OBJECTIVE While breast cancer (BC) incidence is increasing in Low-and Middle-Income countries (LMIC), with an 82% predicted increase in BC diagnoses in Tanzania by 2030, cancer survivorship is a serious challenge in such countries where cultural beliefs act as a barrier to accessing treatment and support. The Holistic Needs Assessment (HNA) is a tool which is offered to all people at the end of cancer treatment developed as part of the UK National Cancer Survivorship Initiative. This study aimed to explore the feasibility of implementing the HNA to capture the unmet needs amongst women who had received treatment for primary breast cancer at two centres in Tanzania and Ghana.
METHODS The study used a mixed-methods design in two phases. In Phase 1, focus group interviews were conducted with women following breast cancer treatment and staff to ask about their needs, evaluate current practice, resources and the potential challenges for developing survivorship services in Tanzania and Ghana. Interviews were transcribed, translated and analysed using framework analysis. In Phase 2, the UK Holistic Needs Assessment was translated and adapted to be culturally sensitive so that it could be used as a way of scoping unmet need at the end of primary breast cancer treatment. Descriptive statistics were used to analyse this data. This paper reports on Phase 1.
RESULTS Emergent themes show the impact of having breast cancer on the women's lives. Themes include the impact of cultural beliefs on the experience of women with breast cancer, accessibility of treatment and services, the impact on finance, the women's role in her family, and lack of communication and support. Women spoke about the importance of peer support from others with breast cancer and challenging cultural beliefs and practices.
CONCLUSIONS These findings suggest that understanding physical, financial, and psychological challenges in breast cancer survivors face even many years after completing treatment could help improve how these needs are met in an evidence based and resource sensitive manner.

OBJECTIVE More than 400,000 annual endoscopic retrograde cholangiopancreatography (ERCP) are performed in the US. In Nigeria, population 190 million, there are 2 gastroenterologists performing ERCPs, with approximately 100 over the past 15 years. Our objective is to assess the clinical outcomes and feasibility of performing an ERCP at a tertiary centre in Nigeria.
METHOD Patient referral requests were sent to the members of the Society of Gastroenterology and Hepatology (SOGHIN) via digital media using What’s app. ERCPs were scheduled every 4 months over one year, each session 5 days. A multidisciplinary meeting was held the day prior to each session week and attended by gastroenterologists, surgeons, anaesthesiologist, radiologist and nurses. Patients were admitted at least the day before their scheduled procedure and monitored until discharge. A history and physical examination were performed. We prospectively collected demographic data (age, gender, place of residence), clinical presentation, imaging modality of diagnosis (Abdominal ultrasound, CT or MRI), laboratory data (fractionated bilirubin, AST, ALT, alkaline phosphatase, HIV, HBV DNA, Hepatitis C RNA) and clinical outcomes at 24 hours post ERCP.
RESULTS Total of 94 patients were referred, 75 procedures performed (53 ERCPS, 22 EGDs), 20 procedures not performed due to lack of time or not indicated. There was an increase in number of referrals over the year from 17 patients at week 1 to 30 at week 4. Majority of patients were referred from external sites (74/94, 78 %), the furthest referral site was almost 900 kilometres away. There were 38 females (51%), age range 8 to 83 years, mean 52 years. Clinical outcomes at 24 hours post procedure revealed: 2/75 (2 %) died (aetiology acute renal insufficiency), 4/75 (5%) had mild pancreatitis.
CONCLUSION ERCP is feasible and safe in Nigeria. Awareness amongst healthcare providers to the available procedure resulted in increased patient referral.

OBJECTIVE There is a documented disparity in the distribution of radiotherapy (RT) services and professionals to address the cancer care needs across the continent of Africa. To further understand the current treatment landscape, we developed a survey to assess radiation oncology training, equipment, resources and future needs.
METHODS At the 2017 AORTIC Meeting in Kigali, Rwanda, a 37-question survey was distributed to radiation oncologists (RO), medical physicists (MP), and radiation therapy technologists (RTTs) in attendance. The survey was divided into 4 sections including: 1) Demographics and Training 2) Current Practice Capacity, 3) Future Needs, and 4) Case Vignettes.
RESULTS A total of 24 completed surveys, representing 11 countries and 15 cancer treatment centres across Africa, were analysed. The majority of respondents were radiation oncologists (19/24, 76%) a third of whom have been in practice for >10 years (6/19). The majority received training in cobalt RT (14/19, 58.3%), 3D conformal RT (14/19, 58.3%) and brachytherapy (13/19, 54.2%). Four percent (n=1) were trained in SBRT, proton, or rapid arc therapy. The median number of patients treated on a daily basis was 60 (IQR 50-100). The majority (10/15, 66.7%) of centres had a diagnostic CT scanner, 7/15 (46.7%) had a cobalt treatment machine and 9/15 (60.0%) had a linear accelerator. The most common cancers seen at their centres were cervical (24/24, 100%), breast (23/24, 95.8%), and prostate (15/24, 62.5%). For future needs, the majority of respondents believed that new machinery, an exchange program with overseas institutions, or access to educational resources would be beneficial (n=15, 65%). Over half of respondents requested training in intensity modulated RT (IMRT) (15/24, 62.5%), image guided RT (IGRT) (15/24, 62.5%), and 3D-conformal RT (14/24, 58.3%)).
CONCLUSIONS Of the surveyed respondents at AORTIC 2017, radiation centres reported a heavy patient load and comfort with treatment techniques in cobalt/3D-confromal RT. Most centres have a linear accelerator and are interested in further training in IMRT and IGRT. Future collaborations that assist with new machinery and international exchange programs are needs identified by centres to best manage their current cancer burden.

OBJECTIVE An array of global oncology research and training activities are led by the National Cancer Institute (NCI)-Designated Cancer Centers (NDCCs) with international collaborators. To better understand the scope of the non-NIH-funded global oncology activities and collaborations, including in the Africa region, the NCI Center for Global Health (NCI-CGH) collaborated with the American Society of Clinical Oncology (ASCO) to conduct the 2018 NCI/ASCO Global Oncology Survey of NDCCs.
METHODS In 2018, the 70 NDCCs received a two-part survey that focused on global oncology programs at NDCCs and non-NIH funded-global oncology projects led by the NDCCs with an international collaborator. Sixty-five NDCCs responded to the survey, and 57 reported non-NIH-funded global oncology projects. Data were cleaned, coded, and analysed by NCI-CGH staff.
RESULTS Overall, NDCCs reported more than 530 non-NIH-funded global oncology projects, and 147 projects (or 28% of total projects reported) focused on capacity building or training. Twenty-seven NDCCs reported 97 (18%) global oncology projects with collaborators from 20 African countries. Capacity building/training projects with collaborators in Africa made up 52 (35%) of the total 147 capacity building/training projects. Example projects include: telementoring to improve cancer screening and palliation, and pathology training programs. Top cancer sites studied were breast (28), non-site-specific (28), and cervical cancers (16), and top CSO codes addressed included treatment (52), early detection, diagnosis, and prognosis (51), and cancer control, survivorship, and outcomes research (31).
CONCUSIONS Survey results indicate that almost half of NDCCs (47%) with non-NIH-funded global oncology projects work with collaborators in the Africa region, and there is a substantial number of projects that focus on capacity building or training (54% of projects). The 2018 survey can be used to foster opportunities for researchers in the Africa region to network with NDCCs to further strengthen global oncology research and training in the Africa region.

OBJECTIVE To increase capacity in the African cancer workforce through international fellowships, that allow knowledge exchange, network creation and dissemination of skills to the home organisation, thus maximising overall impact.
METHODS Union for International Cancer Control adapted its Technical Fellowship programme in 2017, creating two sub-programmes: one for the Francophone Africa region (Bourses pour l’Afrique Francophone), with support in French, and a second (African Cancer Fellowships) for those working in cancer care delivery in Africa. Both opportunities were highlighted at the 2017 AORTIC conference.
RESULTS As a result, 125 fellowship applications were received from Africa during 2017 and 2018, compared to only 25 applications in 2016. For Francophone Africa, 72 applications were received, compared to 4 in 2016. 57 fellowships were awarded to candidates from Africa during 2017 and 2018, compared to 9 in 2016, and 31 of these to Francophone Africa, up from 3 in 2016. Fellows went on international one-month visits within Africa or further afield, gaining hands-on experience in cancer registration, radiotherapy, surgery and palliative care. 12 Fellows also participated in the 2018 World Cancer Congress, showcasing their work and receiving additional training and networking opportunities through a workshop on cancer care delivery in Africa. Fellows’ feedback about their experience was positive, with 90% able to effectively implement the skills they had learned abroad, organising workshops and presentations to disseminate the new knowledge and skills to their colleagues. Outcomes of the fellowship visits included publication of population-based cancer data in South Africa, radiotherapy training on a LINAC machine using 3D technology in Tanzania and establishing a new palliative care centre in Egypt.
CONCLUSIONS Dedicated fellowship programmes substantially increased engagement from the region, supporting long-term development of the health workforce for cancer. Applicants from Africa are encouraged to apply for Technical fellowships and Bourses pour l’Afrique Francophone.

BACKGROUND In a context where well-trained specialist physicians are usually inaccessible, trained nurses run the Women’s Health Program (WHP) of the Cameroon Baptist Convention Health Services (CBCHS), which has provided affordable cervical cancer screening and treatment of precancers to over 90,000 women since 2007, including cryotherapy, thermal coagulation and LEEP. The WHP providers need to regularly update their skills and knowledge in the most economical way possible. The management of difficult cases is challenging, as many patients referred for specialty care cannot afford those services and their local caregivers must continue to care for them.
OBJECTIVE To establish an evidence based telementoring program aiming at building capacity of providers within the CBCHS.
METHODS In 2003, the University of New Mexico developed ECHO (extension for community health outcomes), a telementoring model that connects community-based providers with distant specialty consultants, to de-monopolize specialized knowledge, to build capacity of frontline clinicians and to improve their skills in handling difficult cases. The University of Texas MD Anderson Cancer Center coordinates Project ECHO for cancer prevention and treatment in multiple countries, including the Cameroon Cervical Cancer ECHO Program.
RESULTS In June 2018, Cameroon Program initiated monthly ECHO teleconferences: i) WHP nurses select and present two difficult cases including cervical photos to experts who provide recommendations for management, and ii) Experts present a short didactic lecture to WHP nurses and providers in other African countries. The sessions are interactive and focus on resources available locally that can improve care.
CONCLUSION Project ECHO is a simple, inexpensive tool that is useful for quality improvement of cervical cancer prevention programs in resource limited countries.

OBJECTIVE Despite the global burden of breast cancer, awareness and understanding in Africa is generally low, coupled with an increase in incidence among younger women. The study aimed to determine the effect of an educational intervention on breast cancer knowledge and breast self-examination among in female secondary school students.
METHODOLOGY The study was a quasi-experimental study that utilized a three-stage sampling technique to select 600 female students attending secondary schools in IbNELGA. The intervention consisted of lecture series on breast cancer for the experimental group and educational leaflets for the control group. A pre-tested, semi-structured questionnaire was administered at baseline and 3 months post intervention to elicit necessary information from participating adolescents. Mean knowledge and attitude scores were compared pre and post intervention. Data was entered and analysed using SPSS version 20. Level of statistical significance was set at P<0.005.
RESULTS The mean age of participants was 16.1±1.5 years and 15.4±1.5 years for the intervention and control group respectively. At baseline, study participants in the control group had a significantly higher mean knowledge score for breast cancer compared to the experimental group (5.5±2.1 & 4.4±2.5). The reverse was however the case post intervention where the experimental group had a higher knowledge score compared to the control (20.5±1.5 and 7.0±3.1) respectively. This was also the case with knowledge of BSE where study participants in the control group had a higher mean knowledge score for BSE compared to the experimental group (1.4±1.6 & 1.3±1.4). The reverse was however the case post intervention where the experimental group had a higher knowledge score compared to the control (7.4±0.6 and 2.1±2.2) respectively.
CONCLUSION The educational intervention helped improved participants knowledge on breast cancer and BSE. Acquiring knowledge on breast cancer and BSE at an early age has the potential to increase its practice in the later future leading to early detection of breast cancer.

OBJECTIVES Delayed cancer treatment contributes to poor cancer survival globally, particularly in resource-limited settings. We implemented and assessed impact of the multi-level Potlako (“hurry”) intervention intended to improve timely cancer treatment in Botswana.
METHODS We conducted a controlled, non-randomized pilot trial of the Potlako intervention compared with standard care. Intervention components included short-course training of primary care providers and phone-based navigation for cancer suspects. The Potlako intervention was implemented in rural Kweneng-East (35 health facilities, population 110,000) beginning in April 2016. Primary endpoints were time from first clinic visit for cancer symptom to cancer treatment, and proportion treated for limited stage cancer (IIIA or lower) for adults 18+ years. Endpoints were measured in nationwide Thabatse Cancer Cohort. We employed a difference-in-difference analytic approach utilizing inverse-probability weighted Cox and log-binomial marginal structural models to compare endpoints pre- and post-Potlako in Kweneng-East and similar non-intervention districts. Models were adjusted for cancer type, sex, wealth, type of health facility visited, age, and HIV status.
RESULTS From July 2014-January 2019, 798 patients (79% female, 49% HIV+, 46% limited stage) presented with symptoms subsequently found to be cancer (39% cervix, 20% breast, 10% anogenital). 114 patients presented in Kweneng-East after April 2016 and were considered Potlako-exposed (intent-to-treat). Baseline characteristics were similar. Median time-to-treatment was 7.6 months (95%CI 5.9-9.7 months) and 10.9 months (95%CI 9.6-12.0 months) for Potlako-exposed and -unexposed, respectively. In adjusted analyses, there was improvement across assessed districts in time-to-treatment (p=0.010), but improvement appeared greater in Potlako-exposed, aHR 1.72 (95%CI 0.95-3.15). The proportion of patients treated for limited-stage cancer was greater among Potlako-exposed, aRR 2.10 (95%CI 1.07-4.11).
CONCLUSIONS A resource-conscious intervention involving provider education and telephone-based navigation support for cancer suspects was associated with meaningfully earlier treatment and reduced cancer stage. This strategy has promise to reduce cancer mortality and should be investigated further.

OBJECTIVE Power dynamics in the African context between healthcare providers and patients coupled with pressures from workload pose threats to comprehensive care for patients especially in oncology healthcare delivery. Patients’ involvement has been reported to positively influence health outcomes of cancer patients in the developed world. However, there is dearth of evidence on how shared decision making-an integral part of patient-centred care, influences health outcomes in a low resource setting like Ghana. This study therefore examined shared decision making and how its influences doctor-patient relationship, depression and anxiety among women living with breast cancer.
METHODS A cross-sectional survey design was used to purposively sample 205 women receiving oncology care at a referral health facility. Participants were administered measures of shared decision making, doctor-patient relationship, depression and anxiety. Data analyses were done by means of SPSS using both descriptive (frequencies, means and standard deviation) and inferential (independent t-test) statistical techniques.
RESULTS The participants had a mean age of 52.49 years (SD = 11.14years) and about 64% of the participants have received two or more treatment types. The majority (83.9%) of the participants reported being involved in their treatment decision making. Participants who felt involved by their oncology physicians in treatment decision making reported better doctor-patient relationships, lower depression and anxiety levels compared to participants who felt they were not involved in their treatment decision making.
CONCLUSION These findings represent a new shift in health communication in oncology practice in a low resource setting which may hold promise for re-orientation in communication in healthcare delivery for cancer patients. These findings underscore the need for the development of evidence based cost-effective and innovative ways of involving patients in their treatment decision making.