OBJECTIVE The study objective is to assess the current level of safe handling and administration in 12 hospitals providing chemotherapy services.
METHODS The chemotherapy handling practices of 12 hospitals providing chemotherapy services were assessed using a pre-designed Chemosafe facility assessment tool.
RESULTS Local Chemosafe working group established. The local team designed and developed training materials, SOPs, and safety guidelines to influence policy and strategy at national level. None of the assessed facilities has any safety standards or equipment in place. Personal protective supplies are not available. Staffs in cancer care did not receive systematic training on safe handling and administration of drugs. Against international standard, none of the hospitals involve pharmacists in drug preparation and administration. A team of nurses and pharmacists from 8 of the 12 hospitals (67%) got a comprehensive training on chemotherapy safety with practical skill stations. Local Chemosafe working group established. International team with wide experience in Chemo safety was involved in the first training of cancer care team.
CONCLUSIONS Local team with high level of expertise can be constituted to support local efforts. The local team can influence policy and national safety strategy to impact change of practice. International collaboration would facilitate development of in country capacity. Expansion of cancer care in the country is not commensurate with the development of a system for safety. Safety provision (to the provider as well as to patients) is an urgent issue that needs immediate intervention.

OBJECTIVES Adjuvant trastuzumab has significantly improved outcomes for HER2+ EBC pts, using the 12m duration empirically adopted from the pivotal registration trials. A shorter duration could reduce toxicities and cost whilst providing similar efficacy. No reduced-duration trial to date has demonstrated non-inferiority. Duration studies are particularly important to some low- and middle-income countries who may not have access to new drugs.
METHODS PERSEPHONE is a randomised phase 3 non-inferiority trial comparing 6 to 12m trastuzumab, the largest reduced-duration non-inferiority trial internationally. Mapping onto standard UK practice, all HER2+ EBC pts were eligible. Stratification is by ER status, chemotherapy (CT) type, and CT and trastuzumab timing. The primary endpoint is DFS from diagnosis (first relapse or death from any cause). Randomising 4000 pts (1:1) enabled the trial to assess the non-inferiority of 6m (5% 1-sided significance, 85% power), defining non-inferiority as ‘no worse than 3%’ below the 12m arm’s assumed 80% 4-yr DFS. The pre-planned definitive DFS analysis required 500 events.
RESULTS 4088 pts were randomised (Oct’07 – Jul’15). ER+ 69%; CT - 42% anthracycline (A)-based / 48% A and taxane (T)-based / 10% T-based; adjuvant CT 85%; sequential trastuzumab 54%. At 5.4 yrs median follow-up, there were 335 (8%) deaths and 512 (13%) DFS events. With a 4-yr DFS rate of 89% (90%CI 88 – 91) in both arms. The hazard ratio (HR) non-inferiority limit was set at 1.29. The calculated HR was 1.07 (90%CI 0.93 – 1.24, 95th percentile=1.22) demonstrating non-inferiority (HR<1.29) of 6m trastuzumab (1-sided p=0.01): Superiority p=0.49. Congruent results were found for overall survival and for the pre-planned landmark analyses. Cardiac events were reduced in 6m pts (3% v 8% of 12m pts stopping treatment due to cardiotoxicity (p<0.0001)).
CONCLUSION PERSEPHONE has demonstrated 6m of trastuzumab as non-inferior to 12m (3% non-inferiority margin). Given cardiac and other toxicities during months 7-12 of treatment, our results would support a reduction of standard trastuzumab duration to 6 months. Demonstrating non- inferiority in favour of a shorter treatment duration has obvious benefits for patients but also important strategic benefits to the healthcare system.

BACKGROUND Patients with Lynch syndrome have a high risk of colorectal cancer (CRC). In this study, we estimated the penetrance of CRC in patients with Lynch syndrome.
METHODS Of the 1009 patients with hereditary non-polyposis colorectal cancer, 300 patients were carriers of germline mutations in MLH1 or MSH2, whereas 709 patients were non-mutation carriers of these mutations. Penetrance of CRC was calculated using a modified segregation analysis implemented by Mendel. RESULTS The median age at CRC diagnosis were younger in patients with Lynch syndrome than in non-mutation carriers (44.3 vs. 50.4 years, P = 0.0001). The cumulative risk (penetrance) of CRC at the age of 70 years were 36.5% (95% CI = 27.7%–46.9%), 34.8% (95% CI = 26.1%–45.5%), and 42.7% (95% CI = 30.1%–57.8%) in the male carriers of MLH1 or MSH2, MLH1, and MSH2 germline mutations, respectively. The penetrance of CRC in the female carriers of MLH1 or MSH2, MLH1, and MSH2 germline mutations were 25.8% (95% CI = 18.6%–35.2%), 24.5% (95% CI = 17.4%–33.6%) and 32.2% (95% CI = 26.3%–39.1%), respectively.
CONCLUSION Cumulative risk of developing CRC in patients with Lynch syndrome is 34.8%–42.7% in men and 24.5%–32.2% in women.

BACKGROUND In 2014 KNH cancer registry was established as one of the flagship research projects with objective to establish a central cancer database at the KNH by capturing and integrating existing cancer information from all hospital departments. The registry gives the cancer incidence and also cancer burden at the hospital, the leading cancer cases in both sexes and children which have been chosen to depict trends in incidence rates over time.
METHOD During the period the most common cancers among the patients attending the hospital from all counties in the country were recorded. Cancer registrars visit various departments on a daily or regular basis to collect cancer data from patient records by obtaining information from the central health information department, patient’s records from all laboratories within KNH, mortality unit, palliative care centre, Nairobi Hospice, Cancer treatment Centre, HIV Comprehensive Care Centre ,Clinical departments and Paediatrics Oncology unit. The registry also captures HIV -linked malignancies
RESULT A total of 4211 cases were registered of which 1627 Male while 2584 were female. Female cancers Cervix uteri786 and Breast 549 were the most common of all cancer cases registered. In male Cancer of Oesophagus 193, was the most diagnosed malignancy during the period of one year closely followed by Prostate 173. The most common childhood cancers were, Leukaemia’s 74 (25.3%), Retinoblastoma 54, Wilm’s tumor 35 , Lymphomas 32 and CNS Neoplasm’s 31. A large number of these cases are from Nairobi County (1028) followed by Kiambu (448). There were 204 HIV cases among males and 599 HIV positive case among women with cervical cancer with the most HIV cases recorded.
CONCLUSION The trends showed a fair account of direction in which incidence rates of the leading cancer cases occurred among the patients attended however, deaths accounted for 514 of all cancers. It also shows10 most deaths by cancer type where cancer of the blood (leukaemia’s and myeloma) 81 was the major cause of death followed by cervix Uteri 64.

OBJECTIVE As part of cancer prevention and control strategy, Kenya has prioritised cancer registration to inform policy and guide control efforts. We describe the process of setting up the first, nationally representative, population-based cancer registry in Kenya.
METHODS We carried out Concept Mapping, bringing together stakeholders under the umbrella of the cancer registration, surveillance, research, monitoring and evaluation technical working group (TWG) of the National Cancer Control Programme (NCCP) and the National Cancer Institute of Kenya (NCIK). We defined reporting structural and legal frameworks, catchment population and the roles and responsibilities of the two levels of government.
RESULTS A national, population-based cancer registry; the Kenya National Cancer Registry (KNCR); was set up with a secretariat at the NCIK. CanReg5 was chosen as the cancer registration and reporting tool for KNCR; a customized database structure with Kenyan counties, sub-counties and health facility codes was created. A devolved structure for the registry was selected; twelve regional cancer centers will host regional registries, which feed into the KNCR. The national institutions (NCCP and NCIK) will carry out training and technical support, while counties employ registrars and equip the regional registries. Cancer registrars from half of the target counties have already been trained. Private institutions carrying out cancer diagnosis and/or treatment will be given technical assistance to start hospital-based cancer registries that feed into the KNCR. The KNCR national secretariat is responsible for data validation, merging and calculation of the national estimates. The system was launched in March 2019; the first nationally representative cancer data is expected in the third quarter of 2019.
CONCLUSIONS Establishing a national population-based registry is challenging in a devolved system of healthcare provision; involving stakeholders early is key in forging partnerships and promoting ownership of cancer reporting by regional units.

OBJECTIVE To find out the cause for the under-diagnosis of Lung Cancer (LC) at AMPATH by using community engagement and high-risk screening at the TB clinics.
METHODS FGDs with community cough monitors in counties were done due to overlap of LC and TB presentations. Consequently through establishing a multinational-lung cancer control program (MLCCP) to improve diagnosis and patient journey for lung cancer patients in our settings, we classified patients with symptomatic lung disease (chest pain, cough, SOB, weight loss, haemoptysis) and negative gene expert/negative sputum for AAFB as high-risk for further evaluation. CT scans were done for anyone with a chest mass/lesion and Image-guided biopsy offered.
RESULTS Jan 2018-Mar 2019, 331 high risk clients were evaluated. 214 with masses CT scans of which 205 were lung and 9 were mediastinal. 131/214 had biopsy, of which 83 (60 LC, 23 secondary mets) while 48 were other conditions. These included: Lung Fibrosis, Aspergillosis, Chronic granulomatous inflammation, TB, Thymoma, viral histiocytosis, Granuloma and unconfirmed diagnosis. For the biopsied lung masses-131/214, 60 had confirmed LC. This represented 45.8% of those biopsied. Male to Female ratio was 1:1, median age at diagnosis was 62 with 55-74 age range accounting for 73.2% of LC cases. The mean duration of symptoms was 8 months, range of 1 to 12 months. >50% of the cancer patients made 7-10 hospital visits before diagnosis, with 25% making more than 14 visits. NSCLC accounted for 92.2% of the diagnosis with SCLC 7.8%. Adenocarcinoma was the commonest diagnosed histological sub-type at 66% of NSCLC. Majority of the patients were diagnosed at stage IV, 78.1% with only three patients diagnosed in stage II. 39% (25/64) patients are alive and on follow-up.
CONCLUSION Early detection is key. Poor referral patterns and lack of LC knowledge and diagnostic skills by HC professionals causes late stage at diagnosis. Patients do not present Late. Community engagement and embedding simple protocols for prompt referrals/diagnostic work-up in TB control programs may lead to improved outcomes. Prevention measures should also be rolled out. Cough monitors were essential to improving the LC patient's journey.
ACKNOWLEDGEMENTS MLCCP is a Multi-National Lung Cancer Control Program with Dr. Asirwa the overall PI for Kenya, Tanzania, Swaziland and South Africa. Funding for the program has been provided by Bristol Myers Squib Foundation (BMSF). MLCCP Team is the Kenyan Team for this Western Kenya Program Component.

OBJECTIVE Laryngeal carcinoma is an important epithelial cancer of the head and neck region. The aim of the study was to determine the clinical profiles and management outcomes of laryngeal carcinomas at two different tertiary hospitals from different geopolitical region of Northern Nigeria.
METHODS It was a 20-year review of cases managed at the ENT-HN Surgery departments of University of Abuja Teaching Hospital, Gwagwalada, Abuja and Federal Teaching Hospital, Gombe from January 1999 to December 2018. Data from the clinic histology register and case notes of patients were collated and analysed according to the aim of the study, with simple descriptive statistics.
RESULTS There were 29 cases of laryngeal cancers managed within the study period, but 28 cases had complete data for the study, with a Male:Female of 13:1 and a mean age of 64.8 ± 16.6years. The commonest symptom was hoarseness (100%); others included dyspnoea (78.6%), odynophagia and dysphagia (25.0%) each, cough (21.4.0%), hemoptysis (17.9%). No aetiological factor was identified in most of the patients, while there were 4 (14.3%) long standing cigarette chain smokers. All the patients presented with late disease except two cases of carcinoma-in-situ, while others were squamous cell carcinoma. Ten (35.7%) patients had total laryngectomy with a complication rate of 40% while only 2 (7.1%) had radiotherapy. Five-year survival Post-laryngectomy was 20%. An interplay of poverty/ cost of care, delay in accessing radiotherapy, low motivation and lack of social support system had negative impact on the survival of patients and accounted for the loss to follow-up in the majority.
CONCLUSION This study revealed clinical profiles and management outcomes that are similar to findings in previous studies, with slight variation. Late presentation, poverty, untimely availability of radiotherapy, motivation and family support contributed significantly to survival

OBJECTIVE To compare treatment and outcomes of locally advanced breast cancer in Nigeria and the U.S., highlighting the impact of resource availability.
METHODS Retrospective review was performed at Memorial Sloan Kettering Cancer Center (New York, U.S.) and Obafemi Awolowo University Teaching Hospitals Complex (Ile Ife, Nigeria). Clinicopathologic information, diagnosis, work-up, and treatment of non-metastatic, T4 breast cancer patients treated at each institution from 2010-2016 were compared with Fisher’s Exact Test, Wilcoxon Rank Sum test, and Log-rank test, where appropriate.
RESULTS 308 patients met inclusion criteria: 151 (49%) in Nigeria, and 157 (51%) in the U.S. All U.S. patients received neoadjuvant chemotherapy, vs. 86% in Nigeria (P<0.001). All patients in the U.S. underwent surgery, vs. 66% in Nigeria. Pathologic complete response was seen in the breast in 45 (29%) and 4 (4%), and in the lymph nodes in 66 (42%) and 26 (26%) of U.S. and Nigerian patients, respectively. Post-operative radiation was performed in 152 (97%) U.S. patients, vs. 16 (11%) Nigerian patients. Immunohistochemistry was performed in all U.S. patients, vs. 18% in Nigeria. All patients in the U.S. with hormone receptor positive tumours were offered endocrine therapy. In Nigeria, 10% of patients received endocrine therapy. All U.S. patients with Her2 positive tumours received one year of anti-Her2 therapy; no patients in Nigeria were offered Her2 targeted treatment. Estimated 5-year survival was 61% (48.3-70.7 95% CI) from the date of presentation in Nigeria, compared with 72% (61.7-79.7 95% CI) from the date of diagnosis in the U.S. (p=0.005).
CONCLUSION These data support the importance of addressing access to breast cancer care in Nigeria. Effective neoadjuvant chemotherapy is necessary to help downstage disease, allow for more effective locoregional treatment, and reduce morbidity and mortality.