy-makers' decisions for cancer control and the allocation of clinical and public health services. Despite the centrality of pathology in many components of cancer care and control, countries in sub-Saharan Africa have at best a tenth of the pathology coverage of that in high-income countries. Equipment, processes, and services are lacking, and there is a need for quality assurance for the definition and implementation of high-quality, accurate diagnosis. Training and advocacy for pathology are also needed. We propose approaches to improve the status of pathology in sub-Saharan Africa to address the needs of patients with cancer and other diseases.

Treatment of cancer in sub-Saharan Africa

Cancer is rapidly becoming a public health crisis in low-income and middle-income countries. In sub-Saharan Africa, patients often present with advanced disease. Little health-care infrastructure exists, and few personnel are available for the care of patients. Surgeons are often central to cancer care in the region, since they can be the only physician a patient sees for diagnosis, treatment (including chemotherapy), and palliative care. Poor access to surgical care is a major impediment to cancer care in sub-Saharan Africa. Additional obstacles include the cost of oncological care, poor infrastructure, and the scarcity of medical oncologists, pathologists, radiation oncologists, and other health-care workers who are needed for cancer care. We describe treatment options for patients with cancer in sub-Saharan Africa, with a focus on the role of surgery in relation to medical and radiation oncology, and argue that surgery must be included in public health efforts to improve cancer care in the region.

Cancer control in Africa: which priorities?

Cancer control in Africa: which priorities?

Developing cancer control plans in Africa: examples from five countries

The creation and implementation of national cancer control plans is becoming increasingly necessary for countries in Africa, with the number of new cancer cases per year in the continent expected to reach up to 1·5 million by 2020. Examples from South Africa, Egypt, Nigeria, Ghana, and Rwanda describe the state of national cancer control plans and their implementation. Whereas in Rwanda the emphasis is on development of basic facilities needed for cancer care, in those countries with more developed economies, such as South Africa and Nigeria, the political will to fund national cancer control plans is limited, even though the plans exist and are otherwise well conceived. Improved awareness of the increasing burden of cancer and increased advocacy are needed to put pressure on governments to develop, fund, and implement national cancer control plans across the continent.

The African Organization for Research and Training in Cancer: Historical Perspective

The African Organization for Research and Training in Cancer (aortic) is a bilingual (English and French) nonprofit organization dedicated to the promotion of cancer control and palliation in Africa. Its mission in respect to cancer control in Africa includes support of research and training;provision of relevant and accurate information on the prevention, early diagnosis, treatment, and palliation of cancer;promotion of public awareness about cancer and reduction of the stigma associated with it.In seeking to achieve its goal of cancer control in Africa, aortic strives to unite the continent and to make a positive impact throughout the region by collaboration with health ministries and global cancer organizations. The organization's key objectives are to further research relating to cancers prevalent in Africa, to support training programs in oncology for health care workers, to deal with the challenges of creating cancer control and prevention programs, and to raise public awareness of cancer in Africa. It also plans to organize symposia, workshops, meetings, and conferences that support its mission.Founded in September 1982, aortic was active only between 1983 (when its inaugural conference was held in the City of Lome, Togo, West Africa) and the late 1980s. The organization subsequently became inactive and moribund. In 2000, a group of expatriate African physicians and scientists joined in an effort with their non-African friends and colleagues to reactivate the dormant organization. Since its reactivation, aortic has succeeded in putting cancer on the public health agenda in many African countries by highlighting Africa's urgent need for cancer control and by holding meetings every two years in various African cities. National and international cancer control organizations worldwide have recognized the challenges facing Africa and have joined in aortic's mission.