Cancer In Africa Research Articles

Stage at diagnosis and survival by stage for the leading childhood cancers in three populations of sub-Saharan Africa.

The lack of accurate population-based information on childhood cancer stage and survival in low-income countries is a barrier to improving childhood cancer outcomes. In our study, data from three population-based registries in sub-Saharan Africa (Abidjan, Harare and Kampala) were examined for children aged under 15. We assessed the feasibility of assigning stage at diagnosis according to Tier 1 of the Toronto Childhood Cancer Stage Guidelines for patients with non-Hodgkin lymphoma [including Burkitt lymphoma (BL)], retinoblastoma and Wilms' tumour. Patients were actively followed-up, allowing calculation of 3-year relative survival by cancer type and registry. Stage-specific observed survival was estimated. The cohort comprised 381 children, of whom half (n = 192, 50%) died from any cause within 3 years of diagnosis. Three-year relative survival varied by malignancy and location and ranged from 17% [95% confidence interval (CI) = 6%-33%] for BL in Harare to 57% (95% CI = 31%-76%) for retinoblastoma in Kampala. Stage was assigned for 83% of patients (n = 317 of 381), with over half having metastatic or advanced disease at diagnosis (n = 166, 52%). Stage was a strong predictor of survival for each malignancy; for example, 3-year observed survival was 88% (95% CI = 68%-96%) and 13% (4%-29%) for localised and advanced BL, respectively (P < .001). These are the first data on stage distribution and stage-specific survival for childhood cancers in Africa. They demonstrate the feasibility of the Toronto Stage Guidelines in a low-resource setting and highlight the value of population-based cancer registries in aiding our understanding of the poor outcomes experienced by this population.

Aberrant Splicing Events and Epigenetics in Viral Oncogenomics: Current Therapeutic Strategies.

Global cancer incidence and mortality are on the rise. Although cancer is fundamentally a non-communicable disease, a large number of cancers are known to have a viral aetiology. A high burden of infectious agents (Human immunodeficiency virus (HIV), human papillomavirus (HPV), hepatitis B virus (HBV)) in certain Sub-Saharan African countries drives the rates of certain cancers. About one-third of all cancers in Africa are attributed to infection. Seven viruses have been identified with carcinogenic characteristics, namely the HPV, HBV, Hepatitis C virus (HCV), Epstein–Barr virus (EBV), Human T cell leukaemia virus 1 (HTLV-1), Kaposi’s Sarcoma Herpesvirus (KSHV), and HIV-1. The cellular splicing machinery is compromised upon infection, and the virus generates splicing variants that promote cell proliferation, suppress signalling pathways, inhibition of tumour suppressors, alter gene expression through epigenetic modification, and mechanisms to evade an immune response, promoting carcinogenesis. A number of these splice variants are specific to virally-induced cancers. Elucidating mechanisms underlying how the virus utilises these splice variants to maintain its latent and lytic phase will provide insights into novel targets for drug discovery. This review will focus on the splicing genomics, epigenetic modifications induced by and current therapeutic strategies against HPV, HBV, HCV, EBV, HTLV-1, KSHV and HIV-1.

Cytoreductive Nephrectomy in Metastatic Kidney Cancer: Experience of the Urology Department at Aristide Le Dantec University Teaching Hospital

In the management of metastatic kidney cancer, enlarged nephrectomy is part of a multimodal approach with systemic treatment. The lack of data on its place in the management of metastatic kidney cancer in Africa and particularly in Senegal motivated this study. <i>Aim</i>: to assess the place of cytoreductive nephrectomy in the management of metastatic kidney cancer in our daily practice. <i>Patients and methods</i>: This was a retrospective, descriptive and analytical study from January 2010 to December 2014 on patients aged 18 years and over operated for metastatic kidney cancer. The variables studied were prognostic: Performance Status, tumor stage, sites and number of metastatic sites, prognosis group according to Heng's model, histological type and Furhman grade of the nephrectomy specimen, follow-up postoperative course and overall survival. <i>Results</i>: A total of 12 patients were included. The mean size of the largest axis of the tumors was 14.06±5.3 cm with extremes of 8.2 and 23.8 cm and the tumor was graded T3 in 6 cases. The majority of patients had a single metastatic site and the lung was the most common metastatic site in 9 cases. In half of the cases the ECOG-PS score was 1. In 6 cases the patients were classified in the Heng intermediate prognosis group. Lymph node dissection was associated with nephrectomy in 4 cases. Renal adenocarcinoma was the most common histologic type in 8 cases and Furhman's grade was only specified in 6 cases. The mean duration of follow-up was 10.1±13.4 months (range 1 and 39 months), overall survival at 2 years was poor and only 2 patients were alive 3 years and 4 years after their nephrectomy. <i>Conclusion</i>: metastatic kidney cancer is uncommon in our context, most of our patients consult with advanced stage tumors. Systemic treatment remains difficult for our populations to access. Nephrectomy remains the main weapon at our disposal.

Breast cancer risk prediction in African women using Random Forest Classifier

IntroductionOne of the most important steps in combating breast cancer is early and accurate diagnosis. Unfortunately, breast cancer is asymptomatic at the early stage, although some symptoms are presented at a later time, but at symptomatic stage treatment could be complicated or even become impossible thereby leading to death. Proper risk assessment is hence very important in reducing mortality. Some computational techniques have been developed for breast cancer risk assessment in the developed world, but such techniques do not work well in Africa because of the difference in risk profiles of African women e.g. later menarche, low drug abuse and low smoking rate. AimIn this work, we propose a bespoke risk prediction model for African women using Random Forest Classifier (RFC) machine learning technique. MethodsA total of 180 subjects were studied out of which 90 were confirmed cases of breast cancer and 90 were benign. Twenty-five risk factors were included, for example, smoking, alcohol intake, occupational hazards and age at menopause. Four approaches were empirically used in the feature selection, these are the use of Chi-Square, mutual information gain, Spearman correlation and the entire features. RFC algorithm was used to develop the prediction model. ResultsWe found that family history of breast cancer, dense breast, deliberate abortion, age at first child, fruit intake and regular exercise are predictors of breast cancer. The RFC model gave an accuracy of 91.67%, sensitivity of 87.10%, specificity of 96.55% and Area under curve (AUC) of 92% when all the risk factors were included in the model while an accuracy of 96.67%, sensitivity of 93.75%, specificity of 100% and AUC of 97% were obtained when correlation-selected features were included in the model. The Chi-Square selected features gave the best performance with 98.33% accuracy, 100% sensitivity, 96.55 specificity and 98% AUC. Mutual information gain selected feature gave the same results as Chi-Square selected features. ConclusionRandom Forest Classifier has a good potential at predicting the risk of breast cancer in African women. The study helped to identify the risk factors of breast cancer in African women. This is a valuable information which can help African women to pay attention to those risk factors with the intention of reducing the incidence of breast cancer in Africa.

Effects on cancer in Africa

Coronavirus The COVID-19 pandemic struck many countries in Africa as they were already facing multiple public health challenges, in particular high incidence and mortality rates from cancer. In a Perspective, Addai and Ngwa discuss the effects of the COVID-19 response on cancer care, treatment, and outreach aimed at diagnosing patients early. The allocation of limited resources to COVID-19 patients, rather than to cancer patients, could increase the number of late-stage cancer diagnoses and resulting mortality. There have also been effects on fundraising and patient mental health, as well as on cancer research and training. However, opportunities have also been created, such as the development of localized diagnostic capability, more efficient radiotherapy administration, increased focus on understanding phytomedicine use, and use of telemedicine and online learning. Science , this issue p. [25][1] [1]: /lookup/doi/10.1126/science.abd1016

COVID-19 and cancer in Africa.

The impacts of COVID-19 present substantial challenges and opportunities in global oncology

Cancer in Africa: Is It a Genetic or Environmental Health Problem?

Patients of African ancestry have the poorest outcome and the shortest survival rates from cancer globally. This could be attributed to many variables including racial, biological, socioeconomic and sociocultural factors (either single, multiple or combined), which may be responsible for this major health problem. We sought to assess the most common types of cancer that endanger the health of the African people, and tried to investigate the real differences between African and other Non-African patients regarding incidence, prevalence and mortality rates of different cancers. Therefore, identifying the underlying aetiological causes responsible for the increased incidence and mortality rates of African patients will allow for changing the current plans, to make optimized modalities for proper screening, diagnosis and treatment for those African patients, in order to improve their survival and outcomes.

Abstract PO-152: A systematic review and meta-analysis of the prevalence of breast cancer in Africa: Identifying unanswered questions

Abstract Introduction One major limitation to cancer prevention and control in Africa has been lack of accurate and reliable epidemiological data. To date, there is no publicly available systematic review and meta-analysis on the prevalence of breast cancer in Africa. This data is important to understand the burden of the disease in Africa and identify areas lacking reliable studies. Objective The objective of this review was to examine the prevalence of breast cancer in Africa based on region, subtype, and screening. Methods A systematic search of MEDLINE, EMBASE, PUBMED, ISI Web of Science, BIOSIS, African Journal Online, and Global Health was conducted. We included population-based or hospital-based cancer registry studies on breast cancer conducted on African populations and providing estimates of breast cancer cases or prevalence over a period. A random effect meta-analysis was done to determine the pooled prevalence of breast cancer in Africa based on region, subtype and screening, using Stata Statistical Software: Release 16. College Station, TX: StataCorp LLC. Results Our search of databases yielded 2030 references that were imported into Covidence. A total of 44 studies were included in the review. The overall pooled prevalence of breast cancer in Africa was 0.48% (95% CI: 0.05-0.92). With regards to regional prevalence, the estimated prevalence of breast cancer among women in Sub-Saharan Africa (SSA), 0.68% (-0.03 - 0.1.39) was remarkably higher than that of women in North Africa (NA) 0.16% (95% CI: -0.11-0.42). Also, the overall prevalence of triple negative breast cancer (TNBC) among female breast cancer patients was 29.51% (CI: 23.94-35.08). A sub-group analysis revealed, TNBC was more prevalent in women from SSA 29.51 (CI: 23.94- 35.08, 18 studies) than women from NA 20.17(14.63-25.71, 8 studies). Meta-analysis of African women participation in Breast Self-Examination (BSE) produced a prevalence of 29.57 (CI: 7.90-51.25). This was higher than the prevalence of African women participation in Clinical Breast Examination and mammography, 12.22 (7.58-16.86). Conclusions Though the incidence of breast cancer in Africa is relatively low, the same cannot be said of its prevalence. Also, within Africa, there are clear regional and sub-regional differences in both breast cancer prevalence and the prevalence of TNBC among breast cancer patients. This may be attributed to limited infrastructure needed for breast cancer control and prevention especially within SSA regions. Establishment of robust hospital-based cancer registries in Africa will boost the collection of accurate and complete cancer data that can be used in epidemiological research, patient care improvement, and cancer control which will ultimately lead to the reduction of breast cancer burden in Africa. Citation Format: Livingstone Aduse-Poku, Kurt Fernando, Sabrina I. Fossi, Sylvester Antwi, Haythem Ali, Eleanor Walker, Evelyn M. Jiagge. A systematic review and meta-analysis of the prevalence of breast cancer in Africa: Identifying unanswered questions [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-152.

Limited access to care for persons with breast cancer in Africa: A systematic review.

To systematically review the available evidence and examine the factors that may limit patients' access to breast cancer care in Africa. We searched six databases (Google Scholar, Web of Science, PubMed, EMBASE, CINAHL, and Scopus) for studies conducted among breast cancer patients in Africa, highlighting patient challenges and barriers to care or treatment. The search was limited to studies published in the English language and from January 2000 until August 2019. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. There were no limitations to the methodological design of the included studies. In total, 18,154 articles were retrieved through electronic search; twenty-five were eligible for inclusion after quality appraisal. We analyzed the data using the deductive content analysis approach. Three categories emerged as barriers to breast cancer care: Socio-economic challenges, Institutional shortfalls, and Distinctiveness. The findings support that economic hardships, fear, and scarcity of cancer treatments/equipment are critical in limiting access to breast cancer care. Sustainable strategies aimed at scaling-up breast cancer care in the region are necessary. The results also highlight the need for reduced treatment cost and aggressive educational campaigns across healthcare facilities and the local communities.

Optimal management of esophageal cancer in Africa: A systemic review of treatment strategies.

Esophageal cancer (EC) is a leading cause of cancer morbidity and mortality in Africa. Despite the high burden of disease, optimal management strategies for EC in resource-constrained settings have yet to be established. This systematic review evaluates the literature on treatments for EC throughout Africa and compares the efficacy and safety of varying treatment strategies in this context (PROSPERO CRD42017071546). PubMed, Embase and African Index Medicus were searched for studies published on treatment strategies for EC in Africa from 1980 to 2020. Searches were supplemented by examining bibliographies of included studies and relevant conference proceedings. Methodological quality/risk of bias was assessed using the Cochrane Risk-of-Bias tool and the Newcastle-Ottawa Scale. Forty-six studies were included. Case series constituted the majority of studies: 13 were case series reporting on outcomes of esophagectomies, 17 on palliative luminal or surgical interventions, four on radiotherapy and three on concurrent chemoradiation. Nine randomized controlled trials were identified, of which four prospectively compared different treatment modalities (one investigating radiotherapy vs chemoradiation, three evaluating rigid plastic stents vs other treatments). This review summarizes the research on EC treatments in Africa published over the last four decades and outlines critical gaps in knowledge related to management in this context. Areas in need of further research include (a) evaluation of the safety and efficacy of neoadjuvant therapy in patients with locally advanced disease; (b) strategies to improve long-term survival in patients treated with definitive chemoradiation; and (c) the comparative effectiveness of modern palliative interventions, focusing on quality of life and survival as outcome measures.

Toward Optimization of Cancer Care in Sub-Saharan Africa: Development of National Comprehensive Cancer Network Harmonized Guidelines for Sub-Saharan Africa.

PURPOSEStandard treatment guidelines improve patient outcomes, including disease-specific survival, in cancer care. The African Cancer Coalition was formed in 2016 to harmonize cancer treatment guidelines for sub-Saharan Africa.METHODSThe African Cancer Coalition collaborated with the National Comprehensive Cancer Network (NCCN) and the American Cancer Society to harmonize 46 cancer treatment guidelines for use in sub-Saharan Africa. Harmonization for each guideline was completed by a group of approximately 6-10 African cancer experts from a range of specialties and with representation across resource levels. Each working group was chaired by an African oncologist and included a member of the appropriate NCCN guidelines panel. Treatment recommendations from the parent guidelines were distinguished as options that are generally available and should be considered standard care in most of the region or as highly advanced options for which cost or other resources may limit widespread availability. Additional recommendations specific to sub-Saharan Africa were added.RESULTSThe NCCN Harmonized Guidelines for sub-Saharan Africa, available for download on the NCCN website and mobile application, provide flexible recommendations appropriate for the range of resources seen in African cancer programs, from private comprehensive cancer centers to resource-constrained public hospitals. IBM (Armonk, NY) has developed a digital interface—the Cancer Guidelines Navigator—that allows oncologists to access the treatment recommendations for the first five guidelines through an interactive web-based application.CONCLUSIONHarmonized guidelines that reflect the diversity of resource levels that characterize the current state of clinical care for cancer in Africa have the potential to fill a crucial gap in efforts to standardize and improve cancer care in Africa.

Screening for cervical cancer in Africa: A proposal of a different combination of VIA test and cervical smear in Uganda

To evaluate the efficacy of visual inspection with acetic acid (VIA) screening combined with a cervical smear in Uganda. Nine screening campaigns were held in Uganda between January 2011 and October 2019. In the last three campaigns, a new approach was used: the cervical smear was performed before the VIA test and, in case of a positive VIA test, the slide was sent for examination. The data collected were divided into two groups: the first six campaigns and the last three campaigns. During the study period, 10 520 women were screened, of whom 911 had a positive VIA test. The VIA test showed 84.2% false positives. In the first group, the VIA test was positive in 516 women, of whom 93% were referred for further examinations. In the second group, the VIA test was positive in 395 women, but the cervical smear was positive in only 65 women. Thus, only 16.5% women were referred for further examinations. Combining cervical smear, VIA test, and slide analysis in positive VIA tests may allow women who need treatment to be selected more effectively, while waiting for other more expensive solutions to become more affordable for this setting.

Working Together to Build a Better Future for Children With Cancer in Africa.

CITATION: Chitsike, I., et al. 2020. Working together to build a better future for children with cancer in Africa. JCO Global Oncology, 6:1076-1078.

Abstract A18: Characterization of checkpoint inhibitors in the tumor microenvironment (TME) and peripheral blood in endemic Burkitt Lymphoma

Abstract Introduction: The tumor microenvironment and the interaction between immune checkpoint inhibitors (ICIs) and tumor cells are essential to understand for designing future immunotherapy strategies. In this study, we aim to characterize the tumor microenvironment (TME) in children diagnosed with endemic Burkitt lymphoma (eBL), the most common pediatric cancer in Africa. A history of chronic malaria (Plasmodium falciparum) and Epstein-Barr virus (EBV) coinfections are both risk factors in the etiology of eBL. Methods: Using multicolor flow cytometry and single-cell RNA sequencing, we analyzed the expression of immune checkpoint inhibitors in T cells from the tumor microenvironment and from peripheral blood mononuclear cells (PBMC) of eBL patients, along with age-matched controls with different malaria exposure. Additionally, CD8 T-cell infiltration was confirmed by immunohistochemistry. Results: PD-1+ CD4 T cells from eBL PBMCs were increased in number compared to healthy controls from the malaria-endemic area (p=0.03). Both CD4 and CD8 T cells from eBL PBMCs reveal higher frequency of TIGIT expressers compared to healthy controls (non-malaria endemic) (p=0.002, p=0.007 respectively). PD1+ TIGIT+ IFNG- memory CD4 T cells phenotype from eBL PBMCs was increased upon short stimulation with PMA/ionomycin, as well as “naive-like” CD95+ PD1high TIGIT+ CTLA4+ IFNG+ CD8T cells. Tumor samples from 4 eBL patient were used on single-cell analysis; we observed activated T-cells profile that highly upregulated TIGIT within the tumor microenvironment. We also noticed relatively low expression of other ICIs such as PD1, TIM3, LAG3, and CTLA4. Base on all these data, we calculated an exhaustion score that was higher than the cytotoxicity score in our eBL-derived tumor-infiltrating lymphocytes (TILs). In addition, we use immunohistochemistry staining to confirm CD8 T-cell infiltration and ICI expression in eBL tumor fine needle aspirates. Our future directions will employ TIGIT blockade inhibitor studies of CD8 T cells, in order to increase expansion and function of CD8 TILs. Our results will help support future development of ICI therapies in endemic Burkitt lymphoma. Citation Format: Priya Saikumar-Lakshmi, Cliff Oduor, Catherine Forconi, Patrick Marsh, John Michael Ong’echa, Jeffrey Bailey, Ann Moormann. Characterization of checkpoint inhibitors in the tumor microenvironment (TME) and peripheral blood in endemic Burkitt Lymphoma [abstract]. In: Proceedings of the AACR Special Conference on the Advances in Pediatric Cancer Research; 2019 Sep 17-20; Montreal, QC, Canada. Philadelphia (PA): AACR; Cancer Res 2020;80(14 Suppl):Abstract nr A18.

Landscape of Oncology Clinical Trials in Africa

PURPOSEThe burden of cancer in Africa is of significant concern for several reasons, including that incidence of cancer in Africa continues to rise while Africa is also dealing with communicable diseases. To combat cancer in Africa, oncology clinical trials are needed to develop innovative interventions for cancer prevention, screening, diagnosis, treatment, and survivorship. Unfortunately, there is a paucity of clinical trials in Africa and it is difficult for African clinicians to get information on open oncology clinical trials and impossible for African patients with cancer to access this information. The primary objective of this study was to identify open oncology clinical trials in Africa.METHODSThis project was part of a large-scale study to develop an African Virtual Platform for Oncology Clinical Trials Registry. The study was a quantitative, web-based, retrospective review of clinical trials registries.RESULTSA total of 109 open oncology clinical trials were identified. Most of the trials were in Egypt, South Africa, Algeria, and Kenya. The top cancer types for oncology clinical trials in Africa were breast, cervical, and lung cancers. The top sponsor of oncology clinical trials in Africa was academic institutions, especially institutions in the United States.CONCLUSIONThe paucity of clinical trials in Africa will continue to magnify the global disparities of cancer in the African population. Clinical trials are needed to ensure therapeutic interventions are safe and effective in the African population. In the era of personalized and precision health, it no longer suffices to assume that drugs developed in North America, Europe, or Asia will be effective in the African population.

A Custom Genotyping Array Reveals Population-Level Heterogeneity for the Genetic Risks of Prostate Cancer and Other Cancers in Africa.

Although prostate cancer is the leading cause of cancer mortality for African men, the vast majority of known disease associations have been detected in European study cohorts. Furthermore, most genome-wide association studies have used genotyping arrays that are hindered by SNP ascertainment bias. To overcome these disparities in genomic medicine, the Men of African Descent and Carcinoma of the Prostate (MADCaP) Network has developed a genotyping array that is optimized for African populations. The MADCaP Array contains more than 1.5 million markers and an imputation backbone that successfully tags over 94% of common genetic variants in African populations. This array also has a high density of markers in genomic regions associated with cancer susceptibility, including 8q24. We assessed the effectiveness of the MADCaP Array by genotyping 399 prostate cancer cases and 403 controls from seven urban study sites in sub-Saharan Africa. Samples from Ghana and Nigeria clustered together, whereas samples from Senegal and South Africa yielded distinct ancestry clusters. Using the MADCaP array, we identified cancer-associated loci that have large allele frequency differences across African populations. Polygenic risk scores for prostate cancer were higher in Nigeria than in Senegal. In summary, individual and population-level differences in prostate cancer risk were revealed using a novel genotyping array. SIGNIFICANCE: This study presents an Africa-specific genotyping array, which enables investigators to identify novel disease associations and to fine-map genetic loci that are associated with prostate and other cancers.

Abstract IA42: Addressing prostate cancer disparities through precision public health: The CaPTC experience

Abstract Africa is now facing a major public health challenge relative to noncommunicable diseases, especially cancer, while still dealing with the challenges of infectious diseases. Alarmingly, sub-Saharan Africa (SSA) will have more than an 85% increase in cancer deaths by 2030. Cancer continues to create a huge clinical, economic, and humanistic burden for Africa. Based on our research team's work in Africa since 2006, we know firsthand that there are several challenges in fighting cancer in Africa, which requires innovative strategies to overcome the burden of cancer in Africa. Precision medicine (PM) carries the promise of tailoring treatment, prevention, and behavioral interventions in a precise and personalized manner to optimize medical benefit and minimize harm for an individual patient. While the focus on PM brings an exciting era in health care, there is considerable concern that it may shift focus away from social determinants of health and much-needed strategies to address community-based efforts on cancer prevention and control. This is especially of significant concern in low-resource communities that are unable to afford PM, especially SSA countries. The question then becomes, how can we leverage the PM effort to provide effective community health in low-resource communities? The Prostate Cancer Transatlantic Consortium (CaPTC) is an NCI-EGRP approved consortium that addresses the global disproportionate burden of prostate cancer (CaP) among Black men connected by the Transatlantic Slave Trade. Founded in 2015, CaPTC's effort in Africa includes Precision Public Health (PPH): “using community engagement, community data and technology with geographical precision to prevent prostate cancer, predict prostate cancer risks, develop tailored and targeted programs to improve community health, and foster public health policies to reduce CaP disparities.” CaPTC's PPH efforts in Africa include (1) integration of community data, expert opinions and literature review to develop CaP research priorities for Nigeria; (2) use of web-based and mobile technologies to make oncology clinical trials accessible in Africa; (3) geographical mapping of CaP incidence in Nigeria using geospatial analysis; (4) examining genetic, environmental, and behavioral etiology of CaP in familial cohort of West African men in Nigeria, Cameroon, and US; (5) development of standardized and uniform behavioral and epidemiologic measures for the study of CaP in Black men globally; and (6) facilitation of global data sharing for multiethnic studies of prostate cancer in Black men by harmonizing and pooling existing data to create Big Data for the CaP research community. To effectively address the public health challenges of cancer in SSA, deliberate and concerted efforts must be made to implement programs that will provide precise community-tailored intervention to SSA populations at the right time. PPH offers a meaningful approach to address cancer disparities in Africa. Citation Format: Folakemi Odedina, CaPTC Investigators. Addressing prostate cancer disparities through precision public health: The CaPTC experience [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr IA42.

Prevalence of Themes Linked to Delayed Presentation of Breast Cancer in Africa: A Meta-Analysis of Patient-Reported Studies.

PURPOSEThe prevalence of themes linked to delay in presentation of breast cancer (BC) and their underlying factors vary considerably throughout Africa. Regional differences and trends are largely unreported. The purpose of this research was to provide summary estimates of the prevalence and distribution of the themes and underlying factors linked to delay in the presentation of BC, regional variation, and trends in an effort to identify targets for intervention.DESIGNWe screened articles found through PubMed/Medline, African Journal OnLine, Science Direct, Google/Google Scholar, and ResearchGate. We included patient-reported surveys on the reasons linked to delayed presentation under 6 previously identified themes: symptom misinterpretation, fear, preference for alternative care, social influence, hospital-related factors, and access factors. The meta-analytical procedure in MetaXL used the quality-effect model.RESULTSTwelve of the 236 identified articles were eligible for this review. The overall summary estimate of late presentation (> 90 days) was 54% (95% CI, 23 to 85) and was worst in the eastern and central regions. Symptom misinterpretation was the most common theme (50%; 95% CI, 21 to 56), followed by fear (17%; 95% CI, 3 to 27), hospital-related theme (11%; 95% CI, 1 to 21), preference for alternative care (10%; 95% CI, 0 to 21), social influence (7%; 95% CI, 0 to 14), and access-related theme (6%; 95% CI, 0 to 13). The most common factor underlying symptom misinterpretation was mischaracterizing the breast lesion as benign (60%; 95% CI, 4 to 100) which surpassed lack of awareness in the last decade. Misdiagnosis and failure to refer were the dominant hospital-related factors.CONCLUSIONModifiable factors such as mischaracterizing malignant masses as benign, fear, misdiagnosis, and failure to refer were the prevalent factors contributing to delays throughout Africa. These factors are promising targets for intervention.

Perspectives and practices of ototoxicity monitoring.

BackgroundTreatment of cancer with cisplatin can result in hearing loss. Given the increasing burden of cancer in Africa, appropriate and timely identification, intervention and management of hearing loss in affected patients is of paramount importance.ObjectivesThis study describes the perspectives and practices of healthcare professionals in relation to cisplatin-associated ototoxicity at an institution treating patients diagnosed with cancer.MethodA concurrent triangulation study design was used to collect quantitative data from seven oncologists, nine nurses and 13 pharmacists using self-administered questionnaires, and qualitative data from four audiologists through semi-structured interviews for this hospital-based study, conducted in South Africa.ResultsLevels of awareness of cisplatin-associated ototoxicity varied with only 33% of the nursing personnel being aware in comparison to the oncologists and pharmacists. Oncologists were identified as the main custodians for providing information to patients. Whilst 82% of the participants considered the audiologist to be part of the oncology team, there was no provision for ototoxicity monitoring in the chemotherapy protocols, nor any ototoxicity-monitoring programme in place. There was no evidence that knowledge of cisplatin-associated ototoxicity translated into an appropriate management strategy for such patients.ConclusionHealthcare personnel overseeing the care and management of cancer patients need to improve their awareness of ototoxicity and refer timeously for audiological evaluation. Audiologists require greater awareness of monitoring programmes to appropriately implement and manage such programmes within a cancer platform and be part of a multidisciplinary team.Keywordsawareness; cisplatin; South Africa; ototoxicity; cervical cancer; healthcare personnel.

The Experiences of Women Living With Cervical Cancer in Africa: A Metasynthesis of Qualitative Studies.

Cervical cancer is the fourth most common cancer in women worldwide. However, developing countries bear 85% of the burden, with Africa sharing the highest incidence with Melanesia. The aims of this study were to explore the experiences of women living with cervical cancer in Africa and to inform others of the extent of the work done in this field of study by synthesizing the findings of qualitative research. The work of Sandelowski and Barroso guided the study, and 6 databases were searched to identify relevant studies using the key words Africa, cervical cancer, and experiences. A total of 13 studies (n = 13) met the inclusion criteria, and their findings were synthesized. The studies originated primarily from South Africa and focused on the period from diagnosis to 1 year after completing curative treatment. One overarching core theme living a life of suffering, 2 main themes, architects of suffering and mediators of suffering, and 9 subthemes were identified. Women living with cervical cancer in Africa live a life of suffering, which starts when they experience the first symptom of cervical cancer and continues well after completing treatment. The facilitators of suffering outweighed the mediators and could not be guaranteed, as it did not relieve the suffering of all. Nurses practicing in Africa should be acutely aware of cervical cancer and do their utmost within their limited resources to prevent and detect the disease in its earliest stage. Religious and support interventions could be used to lessen the suffering of these women.