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

2020 ◽  
pp. 1412-1418
Author(s):  
Miriam Mutebi ◽  
Isaac Adewole ◽  
Jackson Orem ◽  
Kunuz Abdella ◽  
Olujimi Coker ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
National Comprehensive Cancer Network ◽  
Cancer Care ◽  
Treatment Guidelines ◽  
Treatment Recommendations ◽  
Sub Saharan Africa ◽  
Cancer Coalition ◽  
Sub Saharan ◽  
Resource Levels ◽  
Cancer Network

PURPOSE Standard 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. METHODS The 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. RESULTS The 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. CONCLUSION Harmonized 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.

scholarly journals Management of Renal Cell Carcinoma- Current Practice in Sub-Saharan Africa

2019 ◽  
Vol 6 (2) ◽  
pp. 1-9
Author(s):  
Ayun Kotokai Cassell ◽  
Mohamed Jalloh ◽  
Bashir Yunusa ◽  
Medina Ndoye ◽  
Mouhamadou Mbodji ◽  
...  
Keyword(s):  
Renal Cell ◽  
Radical Nephrectomy ◽  
Treatment Guidelines ◽  
Cell Cancer ◽  
Sub Saharan Africa ◽  
Renal Masses ◽  
Open Radical Nephrectomy ◽  
Sub Saharan ◽  
Developed Nations

There is a global variation in the incidence of renal masses with the developed nations having a greater incidence. About 80–90% of renal malignancies are renal cell carcinomas (RCC) which account for 2–4% of all cancers. In Africa and the Middle East, the age-standardized incidence for RCC is 1.8–4.8/100,000 for males and 1.2–2.2/100,000 for females. The management of renal cell cancer is challenging. A multidisciplinary approach is effective for diagnosis, staging, and treatment. Guidelines recommend active surveillance, thermal ablation, partial nephrectomy, radical nephrectomy, cytoreductive nephrectomy and immunotherapy as various modalities for various stages of RCC. However, open radical nephrectomy is most widely adopted as an option for treatment at various stages of the disease in sub-Saharan Africa due to its cost-effectiveness, applicability at various stages, and the reduced cost of follow-up. Nevertheless, most patients in the region present with the disease in the advanced stage and despite surgery the prognosis is poor.

scholarly journals Receipt of National Comprehensive Cancer Network guideline-concordant prostate cancer care among African American and Caucasian American men in North Carolina

Cancer ◽  
2013 ◽  
Vol 119 (12) ◽  
pp. 2282-2290 ◽  
Author(s):  
Shellie D. Ellis ◽  
Bonny Blackard ◽  
William R. Carpenter ◽  
Merle Mishel ◽  
Ronald C. Chen ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
North Carolina ◽  
African American ◽  
National Comprehensive Cancer Network ◽  
Cancer Care ◽  
Caucasian American ◽  
Cancer Network

scholarly journals Updated assessment of risks and benefits of dolutegravir versus efavirenz in new antiretroviral treatment initiators in sub-Saharan Africa: modelling to inform treatment guidelines

2020 ◽  
Vol 7 (3) ◽  
pp. e193-e200 ◽  
Author(s):  
Andrew N Phillips ◽  
Loveleen Bansi-Matharu ◽  
Francois Venter ◽  
Diane Havlir ◽  
Anton Pozniak ◽  
...  
Keyword(s):  
Antiretroviral Treatment ◽  
Treatment Guidelines ◽  
Sub Saharan Africa ◽  
Risks And Benefits ◽  
Sub Saharan

scholarly journals Identifying Breast Cancer Care Quality Measures for a Cancer Facility in Rural Sub-Saharan Africa: Results of a Systematic Literature Review and Modified Delphi Process

2020 ◽  
pp. 1446-1454
Author(s):  
Lydia E. Pace ◽  
Lauren E. Schleimer ◽  
Cyprien Shyirambere ◽  
André Ilbawi ◽  
Jean Marie Vianney Dusengimana ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Care ◽  
Quality Measurement ◽  
Quality Measures ◽  
Care Quality ◽  
Delphi Process ◽  
Sub Saharan Africa ◽  
Breast Cancer Care ◽  
Modified Delphi ◽  
Sub Saharan

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.

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

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.

scholarly journals Inequities in breast cancer treatment in sub-Saharan Africa: findings from a prospective multi-country observational study

2019 ◽  
Vol 21 (1) ◽  
Author(s):  
Milena Foerster ◽  
Benjamin O. Anderson ◽  
Fiona McKenzie ◽  
Moses Galukande ◽  
Angelica Anele ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Observational Study ◽  
Cancer Treatment ◽  
Breast Cancer Treatment ◽  
Sub Saharan Africa ◽  
Sub Saharan

Initial Experience with Cancer Guidelines Navigator, a tool to standardize and improve the quality of cancer care in Sub-Saharan Africa, at Ocean Road Cancer Institute in Tanzania.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14106-e14106
Author(s):  
Fernando Jose Suarez Saiz ◽  
Leemor Yuravlivker ◽  
Jerry Ndumbalo ◽  
Julius Mwaiselage ◽  
Sadiq Maalim Siu ◽  
...  
Keyword(s):  
Cancer Treatment ◽  
Treatment Planning ◽  
Reference System ◽  
Point Of Care ◽  
Lessons Learned ◽  
Ease Of Use ◽  
Sub Saharan Africa ◽  
Digital Reference ◽  
Sub Saharan ◽  
Cancer Guidelines

e14106 Background: The IBM Cancer Guidelines Navigator (CGN) is a digital reference system to support treatment planning that allows clinicians to enter a cancer patient’s clinical characteristics and presents the corresponding treatment options in the NCCN Harmonized Guidelines (TM) for Sub-Saharan Africa. In October 2019, Ocean Road Cancer Institute (ORCI) in Tanzania became the first site in Africa to initiate a hospital-wide implementation of the tool to help clinicians reduce cancer treatment variability by increasing adherence to standard evidence-based care. We describe training and lessons learned from system introduction. Methods: Training for clinical staff at ORCI occurred over one week and included daily one-hour lectures, followed by personalized hands-on training. A survey was administered to assess usability and use cases of the tool. Results: Thirty-one ORCI clinical and IT staff members participated in training, and 12 completed the survey. Responses indicated that the most beneficial uses for CGN were at point of care and for self-learning. Participants indicated that the top benefits of the tool were quick access to guidelines and evidence (75%) and ease of use (58%). Expanding cancer coverage (42%), offline access and better integration into the workflow (25%) were identified as areas for improvement. Post-training, ORCI implemented easier access to CGN on each computer and tablet used for consultation and care management. Conclusions: CGN is a digital reference system that is designed to support easy and efficient access to regionalized cancer-treatment guidelines for point-of-care treatment planning and education. Expansion of this program has been planned for other hospitals in Tanzania. Future studies will examine whether CGN usage affects guideline adherence.

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

2013 ◽  
Vol 10 (10) ◽  
pp. 599-604 ◽  
Author(s):  
Trijn Israëls ◽  
Joyce Kambugu ◽  
Francine Kouya ◽  
Nader Kim El-Mallawany ◽  
Peter B. Hesseling ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Childhood Cancer ◽  
Cancer Care ◽  
Sub Saharan Africa ◽  
Sub Saharan
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