Clinical trials to improve childhood cancer care and survival in sub-Saharan Africa

PURPOSE The burden of cancer is growing in low- and middle-income countries (LMICs), including sub-Saharan Africa. Ensuring the delivery of high-quality cancer care in such regions is a pressing concern. There is a need for strategies to identify meaningful and relevant quality measures that are applicable to and usable for quality measurement and improvement in resource-constrained settings. METHODS To identify quality measures for breast cancer care at Butaro Cancer Center of Excellence (BCCOE) in Rwanda, we used a modified Delphi process engaging two panels of experts, one with expertise in breast cancer evidence and measures used in high-income countries and one with expertise in cancer care delivery in Rwanda. RESULTS Our systematic review of the literature yielded no publications describing breast cancer quality measures developed in a low-income country, but it did provide 40 quality measures, which we adapted for relevance to our setting. After two surveys, one conference call, and one in-person meeting, 17 measures were identified as relevant to pathology, staging and treatment planning, surgery, chemotherapy, endocrine therapy, palliative care, and retention in care. Successes of the process included participation by a diverse set of global experts and engagement of the BCCOE community in quality measurement and improvement. Anticipated challenges include the need to continually refine these measures as resources, protocols, and measurement capacity rapidly evolve in Rwanda. CONCLUSION A modified Delphi process engaging both global and local expertise was a promising strategy to identify quality measures for breast cancer in Rwanda. The process and resulting measures may also be relevant for other LMIC cancer facilities. Next steps include validation of these measures in a retrospective cohort of patients with breast cancer.

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International Radiotherapy Referrals From Rural Rwanda: Implementation Processes and Early Clinical Outcomes

Journal of Global Oncology ◽

10.1200/jgo.18.00089 ◽

2018 ◽

pp. 1-12

Author(s):

Maud Hanappe ◽

Lowell T. Nicholson ◽

Shekinah N.C. Elmore ◽

Alexandra E. Fehr ◽

Jean Bosco Bigirimana ◽

...

Keyword(s):

Rectal Cancer ◽

Head And Neck ◽

Low Income ◽

Cancer Care ◽

Sub Saharan Africa ◽

Resource Limited Settings ◽

Cancer Centre ◽

Resource Limited ◽

Centre Of Excellence ◽

Sub Saharan

Purpose Low- and middle-income countries disproportionately comprise 65% of cancer deaths. Cancer care delivery in resource-limited settings, especially low-income countries in sub-Saharan Africa, is exceedingly complex, requiring multiple modalities of diagnosis and treatment. Given the vast human, technical, and financial resources required, access to radiotherapy remains limited in sub-Saharan Africa. Through 2017, Rwanda has not had in-country radiotherapy services. The aim of this study was to describe the implementation and early outcomes of the radiotherapy referral program at the Butaro Cancer Centre of Excellence and to identify both successful pathways and barriers to care. Methods Butaro District Hospital is located in a rural area of the Northern Province and is home to the Butaro Cancer Centre of Excellence. We performed a retrospective study from routinely collected data of all patients with a diagnosis of cervical, head and neck, or rectal cancer between July 2012 and June 2015. Results Between 2012 and 2015, 580 patients were identified with these diagnoses and were potential candidates for radiation. Two hundred eight (36%) were referred for radiotherapy treatment in Uganda. Of those referred, 160 (77%) had cervical cancer, 31 (15%) had head and neck cancer, and 17 (8%) had rectal cancer. At the time of data collection, 101 radiotherapy patients (49%) were alive and had completed treatment with no evidence of recurrence, 11 (5%) were alive and continuing treatment, and 12 (6%) were alive and had completed treatment with evidence of recurrence. Conclusion This study demonstrates the feasibility of a rural cancer facility to successfully conduct out-of-country radiotherapy referrals with promising early outcomes. The results of this study also highlight the many challenges and lessons learned in providing comprehensive cancer care in resource-limited settings.

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Clinical Trials in Sub-Saharan Africa and Established Standards of Care

JAMA ◽

10.1001/jama.292.2.237 ◽

2004 ◽

Vol 292 (2) ◽

pp. 237 ◽

Cited By ~ 22

Author(s):

David M. Kent ◽

D. Mkaya Mwamburi ◽

Michael L. Bennish ◽

Bruce Kupelnick ◽

John P. A. Ioannidis

Keyword(s):

Clinical Trials ◽

Sub Saharan Africa ◽

Standards Of Care ◽

Sub Saharan

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"You can save time if…"—A qualitative study on internal factors slowing down clinical trials in Sub-Saharan Africa

PLoS ONE ◽

10.1371/journal.pone.0173796 ◽

2017 ◽

Vol 12 (3) ◽

pp. e0173796 ◽

Cited By ~ 4

Author(s):

Nerina Vischer ◽

Constanze Pfeiffer ◽

Manuela Limacher ◽

Christian Burri

Keyword(s):

Clinical Trials ◽

Qualitative Study ◽

Sub Saharan Africa ◽

Internal Factors ◽

Slowing Down ◽

Sub Saharan

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Therapeutic misconception and clinical trials in sub-saharan Africa: A review

East African Medical Journal ◽

10.4314/eamj.v86i6.54142 ◽

2010 ◽

Vol 86 (6) ◽

Author(s):

VM Lema

Keyword(s):

Clinical Trials ◽

Sub Saharan Africa ◽

Therapeutic Misconception ◽

Sub Saharan

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Disease Comanagement: A Case Study of HIV/AIDS and Cancer Care in Sub-Saharan Africa

Clinical Journal of Oncology Nursing ◽

10.1188/18.cjon.228-231 ◽

2018 ◽

Vol 22 (2) ◽

pp. 228-231

Author(s):

Biemba Maliti ◽

Patience Mbozi

Keyword(s):

Cancer Care ◽

Sub Saharan Africa ◽

Sub Saharan ◽

Hiv Aids

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Conducting clinical trials in emerging markets of sub-Saharan Africa: review of guidelines and resources for foreign sponsors

Open Access Journal of Clinical Trials ◽

10.2147/oajct.s77316 ◽

2015 ◽

pp. 23 ◽

Cited By ~ 7

Author(s):

Gaurav Puppalwar ◽

Meenakshi Mourya ◽

Ganesh Kadhe ◽

Amey Mane

Keyword(s):

Clinical Trials ◽

Emerging Markets ◽

Sub Saharan Africa ◽

Sub Saharan

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Cancer Clinical Trials in Africa—An Untapped Opportunity: Recommendations From AORTIC 2019 Conference Special Interest Group in Clinical Trials

JCO Global Oncology ◽

10.1200/go.21.00096 ◽

2021 ◽

pp. 1358-1363

Author(s):

Abiola Ibraheem ◽

Colin Pillai ◽

Ifeoma Okoye ◽

J. Joshua Smith ◽

Diane Reidy-Lagunes ◽

...

Keyword(s):

Clinical Trial ◽

Clinical Trials ◽

Sub Saharan Africa ◽

Cancer Clinical Trials ◽

Future Directions ◽

Secondary Purpose ◽

Health Care Burden ◽

Sub Saharan ◽

Cancer Disparity ◽

And Training

Cancer is now a formidable health care burden in sub-Saharan Africa (SSA) due to lifestyle westernization and longer life expectancy. The exponential increase in cancer incidence coupled with high mortality rate is not comparable with that seen in westernized countries. To address global cancer disparity, globalization of cancer clinical trials to involve sub-Saharan Africa can serve as a platform where innovative targeted therapies can be made available to patients in the environ. In the 2019 African Organization for Research and Training in Cancer (AORTIC) conference held at Maputo, Mozambique, a group of clinical trialists spanning across multiple continents highlighted the opportunities in Africa for the conduct of cancer clinical trials. The secondary purpose of the meeting was to address the belief that Africa was incapable of conducting interventional cancer trials but showed the in-continent strengths, such as available capacities, trained local clinical trialists with clinical trial experiences, clinical trial consortia, local capabilities, mapping out logistics, ethical consideration, political will, real-time benefits of clinical trials to clinical practice, and future directions for trials.

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