Date Published: July 10, 2017
Publisher: Public Library of Science
Author(s): Satish Gopal
Abstract: Satish Gopal discusses the challenges of deliverable cancer care and cancer trials in sub-Saharan Africa as well as a potential framework for overcoming these challenges.
Partial Text: Cancer burden is increasing in sub-Saharan Africa (SSA), with more than 600,000 estimated new cancer cases in 2012 and age-standardized incidence increases of 10%–20% in most countries between 2005 and 2015 [1,2]. Major regional limitations in pathology, surgery, medical oncology, radiation, and palliation have been extensively described and contribute directly to worse cancer outcomes in SSA than in high-income countries . However, even when treatment is available, there is a remarkable and unacceptable scarcity of high-grade evidence to guide the application of cancer treatment for the 1 billion people living in SSA (Table 1). Interest, investment, and infrastructure are gathering to address this problem. Two cooperative groups sponsored by the United States National Cancer Institute (NCI) have initiated activities in the region, the AIDS Malignancy Consortium (AMC) for human immunodeficiency virus (HIV)-associated malignancies and a second network for pediatric Burkitt lymphoma. Other similar efforts are ongoing. However, conceptualizing cancer treatment trials that are sufficiently informative and appropriate to pursue in SSA continues to prove challenging, even for experienced investigators in the region. This Essay, based on experience in Malawi and broader participation in regional clinical trial groups, elucidates some of these challenges and possible ways forward.
There is a growing recognition in high-income countries that care and research agendas for cancer must be brought closer together, for clinical, scientific, and economic reasons. In SSA, there are simply not sufficient resources to allow these agendas to diverge and/or compete, a luxury born of having excess resources in the first place. Care and research must be aligned and even considered the same—for example, as in international pediatric oncology groups, in which there has been a decades-long commitment to treating cancer on harmonized protocols across centers, to drive clinical science forward for specific diseases and individual children . A potential framework for achieving similar progress in SSA is proposed, to avoid excessive external investment in studies that do not substantially inform or improve care in SSA. With these challenges at the forefront, continued regional efforts and momentum to generate forward progress are eagerly anticipated, by cancer policy makers, clinicians, and patients above all.